Why Pain Matters

Pain.  It’s such a small word for such a large and complicated condition. Our culture surrounds us with so many different messages about pain, especially chronic pain, that it can be difficult to form a clear opinion about how to handle this condition, both in ourselves and in the pets that we love and care for.  How many times have we all heard these statements, or ones like them?

‘No pain, no gain.’

‘Pain is weakness leaving the body.’

‘A little pain never killed anyone.’

‘Just push through the pain.’

‘If it doesn’t hurt you’re not doing it right.’

These – and so many other philosophies – put forth the idea that pain is some kind of badge of honor.  That hurting is somehow proof that you’re working hard, or at the very least that pain in and of itself is harmless, minor, and not a problem that anyone should act on.  That, by treating pain, you’re admitting weakness.  And sadly, nothing could be further than the truth.

Pain is a disease in and of itself.  Pain causes physical damage to the body and permanent changes to the nervous system.  It slows healing.  And, in animals, it is one of the leading causes of death – as our pets reach a point where pain impacts their mobility so severely that they can’t stand or walk anymore, or diminishes their quality of life until they lose all interest in food and interaction, and the people who love and care for them choose to help them pass rather than either watch them suffer or face nursing care challenges that are beyond their capacity to manage.

It is true that some pain serves a purpose – but this is not true in most cases that we treat in medicine.  Ultimately, there are two kinds of pain: adaptive and maladaptive.

Adaptive pain is useful pain.  It is short, immediate, and serves the purpose of warning us that something damaging to our physical body is occurring, and that we need to act to correct that.  When you put your hand on a hot stove, and feel pain, you know to remove your hand before further damage occurs.  This is a normal function of our nervous system, and a way to protect ourselves.

Maladaptive pain is a very different thing – this is pain that serves no protective or helpful purpose.  This can be pain that continues after tissue heals, or pain that exists out of proportion to the stimulus causing that response.  Almost all chronic pain is maladaptive pain, and it can be very difficult to treat.

The problem is that these two forms of pain exist in a spectrum.  In particular, adaptive pain that is left untreated can and will progress to maladaptive pain.  When pain is untreated, there can be permanent physical changes in the neurological system.  Nerve pathways that help decrease or stop pain sensations cease to function, and other pathways that detect and transmit pain become more sensitive.  Other nerves not involved in the initial pain process are recruited and brought into the sensation and transmission of pain.   Once these changes occur, they cannot be undone.  Once chronic maladaptive pain exists, the best we can do is manage it.

There are several tools in our arsenal to manage chronic pain; I’ve talked about some of them in this blog before.  Chronic pain, if recognized and addressed, can be minimized and our pets’ quality of life can be maintained.  But the earlier in the course of a painful experience that we start treatment, and the more thorough that treatment is, the better the chance of preventing its progression to chronic maladaptive pain.  Treating pain early, and completely, is one of the most important tools we have in maintaining quality of life.

Pain is a disease.  We need to recognize it and treat it, just like any other.  Please, don’t let your pets – or yourselves – stay in pain.  Your bodies and your comfort are too valuable to suffer needlessly like that.