Getting to the Bottom of Common Pain Myths

Nov. 19, 2008 — -- "No pain, no gain" is a popular -- albeit misguided -- mind-set in sports and fitness, and it's not a smart approach for managing chronic pain either.

And just as you don't need to feel uncomfortable while exercising to get physically stronger, there's no need to view recurring pain as something you should also gut out.

A grin-and-bear-it mentality could lead you to not acknowledge pain when you feel it and delay seeking medical attention.

"There's a reason pain occurs and it's often to make us stop doing something," said Dr. Carmen Green, an associate professor of anesthesiology and director of the pain research division at the University of Michigan Health System in Ann Arbor.

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The following are seven other misconceptions about pain that we ran by four experts so they could set the record straight for you.

Myth: Pain in infancy doesn't matter because babies can't remember it.

Even premature babies have the neurological development to experience the adverse physical effects of pain, such as increased stress hormones, increased heart rate, difficulty breathing and poorer outcomes after surgery, pointed out Dr. Lonnie Zeltzer, director of the pediatrics pain program at UCLA Mattel Children's Hospital in Los Angeles.

What's more, significant pain exposure in newborns has the potential to shape the development of the sensory nervous system, which transmits information on pain experience and can make the child more vulnerable to pain later.

In fact, early pain exposure in infancy is one of the risk factors for the development of chronic pain in adulthood -- along with genetics, Zeltzer said. Moreover, if pain is undertreated in newborns and children, it can have long-term consequences, even if the pain episode can't be recalled or is a distant memory.

Studies of kindergartners provide evidence that children's early pain experience can influence the development of their nervous system. In follow-up research of premature infants, scientists have found that by age 4 or 5, these children had more stomachaches as well as general aches and pains that seemed to correlate with the amount of time they spent in a neonatal intensive care unit after birth.

Myth: Men are better at dealing with pain than women.

Neither sex has the edge on pain. And medicine has no definitive pain-o-meter to quantify a person's level of discomfort, explained Green. Consequently, pain is often measured by your perception of it and the way you experience it. Both gender and your cultural experience of pain can influence your coping style.

Research suggests that women are better able to tolerate chronic pain than men; yet they are more sensitive to acute pain, such as touching something hot. Women also appear to be less bothered by lingering discomfort.

And there's some evidence that men's and women's nervous systems act on and process pain information differently.

Men may have been socialized to deny pain and to be stoic if they experience it. But women might be more willing to express their pain and don't view admitting it as a sign of weakness.

According to Green, where a woman is in her menstrual cycle as well as her life cycle (pre- or post-menopause) influences her hormone levels, especially estrogen, and this can make a difference in her response to pain stimuli.

Myth: Alternative approaches to pain relief don't last as long as conventional medicine techniques.

Although Dr. Robert Bonakdar, director of pain management at the Scripps Center for Integrative Medicine in La Jolla, Calif., says he hears this kind of thinking about alternative approaches, there's no truth to it. He also often hears that patients think they need to choose either a conventional medical route or an alternative one to manage pain, but in his opinion it's fine to blend the two.

Bonakdar likes to make a distinction between active alternative pain relief methods, such as biofeedback, guided imagery, exercise, yoga and other mind-body approaches, and passive ones, including acupuncture and massage.

In an active approach, he said, the patient "owns" the pain-relief technique. In other words, if you are using biofeedback to help relieve chronic headaches, patients first learn the tool and can put this active tool to use whenever they need to ease their pain. Active approaches are "self-dosed," Bonakdar said.

On the other hand, in a passive approach, pain relief is dependent on a visit to a practitioner so there's a reliance on someone else for treatment.

If a patient has tried a passive method for pain, Bonakdar says he might ask, "Did you do a full course of treatment for pain relief and did you transition to anything active?" For example, he says, in most of the better research trials on the use of acupuncture for pain relief, the patient received 12 to 20 treatment sessions.

Of course, having reasonable expectations is a good idea, whether the pain relief method is an alternative approach or a conventional one, such as a drug.

"If a person was taking a pain medication and stopped it, they wouldn't expect the pain-relief effect to last," Bonakdar said. The same holds true for alternative approaches to pain.

Myth: Children can always tell you when they're in pain and how much pain they're in.

Kids might not always let you know about pain through their words, but they may do so through their actions and behaviors.

Children are more likely to express their suffering in a variety of ways, often based on their development, age and verbal abilities, Zeltzer said. They can also express pain nonverbally. Infants who are in extreme pain for long periods of time may communicate their discomfort by shutting down or seeming listless and passive.

Another telling sign is when a young child becomes quieter and more withdrawn. School-age children may express their pain behaviorally through crying, flailing, kicking or by withdrawing. Teens may clench their fists and tighten their muscles to appear stoic and strong.

Zeltzer added that there is also a difference between a child's reaction to acute and chronic pain. She said that kids tend to be very behaviorally expressive when it comes to acute pain, such as being injured, getting a shot or needing stitches. They might cry, flail or scream.

With chronic pain, she explained, kids look like they're sapped of energy. They look pale, and not interested in playing or engaging with their environment.

Myth: Emotions have little influence on pain.

Pain has both a physical and emotional component. Emotions, such as feeling anxious, stressed or depressed, can make pain feel worse and decrease your ability to cope.

Anxiety, for example, can actually increase the volume of pain signals and make the discomfort worse.

The flip side of the myth that emotions have no effect on pain is the misconception that pain is all in your head. Many causes of chronic pain are invisible to the naked eye, but this doesn't mean that it's not there -- even if a specific reason for it can't be determined. Scientists say there is data that when people are in pain, brain scanning images or fMRIs show the brain is actually involved.

Some patients also mistakenly view a doctor's attempt to put them on antidepressants for their pain or a referral to a psychologist as proof that their physician doesn't believe their pain is real. Dr. Carol Warfield, who is in the department of anesthesia, critical care and pain medicine at Beth Israel Deaconess Medical Center in Boston, said pain is often treated with antidepressants.

"They are real painkillers. It doesn't mean people think you're crazy," Warfield said.

Even so, working with a mental health professional can help to reframe chronic pain so you regain more control over it and can function better.

Myth: You should take as little pain medication as you need.

Many people undertreat their pain out of fear that they will become dependent on or addicted to the pain-relieving medication they are taking. But according to Green, it's rare to develop an addiction when you have acute or chronic pain or even cancer-related pain, unless you have a predisposition to addiction or a history of it.

When using painkillers, the idea is to stay ahead of the pain, Warfield said. You want to take a medication before you get pain, and take it exactly as the dosage directions are written, say it's every six hours, whether you're feeling any discomfort or not. If you get ahead of the pain, this prevents the body from releasing all sorts of substances that make pain worse.

Warfield also said there's no need to feel as though you just have to live with pain. She suggested seeking out a pain clinic, where even if "we can't help you get rid of 100 percent of the pain, we can help a great amount and also help you to cope with it."

Myth: Weather has no influence on joint pain.

Although the exact scientific mechanism is unclear, weather appears to influence joint pain. But it's more likely that barometric pressure is what seems to make a difference rather than heat or humidity, Warfield said.

One theory is that a change in barometric (or air) pressure, which tends to drop during a storm, might lead to a temporary increase in inflammation, pain and stiffness. The reason might be that joints have nerve endings with receptors that can pick up on pressure changes.

Cold temperatures can also make certain types of pain worse. One possible explanation is that when there's a chill in the air, your entire body might tense up and tighten. As a result, your joints might feel stiffer, achier and harder to move.

People with arthritis often say they feel better in a drier, warmer climate, and that's probably true. But there might not be solid evidence to explain why weather has an effect on joint pain.