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Playing In Pain Isn't Always Wise

"All pain is real."

  • Date: 9/21/2009
  • BIDMC Contact: Gary Gillis

It only took one weekend to remind me what a bone-crushingly violent game football is. It's one and done for Chicago linebacker Brian Urlacher (wrist dislocation). The Panthers needed to call on backup quarterback Josh McCown, but after a knee injury he won't be back this season. Donovan McNabb is luckier. The Eagle's QB merely fractured a rib and expects to be back in the line-up sooner rather than later. Imagine if they played 162 games.

Baseball has its share of collisions and wall-banging catches but a glance down the MLB injury report reveals it as a game that's prone to a different brand of damage. Torn ligaments, frayed labrums, shoulder soreness and elbow inflammation. Stress and overuse injuries dominate the list and at this point of the season, everybody is likely nicked up to some degree. If you're playing, you're playing through the pain. Some do that better than others.

"First, let me say that all pain is real."

That statement comes from a gentleman who knows a thing or two about the subject. Dr. Zahid Bajwa is a pain specialist and Director of Education and Clinical Pain Research at the Arnold Pain Center, Beth Israel Deaconess Medical Center.

"That being said, we need only look at the example of a guy like Dustin Pedroia vs. Manny Ramirez," he explains. "Pedroia just about refuses to come out of the line-up while Manny would opt out because of a hamstring twinge. Some people refuse to attempt to play - or go to work in an office - if they feel they'll be less than 100% effective."

I happen to be of the opinion that some people cause more pain than they feel but I'll defer to Dr. Bajwa who is trained to recognize and respond to a pain sufferer's behavior and response.

"We use a classic 0 to 10 scale with 0 being no pain and 10 being the worst pain imaginable," he says. "But measuring pain is subjective, so pain that you might classify as an 8, I might say is a 4. We give people descriptors. For women, 10 might be the pain of natural childbirth. For men, it might be the pain comparable to being punched by Muhammad Ali or Mike Tyson. We observe patients carefully when they are describing the pain, and watch how they move."

How doctors go about addressing the pain depends upon a variety of factors. The age of a patient is a consideration as well as the type of work or other activity they might engage in. Is it acute pain caused by an injury or illness, or is it chronic pain like the kind that frequent migraine sufferers deal with?

Let's take an example of acute pain first. A pitcher with shoulder tendonitis might be a candidate for a cortisone shot. The same holds true for a paperhanger.

"Cortisone is a group of anti-inflammatory medications. If we reduce the inflammation, we can relieve pain. That would allow the patient to begin an exercise program to strengthen the shoulder muscles and reduce the risk of recurrence," Dr. Bajwa says.

"If we're talking about chronic migraine pain - and by chronic I mean more headache days than not per month - we've got a lot more options now. There's a class of drugs called triptans that is quite effective at reducing or relieving pain when they are taken at the onset of a migraine attack. Some patients are also candidates for preventive medications. We are finding that some blood pressure medications, anti-seizure medications and even anti-depressants can substantially reduce the frequency of migraine attacks."

I also asked Dr. Bajwa how often the issue of drug dependence comes up in his conversations and whether it was a major concern.

"What I want to do for my patient's is to heal the injury that's causing the pain. Pain killers like morphine or Vicodin or Oxycontin will reduce the pain score that someone reports, but they do not heal," he says. "I will also explain that people develop a tolerance to opioids so you need a greater dose to obtain the same relief over time. Then there is the issue of drug dependence. My key question is, 'What can you do on opioids that you can't do otherwise?' Opiods have their place in pain therapies, but only as a last resort."

Playing in pain may be admirable but you've also got to play it smart. All pain is real but not all pain lasts. If you're gasping for breath because of the shooting pains that occur every time you bend down to tie your shoe, you might want to see a doctor. If you're having trouble getting out of bed the morning after a rambunctious game of touch football, you might want to take a look in the mirror and tell that guy he's not as young as he used to be.

Now that hurts.