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How does it feel?

On the impossibility of communicating pain

28 May 2011

12:00 AM

28 May 2011

12:00 AM

A couple of years ago I was walking across a ploughed field when I was struck by such a searing pain in my left foot that I fell to the ground, moaning in harmony with the rooks above me. After half an hour of massaging my toes I was able to hobble the half-mile home.

As this seemed to be no ordinary pain, I went to the doctor, who had no exact explanation, but referred me to the hospital. ‘A damaged nerve,’ they said. ‘Needs to be scanned.’ But three appointments were cancelled, and the foot attacks came frequently, so with reluctance I went privately to an orthopaedic consultant in Oxford. He immediately diagnosed a neuroma — a benign tumour on a nerve between two bones. I looked at the enlarged nerve on his ultrasound machine, some 6mm instead of 3mm. Twice I had anti-inflammatory injections, ‘which usually work’. Not on me, they didn’t. Now I wait and wait for a new scan on the NHS. And try to make up my mind whether to have a painful operation which puts you out of action for several weeks, and often doesn’t work.

The point of this rather whingeing story is that what I learnt was that I was hopeless at describing, precisely, the pain. I had foolishly felt confident that I could give a clear picture. At the first meeting with the doctor I said, ‘It feels as if shards of ice are being hammered into the underneath of my second toe.’ He looked bemused. ‘And,’ I went on, ‘the heat is extraordinary. It’s as if as blow torch was scorching the top of my toes. I expect to be burnt if I touch them — but of course I am not. On the outside they feel quite normal.’ Still he did not register any understanding of what it must be like. And nor did anyone else to whom I tried the shards explanation.

The trouble is that explaining pain in a way that communicates exactly what you are experiencing is a hopeless task. I read recently that many afflicted people — usually the elderly — have no hope of making their doctor understand what they are suffering, because they do not have the words. Patient questioning results in small, inadequate answers: ‘a bad ache’, or ‘a constant throb’. As people’s pain thresholds are almost impossible to assess accurately, the method of asking the injured to rate the pain out of ten is mostly useless. One man’s eight is another man’s two. Probably the only really accurate way of making a doctor understand the pain is if he has gone through the same experience himself — broken leg, heart attack, whatever.


Nathaniel Crewe is a paramedic in Australia. In his job the nature of the agony has to be ascertained as quickly as possible. ‘People aren’t used to describing pain,’ he says, ‘so it’s no wonder they’re not much good at it. We always ask the same questions in a commonly understood language. Is it sharp, stabbing, heavy, dull, throbbing? Often people can’t distinguish which it is. And the measure out of ten can be wildly inaccurate. But we write down everything they say. If you’d mentioned your shards of ice they would be in the notes. Some of the hardest cases to understand are the polite elderly who don’t want to be a nuisance, so underplay their suffering.’

I have a cousin who is beset by major migraines. ‘A ring of metal, tightens, tightens round my skull,’ she says. ‘I can’t close my eyes. A sickening, unbearable pain, definitely ten out of ten at its height.’ The tightening of the skull is a common analogy: but for another sufferer I know a migraine is ‘a fierce brushing of the nose and eye bones with very sharp thistles’. I like to think similies do help to visualise pain, but that is far from certain. It would of course be ridiculous for a doctor actually to feel another’s pain: one glance at a patient’s sprained ankle and he would be clutching his own.

The Oxford GP whose patient I was for 30 years sighs when I mention I’m trying to write about pain. ‘Ah: a huge and complicated subject,’ he says. ‘It’s an intrinsic problem of medical education. It’s incumbent on every doctor to understand his patient’s pain, but it’s all about language and syntax, the nature of variety of expression. A doctor has to be agile in his understanding — pain is riveting, fascinating for the doctor, but there’s probably no knowing exactly how it is for different people.’

The writer Georgina Hammick has for years suffered from arthritis, and had four hip replacements with complications. After one operation she fell onto concrete, her leg went black, she could only crawl upstairs, and was on crutches for eighteen months. ‘It was searing, concentrated hell,’ she said, ‘excrutiating. I felt imprisoned, desperate. I felt out of the world. The pain of bone grinding on bone…’ Grinding, I think, is the savage visual word here.

Another writer friend damaged her neck in a bad fall on black ice. ‘It was subliminal pain,’ she says. ‘I felt poisoned. This was met with bafflement. But it’s so hard to communicate. If you try to be evocative the health professional is disconcerted as this doesn’t follow accepted guidelines. Anyone who has had a massage and found how much muscular-skeletal manipulation can spontaneously release emotions, and leave you feeling drained, will know that with these sorts of pains there is a hidden, added dimension for which we seem to lack a shared vocabulary.’

I watched every one of those compelling One Born Every Minute programmes, trying to assess how different were the mothers’ labour pains. Some screamed, some merely grunted. Were they experiencing the same intensity of pain? We can never know. My daughter had her first baby in a birthing pool at home six months ago. Not a whiff of gas and air, just a lot of swearing. Asked to tell me exactly what it was like, she said, ‘It felt like the epicentre of an earthquake in the base of my spine: intense, hot, radiating.’ I seem to remember the same feeling when she was born. But even if precision about pain can sometimes be put into words, the feeling can’t be transmitted to the onlooker as can, say, happiness. The fact is that describing pain is as impossible as describing a piece of music to someone who has never heard it and, until a new means is discovered, that is how it will always be: a challenge to both doctors and patients.


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