Yeah, this one annoyed me - a lot. For decades, women have been complaining about this, only to be told that we're exaggerating, it's not that bad, we're being emotional, it's all in our heads....
Yeah, this one annoyed me - a lot. For decades, women have been complaining about this, only to be told that we're exaggerating, it's not that bad, we're being emotional, it's all in our heads. Then, hey!!
One study found that doctors regularly underestimate the pain that patients report experiencing.
Great! We're going to get more pain options!! Yippee!!
“When considering patient pain, it is important to recognize that the experience of pain is individualized and might be influenced by previous experiences including trauma and mental health conditions, such as depression or anxiety,” according to the CDC’s guidance.
Oh, it's all in our fucking heads again, is it?! #^&)(*%#&%_!!!!!!!!
Okay so on first blush this might look bad, but it follows the guidelines of modern pain medicine which strives to increase smart access to pain medicine - it's essentially patient-centered...
Oh, it's all in our fucking heads again, is it?! #^&)(*%#&%_!!!!!!!!
Okay so on first blush this might look bad, but it follows the guidelines of modern pain medicine which strives to increase smart access to pain medicine - it's essentially patient-centered medicine, where the idea is that the patient isn't lying to you about their experience. The idea is that pain is a personal thing and how much pain one person experiences versus another is influenced by many factors. The idea behind this framing is to encourage doctors to lean a bit less on paternalistic practices and write off the pain as nothing, but rather to acknowledge that pain varies from person to person and some people may require more or less sedation and pain medication in response to a stimulus. It just so happens to unfortunately use a lot of the same phrasing that paternalistic medicine used to use which could make it seem confusing or alienating to an outsider because rather than saying "it's all in your head, so stop overreacting" they're saying something more along the lines of "we recognize that pain is personal, so we should treat it". The first half of the sentence is essentially the same in both of these, what's changed is what comes after the comma; what we do as a response to the recognition of pain as a personal experience.
One of my favorite episodes of the great Ologies podcast is the Dolorology episode, focused on the study of pain. It’s an interview with Dr. Rachel Zoffness, someone that focuses on the...
One of my favorite episodes of the great Ologies podcast is the Dolorology episode, focused on the study of pain. It’s an interview with Dr. Rachel Zoffness, someone that focuses on the measurement and experience of pain, in a number of settings!
Description:
PAIN. What is it? Where does it come from? And how can we hurt less? Which hurts more, a kidney stone or heartache? Why does chronic pain persist? Can we turn down our pain dials? To answer these huge questions, pain psychologist Dr. Rachel Zoffness enthusiastically explains the brain, pain and how to retrain it. She is an unabashed neuronerd and a ray of hope in a field that is misunderstood, neglected and under-explained. A true life-changer of a person.
I wonder if there's a study where subjects get poked repeatedly with a stick with a randomized amount of force. Have subject rank pain from 0 to 10. While there would almost certainly be a...
I wonder if there's a study where subjects get poked repeatedly with a stick with a randomized amount of force. Have subject rank pain from 0 to 10. While there would almost certainly be a relation between increasing pain reported and increasing force, I'm betting that it's almost impossible to relate a given pressure with a given pain level due to the individualized nature of it. There would be a huge number of people hitting 10 while I'm pushing a 6.
There's too many confounding factors to empirically categorize pain.
I think so, there's a lot of other confounding factors yes. Example someone might be okay with a poke but not a slap kind of pain, or a normal room with soft music while this happens might be okay...
I think so, there's a lot of other confounding factors yes. Example someone might be okay with a poke but not a slap kind of pain, or a normal room with soft music while this happens might be okay for some people but not for others, or someone normally totally fine with pain suddenly freaking out at the dentists.
On that last one, pain is very contextual: Not Totally to brag, I went through childbirth without any pain management. Wasn't fun but manageable. That PAIN was P- purposeful A- anticipated I- intermittent N- normal.
But I think probably the worst subjective pain I've ever felt was when I was 11, I fell off a swing set and winded myself, because (1) I was a child (2) I thought I'd mortally injured myself (3) I was embarrassed and (4) I didn't know it was possible to bellyflop out of a swing set like that. I would imagine that if I were to break a bone in the future, that that would be the worst pain I would experience due to similar factors.
Similar feelings about childbirth here. No pain management, 33 hours of labor. I was sweating and tired by the end, but not freaking out about the pain. Then the ring of fire hit. Nobody told me!...
Similar feelings about childbirth here. No pain management, 33 hours of labor. I was sweating and tired by the end, but not freaking out about the pain. Then the ring of fire hit. Nobody told me! Cue freakout.
But the worst pain was a herniated disc giving me sciatica for months. No painkillers would touch it. It was Purposeless, Constant, and had no predictable end. Waking up from surgery was like angels singing. No more pain!
Yikes on a bike! Purposeless constant pain that one isn't sure would end at all :E yeah that's way worse. Our prenatal classes and my midwives were very good about the ring of fire. :) the...
Yikes on a bike! Purposeless constant pain that one isn't sure would end at all :E yeah that's way worse.
Our prenatal classes and my midwives were very good about the ring of fire. :) the midwives tirelessly massaged and applied....something helpful (?) throughout and i did super okay. But yeah I can see panic and freakout if that was not Anticipated. Still, 33 hours is a long long time. High fives!
i've broken two bones, and on both occasions i did not think i had actually broken a bone. i was a bit stunned and shocked, of course, but i don't think the pain was overall much worse than the...
i've broken two bones, and on both occasions i did not think i had actually broken a bone. i was a bit stunned and shocked, of course, but i don't think the pain was overall much worse than the more boring soft tissue stuff i have always struggled with. just more persistent. admittedly, the breaks were pretty clean. i think the worst physical pain i have experienced has probably been in my head and psychologically driven (not the same as the worst mental pain i have experienced though). either when i was 9~10 and terrified of dying, or a few years ago when i was chronically sleep deprived because i was living with my parents
First of all, I hate this nonsense. I have high tolerance, but a low threshold. I refused to even entertain getting an IUD without being under general anesthesia. I personally wanted a...
First of all, I hate this nonsense. I have high tolerance, but a low threshold. I refused to even entertain getting an IUD without being under general anesthesia. I personally wanted a hysterectomy, but compromised with my surgeon to get an IUD during an exploratory laparoscopy to diagnose other issues.
Yes, pain is in your head, but it's more like the nerves are firing on all cylinders when you experience pain in an area and your brain is responding appropriately by feeling the pain. It's so dumb to make the guidelines basically "it's all in your head."
People with uteruses and people who menstruate have been complaining about these issues for such a long time, and no one has cared. It's far past time we stop gaslighting these people and actually accept that pain from nerve endings firing is real.
Oh joy the doctor fought you on whether pain medicine was necessary and then also fought you on whether you deserved the agency to make a decision about children! 😬 Sorry you had such a shitty...
First of all, I hate this nonsense. I have high tolerance, but a low threshold. I refused to even entertain getting an IUD without being under general anesthesia. I personally wanted a hysterectomy, but compromised with my surgeon to get an IUD during an exploratory laparoscopy to diagnose other issues.
Oh joy the doctor fought you on whether pain medicine was necessary and then also fought you on whether you deserved the agency to make a decision about children! 😬 Sorry you had such a shitty doctor, I hope the slow/steady push of advocates for patient-centered medicine brings better experiences in the future 😩
I have had doctors both extremely impressed at my lack of pain and telling me that I'm complaining too much about pain. I think the difference between the two is how much they recognize that the patient is usually the best source of truth about what they're experiencing and how much they realize that diversity is a thing and no two patients present the same way.
Completely tangential, I was taking my kid to an orthodontist recommended baby tooth extraction, and the kid is holding it together levelling their breathing and holding their hand together....
Completely tangential, I was taking my kid to an orthodontist recommended baby tooth extraction, and the kid is holding it together levelling their breathing and holding their hand together. Meanwhile the hygienist kept saying "oh wow! Oh wow! Oooh!! They've got such a high pain tolerance! My kids would have been wailing long before this! They would be crying and screaming!" on repeat!! Seriously she repeated this nonsense basically throughout the entire procedure up through stitches! Right next to my kid who's summoning all of their inner strength to focus on getting through! If I didn't think it might upset the kid I might have resorted to violence. Or at least a harsh comment and hard look.
So, health professionals: as patients, we don't need you to feel impressed or to chide, keep it to yourself whether you think we're being babies or being "so brave!" And don't project patients pain as some kind of criticism of your skills. None of this "well my other patients don't complain" nonsense please.
The child was being talked about, not talked to. And it was apparent to chocobean that the kid was not being supported in that moment. A "you're doing real good, keep it up" would probably have...
The child was being talked about, not talked to. And it was apparent to chocobean that the kid was not being supported in that moment. A "you're doing real good, keep it up" would probably have been better than "every other kid would be crying"
Adults (and older teens) generally want to be empathized with not to be patronized. Which is what "you're so brave" often feels like.
I can’t remember where, but I read that a child overhearing themselves being talked about positively between others, especially people they respect, can be very powerful. I forget exactly, but I...
I can’t remember where, but I read that a child overhearing themselves being talked about positively between others, especially people they respect, can be very powerful. I forget exactly, but I think it was something about being proud that it’s worth telling others, and for those a bit wiser, that it’s not just saying something (to them, potentially exaggerated) to make them feel better.
In the dentist situation above, it’d probably be best to do both. Also not to harp too much on how much kids normally scream, as that might get them hyped up in the wrong direction (like making a big deal out of a minor fall that they’d otherwise shake off)
That's fair but I trust chocobean's knowledge of their kid and what was said that it wasn't helpful at all. I think there's a big difference from a "they did really well" overheard by kid from...
That's fair but I trust chocobean's knowledge of their kid and what was said that it wasn't helpful at all. I think there's a big difference from a "they did really well" overheard by kid from dentist to parent afterwards and what happened here.
What @DefinitelyNotAFae and @DrStone said, yup Dentistry is a weird health thing where we can't see what's happening to us, but we can hear everything that sounds "not normal". There was injected...
Dentistry is a weird health thing where we can't see what's happening to us, but we can hear everything that sounds "not normal". There was injected freezing applied, but the patient can still feel pressure around the site and they can see how much force is being asserted by a grown man.
It would have been great if the hygienist had praised my child once or twice directly, or made a comment to me once or twice, or better yet afterwards. But in the midst of a lot of noises and tools and a grown man using what seemed like his entire upper body strength to yank something out of your skull, all the wince-adjacent coo-ing and "oof that's gotta hurt" type expressions are totally unhelpful. Besides, they've seen this lots of times as a dental hygienist/assistant right? Their exaggerated reaction made it feel like something wrong might be happening?
It's kinda like eating a new foreign cuisine, and the difference between a local saying hey good for you trying something new one time, vs someone going on and on about how ooof, their kids wouldn't touch the stuff and would run away from it, and you're overhearing them tell your travel companion you're so brave for eating this. Over and over.
Poor kid! I've been through that too. I hope next time you can help them by suggesting they let the hygenist/dentist know about their last experience and if it hurt them to please speak up. It's...
Poor kid! I've been through that too. I hope next time you can help them by suggesting they let the hygenist/dentist know about their last experience and if it hurt them to please speak up. It's also very brave to ask for pain mediation and medication before or during the procedure and to be honest about the issue.
Kiddo is a bit like me this this way: understanding why we were doing this helped a lot with the expectations and pain management.......we had a lot of ice cream in the next number of days, lol...
Kiddo is a bit like me this this way: understanding why we were doing this helped a lot with the expectations and pain management.......we had a lot of ice cream in the next number of days, lol and basically whatever they wanted from the store. the tooth that came out still has all the roots, pretty crazy. We just emphasized, checked to make sure things are healing safely, and acknowledged any discomfort, to anticipate when medication might wear off and wait for it to come and go with the next dose, and left it up to them to decide how much and if they need more.
Pain is contextual. I think knowing the healing is happening, that symptoms can be managed and there's a lot more if we need, and that the experience is purposeful for a good reason...that all helped
I'm very proud of them and I hope I can be here to prep and explain and provide comfort to make it all make a bit of sense, for the other painful things that will happen during ones life.
I hope the push for patient-centered care and advocacy also leads to universal healthcare, and being able to just get the healthcare we need when we need it. But yes. I was also 30 AND married...
I hope the push for patient-centered care and advocacy also leads to universal healthcare, and being able to just get the healthcare we need when we need it.
But yes. I was also 30 AND married when this happened. She didn't want to "take away my options." Ma'am, if we don't already have kids, we're never going to. I was already chronically ill when it happened, and now I'm just more ill.
Thankfully, I'm meeting with a new gyn in a few weeks that handles hysterectomy surgeries so I can discuss with her what I want. There's so much that is based on my uterus with my health, and I...
Thankfully, I'm meeting with a new gyn in a few weeks that handles hysterectomy surgeries so I can discuss with her what I want. There's so much that is based on my uterus with my health, and I know so much of it can be dealt with handily once the offending organ is gone.
The thing that gets me about the "it's all in your head" is that, even so, WE'RE STILL FEELING IT. Take the quote from Dumbledore: "Of course, it's all happening inside your head, Harry. Why...
The thing that gets me about the "it's all in your head" is that, even so, WE'RE STILL FEELING IT.
Take the quote from Dumbledore: "Of course, it's all happening inside your head, Harry. Why should that mean it's any less real?"
Like, if I'm experiencing pain, whether someone else in the same situation would experience pain too doesn't matter to me. It'd still hurt me even if someone else didn't feel anything.
So, just treat the pain I'm feeling that someone else wouldn't, and don't treat them for pain.
When I got my IUD back in 2015, I was told to talk 2 ibuprofen before for pain management. It was early enough in the morning that I also hadn't eaten yet (a compounding factor). When dilating my...
Exemplary
When I got my IUD back in 2015, I was told to talk 2 ibuprofen before for pain management. It was early enough in the morning that I also hadn't eaten yet (a compounding factor).
When dilating my cervix, the woman doing it told me there'd be a pinch. I almost passed the fuck out from the pain. It was in fact some of the worst pain I've experienced still. They got me some juice, patted me on the hand, and sent me on my merry way.
It was a horrible experience. I wasn't AT ALL prepared and nothing I had read online bad prepared me for the pain! This was also at a time when IUDs weren't really recommended for people who hadn't had kids. I was told "because they're more likely to fall out."
But I am on one end of the spectrum. Both of my sisters got IUDs and they said it barely hurt. The difference? They'd both had at least one kid at this point.
So it's about fucking time that the CDC put out ANYTHING in regards to pain management for this procedure. It's just such a long long fucking history of ignoring women's pain and not seeing them as autonomous human beings who understand their bodies.
I know now it's better in some places. I went to a women's health clinic last year to get a papsmear and the NP told me she'd happily provide any pain management I needed to be comfortable and that we could swap out my IUD for a new one while medicated. And that at that clinic, that was standard practice.
This is a little rambly but overall, nothing inspires my feminine rage like this kind of systemic bullshit. It fucking kills me how much women have to suffer to get a fucking IOTA of help.
Thank god. I'll admit, my first 2 insertions ranged from barely-noticed to slight-discomfort. While I certainly believed others' stories of pain, it was incredibly difficult for me to bridge those...
Thank god.
I'll admit, my first 2 insertions ranged from barely-noticed to slight-discomfort. While I certainly believed others' stories of pain, it was incredibly difficult for me to bridge those experiences vs. my own.
I have no concrete idea why the 3rd time was so different - I learned the hard way exactly how painful it could be.
That 3rd experience alone led me to the point I've told doctors I'm unlikely to go through a 4th without real pain management. Luckily, this led me to finding about a local facility that can do the procedure under anethesia, but I don't think this info would have been available to me without persistent self-advocacy. (And, to their credit, healthcare providers who heard me!)
My experience is very similar to yours. My first sorta hurt but really it was more on the discomfort side. When I got that one replaced though, my god... I have never experienced such pain. I am...
My experience is very similar to yours. My first sorta hurt but really it was more on the discomfort side. When I got that one replaced though, my god... I have never experienced such pain. I am normally a very grin and bear it person when it comes to pain and discomfort, but I involuntarily screamed. It was so awful I delayed getting a replacement when the time came because I assumed it would be the same.
I wonder how much of your experience has to do with the technique they use during insertion. I have no personal experience with IUDs, but when I have donated blood, I have found it 100% painless...
I wonder how much of your experience has to do with the technique they use during insertion.
I have no personal experience with IUDs, but when I have donated blood, I have found it 100% painless very nearly every single time — so long as I get it done by anyone except this one particular nurse, who manages to really hurt me every single time.
I've absolutely wondered if that was a contributing factor. My first 2 times were at clinics specializing in reproductive health, and the 3rd was by a GP (not to knock them, just an observation)...
I've absolutely wondered if that was a contributing factor. My first 2 times were at clinics specializing in reproductive health, and the 3rd was by a GP (not to knock them, just an observation)
I've also wondered if it was related to menstruation and related physiological changes. My first (copper) was timed during my period, second (hormonal) wasn't timed bang-on but close. By my 3rd, I no longer experienced periods so literally nothing to time against, which may have required working "against" vs. "with" my physical state.
Seems like a no brainer to use anesthestic gels. There's a reason why it takes hours and hours and hours of active labour to open the cervix. It's a very very tightly closed muscle whose job is to...
Seems like a no brainer to use anesthestic gels. There's a reason why it takes hours and hours and hours of active labour to open the cervix. It's a very very tightly closed muscle whose job is to keep baby + all the life sustaining fluids locked in for 40 weeks: it doesn't want to open. It takes the first number of hours to get to the first 1cm mark, and that's aided by a truck tonne of chemicals flooding the brain to get ready. It's not like putting a swab up your nose at all.
[slightly graphical description warning]
And news flash, the doctor isn't able to see much while they're inserting: they take a good look, they aim, then they gotta step back before getting their hand+tool in there. Try threading yarn through a yarn needle with 8" long alligator forceps through a velvet lined toilet paper tube. The whole time, the person is in stirrups being held open by hard cold metal clamps, already vulnerable and cold and uncomfortable.
O'Byrne said the procedure left her sweating and struggling to drive home. She said she was forced to pull over multiple times. Years later, after childbirth, she realized the pain of the IUD insertion was similar to labour pains. (CBC 2022)
Anyway. Yes. Please offer options so more people can make informed decisions. And for heaven's sake stop telling folks you might feel a slight pinch. Its unnecessary and patronizing and false for most folks.
"You're gonna feel it, that's normal, I can confirm nothing is bleeding and you're in a safe place with trained professionals and all the right tools to help. I've applied numbing gels, let me know if you'd like more. There's a prescription ready for you if you need more at home."
Wouldn't a space heater or something help? Everything is more painful when you're cold. Heck, even having a full bladder hurts more when its cold, I imagine for either sex
cold
Wouldn't a space heater or something help? Everything is more painful when you're cold. Heck, even having a full bladder hurts more when its cold, I imagine for either sex
Possibly? Maybe some thigh high cozy socks. But honestly there's not much we can do about the ice cold speculums in direct contact with bits that usually are, not.
Possibly? Maybe some thigh high cozy socks. But honestly there's not much we can do about the ice cold speculums in direct contact with bits that usually are, not.
We have blanket warmers, there's no reason we couldn't warm metal speculums first. Personally speaking I kind of prefer the plastic disposable speculums for this reason- it's a slightly more...
We have blanket warmers, there's no reason we couldn't warm metal speculums first.
Personally speaking I kind of prefer the plastic disposable speculums for this reason- it's a slightly more pleasant experience. Both have an issue of causing a reasonable amount of pinching because they have a seam, however, and I'm not sure how one can really solve that (although I've often wondered why they don't just use anal speculums which are designed with this in mind 🤷♀️).
That's a great point why aren't they kept in the warmer? :( too hot?! Surely an OBGYN office can have a dedicated tools warmer. Side question, you might have already mentioned and I forget, do you...
That's a great point why aren't they kept in the warmer? :( too hot?! Surely an OBGYN office can have a dedicated tools warmer.
Side question, you might have already mentioned and I forget, do you work in the health profession and if so in what role?
Warmers aren't super common, they're mostly at hospitals and not clinics and they seem to only be used for blankets and rarely anything else. I'm often an advocate to people who work at the...
Warmers aren't super common, they're mostly at hospitals and not clinics and they seem to only be used for blankets and rarely anything else. I'm often an advocate to people who work at the hospital to use it for more things! Like I also hate super cold IVs, those are usually super destabilizing to me, whereas when it's been sitting out (rather than straight out the fridge) it usually doesn't bother me.
I work in healthcare, yes. I've served in a lot of roles - I've been an EMT, a health contractor doing nursing stuff like basic screenings, vaccinations, etc. I got into (but didn't go to) medical school, I've got a masters in Health Informatics, and I currently work as a data scientist for a rather well-known academic medical center in a role that is no longer patient facing.
Oh man, IVs give me the heebies >..< cold ones.....nonononono..... That's a lot of really cool roles! Thanks for your insights as a behind the scenes guy :D and I hope your advocating contributes...
Oh man, IVs give me the heebies >..< cold ones.....nonononono.....
That's a lot of really cool roles! Thanks for your insights as a behind the scenes guy :D and I hope your advocating contributes to better health outcomes to all
I mean, some of the insight is from being behind the scenes, but some of the insights, such as those about speculums comes more from my own time spent in stirrups with uncomfortable objects in my...
I mean, some of the insight is from being behind the scenes, but some of the insights, such as those about speculums comes more from my own time spent in stirrups with uncomfortable objects in my vagina than it comes from my clinical and medical experience 😂
We absolutely can, by using plastic speculums, like every gynecologist I've seen since moving to Europe has. Getting my PAP smears still hasn't been exactly pleasant, but the room temperature...
But honestly there's not much we can do about the ice cold speculums in direct contact with bits that usually are, not.
We absolutely can, by using plastic speculums, like every gynecologist I've seen since moving to Europe has. Getting my PAP smears still hasn't been exactly pleasant, but the room temperature plastic is a marked improvement over cold metal.
FWIW in the US I've almost exclusively seen plastic speculums in the clinic. I'm torn on this. I just hate all of the medical waste we create for all kinds of procedures. The clinic I know that...
FWIW in the US I've almost exclusively seen plastic speculums in the clinic. I'm torn on this. I just hate all of the medical waste we create for all kinds of procedures. The clinic I know that uses metal speculums does warm them up to body temp before any procedures. I also have to admit that I think the mechanism for locking the metal speculums open is better designed than the plastic ones. I want to do right by the women coming to seek care but I think it is possible to provide good care without the single use plastic. In the end, I'm glad we are trying to accomodate the comfort of the women in a vulnerable exam.
It's not a dumb question at all. The last male GYN I ever entrusted my body to thought it was cute to leave his instruments next to an open window in November (in Michigan). He very clearly...
It's not a dumb question at all. The last male GYN I ever entrusted my body to thought it was cute to leave his instruments next to an open window in November (in Michigan). He very clearly thought it was a good joke, but everything spasmed so hard from the insertion of a freezing-cold speculum that I was aching for hours afterwards.
The female GYN I saw next put fuzzy socks on the metal stirrups and used a lamp to keep the instruments warm. So yes, it's perfectly possible to keep a speculum at body temperature, but you have to care or have actual empathy for your patients.
That is absolutely not true. Almost every gyn I've been to since 2015 has had heated speculums, whether they be metal or plastic, pulled from steripacks that were on a heating pad waiting to be...
That is absolutely not true. Almost every gyn I've been to since 2015 has had heated speculums, whether they be metal or plastic, pulled from steripacks that were on a heating pad waiting to be used.
Doctors know heat is better. I've also had a heating pad placed on my abdomen before procedures the last two times I saw my old gyn to help with pain, increase bloodflow, and help relax my pelvic muscles.
Yeah, this one annoyed me - a lot. For decades, women have been complaining about this, only to be told that we're exaggerating, it's not that bad, we're being emotional, it's all in our heads. Then, hey!!
Great! We're going to get more pain options!! Yippee!!
Oh, it's all in our fucking heads again, is it?! #^&)(*%#&%_!!!!!!!!
Okay so on first blush this might look bad, but it follows the guidelines of modern pain medicine which strives to increase smart access to pain medicine - it's essentially patient-centered medicine, where the idea is that the patient isn't lying to you about their experience. The idea is that pain is a personal thing and how much pain one person experiences versus another is influenced by many factors. The idea behind this framing is to encourage doctors to lean a bit less on paternalistic practices and write off the pain as nothing, but rather to acknowledge that pain varies from person to person and some people may require more or less sedation and pain medication in response to a stimulus. It just so happens to unfortunately use a lot of the same phrasing that paternalistic medicine used to use which could make it seem confusing or alienating to an outsider because rather than saying "it's all in your head, so stop overreacting" they're saying something more along the lines of "we recognize that pain is personal, so we should treat it". The first half of the sentence is essentially the same in both of these, what's changed is what comes after the comma; what we do as a response to the recognition of pain as a personal experience.
One of my favorite episodes of the great Ologies podcast is the Dolorology episode, focused on the study of pain. It’s an interview with Dr. Rachel Zoffness, someone that focuses on the measurement and experience of pain, in a number of settings!
Description:
https://www.alieward.com/ologies/dolorology
I wonder if there's a study where subjects get poked repeatedly with a stick with a randomized amount of force. Have subject rank pain from 0 to 10. While there would almost certainly be a relation between increasing pain reported and increasing force, I'm betting that it's almost impossible to relate a given pressure with a given pain level due to the individualized nature of it. There would be a huge number of people hitting 10 while I'm pushing a 6.
There's too many confounding factors to empirically categorize pain.
I think so, there's a lot of other confounding factors yes. Example someone might be okay with a poke but not a slap kind of pain, or a normal room with soft music while this happens might be okay for some people but not for others, or someone normally totally fine with pain suddenly freaking out at the dentists.
On that last one, pain is very contextual:
NotTotally to brag, I went through childbirth without any pain management. Wasn't fun but manageable. That PAIN was P- purposeful A- anticipated I- intermittent N- normal.But I think probably the worst subjective pain I've ever felt was when I was 11, I fell off a swing set and winded myself, because (1) I was a child (2) I thought I'd mortally injured myself (3) I was embarrassed and (4) I didn't know it was possible to bellyflop out of a swing set like that. I would imagine that if I were to break a bone in the future, that that would be the worst pain I would experience due to similar factors.
Similar feelings about childbirth here. No pain management, 33 hours of labor. I was sweating and tired by the end, but not freaking out about the pain. Then the ring of fire hit. Nobody told me! Cue freakout.
But the worst pain was a herniated disc giving me sciatica for months. No painkillers would touch it. It was Purposeless, Constant, and had no predictable end. Waking up from surgery was like angels singing. No more pain!
Yikes on a bike! Purposeless constant pain that one isn't sure would end at all :E yeah that's way worse.
Our prenatal classes and my midwives were very good about the ring of fire. :) the midwives tirelessly massaged and applied....something helpful (?) throughout and i did super okay. But yeah I can see panic and freakout if that was not Anticipated. Still, 33 hours is a long long time. High fives!
i've broken two bones, and on both occasions i did not think i had actually broken a bone. i was a bit stunned and shocked, of course, but i don't think the pain was overall much worse than the more boring soft tissue stuff i have always struggled with. just more persistent. admittedly, the breaks were pretty clean. i think the worst physical pain i have experienced has probably been in my head and psychologically driven (not the same as the worst mental pain i have experienced though). either when i was 9~10 and terrified of dying, or a few years ago when i was chronically sleep deprived because i was living with my parents
Oooh sleep deprivation is a kind of pain, I'd forgotten about that . Is your sleep deprivation all better now?
i've always had sleep problems and i think i probably always will, but it is much better now!
First of all, I hate this nonsense. I have high tolerance, but a low threshold. I refused to even entertain getting an IUD without being under general anesthesia. I personally wanted a hysterectomy, but compromised with my surgeon to get an IUD during an exploratory laparoscopy to diagnose other issues.
Yes, pain is in your head, but it's more like the nerves are firing on all cylinders when you experience pain in an area and your brain is responding appropriately by feeling the pain. It's so dumb to make the guidelines basically "it's all in your head."
People with uteruses and people who menstruate have been complaining about these issues for such a long time, and no one has cared. It's far past time we stop gaslighting these people and actually accept that pain from nerve endings firing is real.
Oh joy the doctor fought you on whether pain medicine was necessary and then also fought you on whether you deserved the agency to make a decision about children! 😬 Sorry you had such a shitty doctor, I hope the slow/steady push of advocates for patient-centered medicine brings better experiences in the future 😩
I have had doctors both extremely impressed at my lack of pain and telling me that I'm complaining too much about pain. I think the difference between the two is how much they recognize that the patient is usually the best source of truth about what they're experiencing and how much they realize that diversity is a thing and no two patients present the same way.
Completely tangential, I was taking my kid to an orthodontist recommended baby tooth extraction, and the kid is holding it together levelling their breathing and holding their hand together. Meanwhile the hygienist kept saying "oh wow! Oh wow! Oooh!! They've got such a high pain tolerance! My kids would have been wailing long before this! They would be crying and screaming!" on repeat!! Seriously she repeated this nonsense basically throughout the entire procedure up through stitches! Right next to my kid who's summoning all of their inner strength to focus on getting through! If I didn't think it might upset the kid I might have resorted to violence. Or at least a harsh comment and hard look.
So, health professionals: as patients, we don't need you to feel impressed or to chide, keep it to yourself whether you think we're being babies or being "so brave!" And don't project patients pain as some kind of criticism of your skills. None of this "well my other patients don't complain" nonsense please.
...what's wrong with telling a kid they're being brave?
The child was being talked about, not talked to. And it was apparent to chocobean that the kid was not being supported in that moment. A "you're doing real good, keep it up" would probably have been better than "every other kid would be crying"
Adults (and older teens) generally want to be empathized with not to be patronized. Which is what "you're so brave" often feels like.
I can’t remember where, but I read that a child overhearing themselves being talked about positively between others, especially people they respect, can be very powerful. I forget exactly, but I think it was something about being proud that it’s worth telling others, and for those a bit wiser, that it’s not just saying something (to them, potentially exaggerated) to make them feel better.
In the dentist situation above, it’d probably be best to do both. Also not to harp too much on how much kids normally scream, as that might get them hyped up in the wrong direction (like making a big deal out of a minor fall that they’d otherwise shake off)
That's fair but I trust chocobean's knowledge of their kid and what was said that it wasn't helpful at all. I think there's a big difference from a "they did really well" overheard by kid from dentist to parent afterwards and what happened here.
Context matters
What @DefinitelyNotAFae and @DrStone said, yup
Dentistry is a weird health thing where we can't see what's happening to us, but we can hear everything that sounds "not normal". There was injected freezing applied, but the patient can still feel pressure around the site and they can see how much force is being asserted by a grown man.
It would have been great if the hygienist had praised my child once or twice directly, or made a comment to me once or twice, or better yet afterwards. But in the midst of a lot of noises and tools and a grown man using what seemed like his entire upper body strength to yank something out of your skull, all the wince-adjacent coo-ing and "oof that's gotta hurt" type expressions are totally unhelpful. Besides, they've seen this lots of times as a dental hygienist/assistant right? Their exaggerated reaction made it feel like something wrong might be happening?
It's kinda like eating a new foreign cuisine, and the difference between a local saying hey good for you trying something new one time, vs someone going on and on about how ooof, their kids wouldn't touch the stuff and would run away from it, and you're overhearing them tell your travel companion you're so brave for eating this. Over and over.
Poor kid! I've been through that too. I hope next time you can help them by suggesting they let the hygenist/dentist know about their last experience and if it hurt them to please speak up. It's also very brave to ask for pain mediation and medication before or during the procedure and to be honest about the issue.
I'm proud of kiddo for keeping it together.
Kiddo is a bit like me this this way: understanding why we were doing this helped a lot with the expectations and pain management.......we had a lot of ice cream in the next number of days, lol and basically whatever they wanted from the store. the tooth that came out still has all the roots, pretty crazy. We just emphasized, checked to make sure things are healing safely, and acknowledged any discomfort, to anticipate when medication might wear off and wait for it to come and go with the next dose, and left it up to them to decide how much and if they need more.
Pain is contextual. I think knowing the healing is happening, that symptoms can be managed and there's a lot more if we need, and that the experience is purposeful for a good reason...that all helped
I'm very proud of them and I hope I can be here to prep and explain and provide comfort to make it all make a bit of sense, for the other painful things that will happen during ones life.
I hope the push for patient-centered care and advocacy also leads to universal healthcare, and being able to just get the healthcare we need when we need it.
But yes. I was also 30 AND married when this happened. She didn't want to "take away my options." Ma'am, if we don't already have kids, we're never going to. I was already chronically ill when it happened, and now I'm just more ill.
Thankfully, I'm meeting with a new gyn in a few weeks that handles hysterectomy surgeries so I can discuss with her what I want. There's so much that is based on my uterus with my health, and I know so much of it can be dealt with handily once the offending organ is gone.
The thing that gets me about the "it's all in your head" is that, even so, WE'RE STILL FEELING IT.
Take the quote from Dumbledore: "Of course, it's all happening inside your head, Harry. Why should that mean it's any less real?"
Like, if I'm experiencing pain, whether someone else in the same situation would experience pain too doesn't matter to me. It'd still hurt me even if someone else didn't feel anything.
So, just treat the pain I'm feeling that someone else wouldn't, and don't treat them for pain.
When I got my IUD back in 2015, I was told to talk 2 ibuprofen before for pain management. It was early enough in the morning that I also hadn't eaten yet (a compounding factor).
When dilating my cervix, the woman doing it told me there'd be a pinch. I almost passed the fuck out from the pain. It was in fact some of the worst pain I've experienced still. They got me some juice, patted me on the hand, and sent me on my merry way.
It was a horrible experience. I wasn't AT ALL prepared and nothing I had read online bad prepared me for the pain! This was also at a time when IUDs weren't really recommended for people who hadn't had kids. I was told "because they're more likely to fall out."
But I am on one end of the spectrum. Both of my sisters got IUDs and they said it barely hurt. The difference? They'd both had at least one kid at this point.
So it's about fucking time that the CDC put out ANYTHING in regards to pain management for this procedure. It's just such a long long fucking history of ignoring women's pain and not seeing them as autonomous human beings who understand their bodies.
I know now it's better in some places. I went to a women's health clinic last year to get a papsmear and the NP told me she'd happily provide any pain management I needed to be comfortable and that we could swap out my IUD for a new one while medicated. And that at that clinic, that was standard practice.
This is a little rambly but overall, nothing inspires my feminine rage like this kind of systemic bullshit. It fucking kills me how much women have to suffer to get a fucking IOTA of help.
I'm very glad you found a better place! I hope that become standard of care everywhere soon :)
Thank god.
I'll admit, my first 2 insertions ranged from barely-noticed to slight-discomfort. While I certainly believed others' stories of pain, it was incredibly difficult for me to bridge those experiences vs. my own.
I have no concrete idea why the 3rd time was so different - I learned the hard way exactly how painful it could be.
That 3rd experience alone led me to the point I've told doctors I'm unlikely to go through a 4th without real pain management. Luckily, this led me to finding about a local facility that can do the procedure under anethesia, but I don't think this info would have been available to me without persistent self-advocacy. (And, to their credit, healthcare providers who heard me!)
My experience is very similar to yours. My first sorta hurt but really it was more on the discomfort side. When I got that one replaced though, my god... I have never experienced such pain. I am normally a very grin and bear it person when it comes to pain and discomfort, but I involuntarily screamed. It was so awful I delayed getting a replacement when the time came because I assumed it would be the same.
I wonder how much of your experience has to do with the technique they use during insertion.
I have no personal experience with IUDs, but when I have donated blood, I have found it 100% painless very nearly every single time — so long as I get it done by anyone except this one particular nurse, who manages to really hurt me every single time.
I've absolutely wondered if that was a contributing factor. My first 2 times were at clinics specializing in reproductive health, and the 3rd was by a GP (not to knock them, just an observation)
I've also wondered if it was related to menstruation and related physiological changes. My first (copper) was timed during my period, second (hormonal) wasn't timed bang-on but close. By my 3rd, I no longer experienced periods so literally nothing to time against, which may have required working "against" vs. "with" my physical state.
Huh, it would make sense to me if the timing makes a huge difference. The cervix opens a bit and sits lower (more accessible) during menstruation.
Seems like a no brainer to use anesthestic gels. There's a reason why it takes hours and hours and hours of active labour to open the cervix. It's a very very tightly closed muscle whose job is to keep baby + all the life sustaining fluids locked in for 40 weeks: it doesn't want to open. It takes the first number of hours to get to the first 1cm mark, and that's aided by a truck tonne of chemicals flooding the brain to get ready. It's not like putting a swab up your nose at all.
[slightly graphical description warning]
And news flash, the doctor isn't able to see much while they're inserting: they take a good look, they aim, then they gotta step back before getting their hand+tool in there. Try threading yarn through a yarn needle with 8" long alligator forceps through a velvet lined toilet paper tube. The whole time, the person is in stirrups being held open by hard cold metal clamps, already vulnerable and cold and uncomfortable.
Anyway. Yes. Please offer options so more people can make informed decisions. And for heaven's sake stop telling folks you might feel a slight pinch. Its unnecessary and patronizing and false for most folks.
"You're gonna feel it, that's normal, I can confirm nothing is bleeding and you're in a safe place with trained professionals and all the right tools to help. I've applied numbing gels, let me know if you'd like more. There's a prescription ready for you if you need more at home."
Wouldn't a space heater or something help? Everything is more painful when you're cold. Heck, even having a full bladder hurts more when its cold, I imagine for either sex
Possibly? Maybe some thigh high cozy socks. But honestly there's not much we can do about the ice cold speculums in direct contact with bits that usually are, not.
We have blanket warmers, there's no reason we couldn't warm metal speculums first.
Personally speaking I kind of prefer the plastic disposable speculums for this reason- it's a slightly more pleasant experience. Both have an issue of causing a reasonable amount of pinching because they have a seam, however, and I'm not sure how one can really solve that (although I've often wondered why they don't just use anal speculums which are designed with this in mind 🤷♀️).
That's a great point why aren't they kept in the warmer? :( too hot?! Surely an OBGYN office can have a dedicated tools warmer.
Side question, you might have already mentioned and I forget, do you work in the health profession and if so in what role?
Warmers aren't super common, they're mostly at hospitals and not clinics and they seem to only be used for blankets and rarely anything else. I'm often an advocate to people who work at the hospital to use it for more things! Like I also hate super cold IVs, those are usually super destabilizing to me, whereas when it's been sitting out (rather than straight out the fridge) it usually doesn't bother me.
I work in healthcare, yes. I've served in a lot of roles - I've been an EMT, a health contractor doing nursing stuff like basic screenings, vaccinations, etc. I got into (but didn't go to) medical school, I've got a masters in Health Informatics, and I currently work as a data scientist for a rather well-known academic medical center in a role that is no longer patient facing.
Oh man, IVs give me the heebies >..< cold ones.....nonononono.....
That's a lot of really cool roles! Thanks for your insights as a behind the scenes guy :D and I hope your advocating contributes to better health outcomes to all
I mean, some of the insight is from being behind the scenes, but some of the insights, such as those about speculums comes more from my own time spent in stirrups with uncomfortable objects in my vagina than it comes from my clinical and medical experience 😂
Ah dang, yeah, c'mon clinics get those warmers!
The plastic ones also aren't as sharp and pokey as the metal ones from my experience.
We absolutely can, by using plastic speculums, like every gynecologist I've seen since moving to Europe has. Getting my PAP smears still hasn't been exactly pleasant, but the room temperature plastic is a marked improvement over cold metal.
FWIW in the US I've almost exclusively seen plastic speculums in the clinic. I'm torn on this. I just hate all of the medical waste we create for all kinds of procedures. The clinic I know that uses metal speculums does warm them up to body temp before any procedures. I also have to admit that I think the mechanism for locking the metal speculums open is better designed than the plastic ones. I want to do right by the women coming to seek care but I think it is possible to provide good care without the single use plastic. In the end, I'm glad we are trying to accomodate the comfort of the women in a vulnerable exam.
It's not a dumb question at all. The last male GYN I ever entrusted my body to thought it was cute to leave his instruments next to an open window in November (in Michigan). He very clearly thought it was a good joke, but everything spasmed so hard from the insertion of a freezing-cold speculum that I was aching for hours afterwards.
The female GYN I saw next put fuzzy socks on the metal stirrups and used a lamp to keep the instruments warm. So yes, it's perfectly possible to keep a speculum at body temperature, but you have to care or have actual empathy for your patients.
They make plastic ones, although there can be sterility concerns with that. As for why the metal ones aren’t warmed up beforehand, no clue.
That is absolutely not true. Almost every gyn I've been to since 2015 has had heated speculums, whether they be metal or plastic, pulled from steripacks that were on a heating pad waiting to be used.
Doctors know heat is better. I've also had a heating pad placed on my abdomen before procedures the last two times I saw my old gyn to help with pain, increase bloodflow, and help relax my pelvic muscles.
Oh great to hear, I might even ask next time if isn't already default