Resetting the pain threshold

I’ve long discussed the topic of physical pain on this blog and I’ve touted the idea that our sense of pain is not a simple measurement system by which X amount of damage to the body results in a corollary amount of pain. I suspect, mood, anxiety and other aspects of psychology change how much pain we feel. A depressing new article alleging that Americans are facing greater pain toward the end of their lives offers some food for thought.

Reports of patients experiencing pain near the end of life increased 11 percent between 1998 and 2010, according to a new study published in theAnnals of Internal Medicine. Reports of depression and periodic confusion also increased 26 percent over this time.

“There were certainly reasons to think that things were getting better,” said Joanne Lynn, the author of the report and a palliative care clinician. “We were using hospice so much more, there was more use of narcotics and so much more attention to symptoms, there was reason to think we were doing better.”

Lynn sees two major possible explanations for her conclusion. Patients and family members could be expecting more from the care provided and have “reset their thresholds” over the 12 years in this study. Another is that the number of treatments have increased, allowing patients to live longer with the diseases that ultimately kill them.

This resetting of thresholds ties directly into my thoughts on the psychological aspects of pain. Having said that, it seems likely the second reason is a factor as well.

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