Pain is Relative

We’re all familiar with that common and oh-so-subjective medical tool, the pain rating scale. “On a scale of 1 to 10, where do you rate your pain?” is a common question in doctor’s offices, ER exam rooms, and on posters on medical facility walls. This may be a helpful tool for a doctor treating the same patient over a long period of time, as she can then have a point of reference for whether symptoms are typical to the patient’s experience, or whether they are improving or worsening.  However, when it comes to a first encounter, I wonder how useful this tool really is.

Everyone has a different threshold for RA pain

There are people who rarely experience pain. For the person whose default is feeling good, a badly stubbed toe or sprained wrist might be excruciating and all-encompassing. For those of us living with rheumatoid arthritis/rheumatoid disease (RA/RD), learning to tune out pain is essential to survival.

Our brains use pain signals to tell us that something is wrong so that we will either remove ourselves from danger or tend to our wounds. However, when the thing that is wrong is not proximity to a hot surface or a broken bone that must mend, but rather one’s own misguided immune system, there is no immediate remedy. We can’t escape our immune systems, and no amount of rest is going to cure us (and too little activity actually makes RA/RD worse). Therefore, those of us with this disease start tuning out some of our pain signals, as it would be impossible to have any quality of life if we reacted each time we felt pain.

With regular RA pain, one becomes adept at tuning it out

I’ve become so adept at tuning out my pain, that I question my pain when it is severe and even doubt myself. I can be in agonizing pain and still catch myself thinking, “Why does it hurt this much? It shouldn’t hurt this bad. Maybe I’m making too much of it.” How strange that I push through pain on a daily basis to work, shop, drive, clean, exercise, and care for my kids, yet when it is so intense that I can’t push through I question my own self-assessment and the very sensations I’m feeling.

I’m working to stop second-guessing myself. The other day I was talking to a friend who is struggling to adjust to the pain and limitations a recent injury has caused her. When I walked away from the conversation, my hip had sparks of pain shooting through it. I took a deep breath and focused on not limping, as that throws my body out of alignment and makes everything worse, and then went about my day in a way that my friend is not yet able to.

I reflected on how good I’ve become at pushing pain to the outer boundaries of my awareness. Over the nearly two decades I’ve been diagnosed with RA/RD, I have strengthened my ability to not be overcome by mild to moderate pain. Therefore, when the pain is so severe that I cannot continue with my normal activities, the last thing I need to do is second-guess myself. Rather, I need to acknowledge that if the pain is stronger than my considerable coping mechanisms then my body needs a break, both from activity and from self-inflicted judgment and guilt trips.

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