Thursday, March 18, 2010

Pain-is it the same for everyone?

Does everyone feel pain the same way? 

This has been a topic of much discussion between Dr. Kerr and myself over the years.  We have noted that we are on opposite ends of the teeter totter when it comes to pain tolerance.  Dr. Kerr's idea of a massage, for example, is a light touch...nothing too deep.   I, on the other hand, want to go deep to the bone.  Thankfully our massage therapist knows us and gives us our own dream massage.

So what gives?  Why the big difference between us? Maybe a woman vs. man thing?  Maybe the fact that I've had 5 babies, 3 kidney stones and major back surgery makes me tougher?  I've championed my way through botox, fillers, CO2 skin resurfacing and Smartlipo all with flying colors.  I got off the table after Smartlipo and did 3 consults following the treatment.  The next day I worked a 10 hour day with no pain medications whatsoever.  Well, now I can get off my high horse and stop telling those more "sensitive" to buck up. 

It seems that there is some evidence to support the notion that people feel pain differently.   Rosie Mestel (Los Angeles Times) wrote an article on this subject and it was featured in the Idaho Statesman on Monday March 15, 2010.   A study done in the Proceedings of the National Academy of Sciences found a genetic link to pain.   It seems there are rare pain conditions caused by mistakes in a gene called SCN9A.

We have all heard of the children who have no pain sensation at all.  A parent's worse nightmare!  A child accidentally touches the stove and feels nothing...but receives 3rd degree burns!  Oh my!
So we know there is an extreme "non-reaction" to pain, so it seems very possible that there are those that are "highly sensitive" to pain on the opposite end of the spectrum. Evidently this gene called SCN9A is to blame.

Dr. Kerr and I have commented on the difference in pain tolerance in our Smartlipo and Vaser laser-assisted lipo patients.  Everyone wants to painful is it?  How long does it take to recover?  We are careful to educate our patients that there is a bell curve.   Most patients thankfully feel very little or no discomfort and heal very quickly during their Smartlipo procedures.  Most (about 95%) of our patients are back to work within 2-3 days and off any pain medication within that same amount of time.  We have observed over the past three years the differences between our Smartlipo & Vaser patients, but nothing concrete to attribute it to?  Why does one client get up from their surgical procedure, walk out and report that they had little or no pain or discomfort during the procedure and in recovery?  Alternatively, there are those who are much more sensitive to discomfort.  Intuitively, we have adjusted to allow more time for the anesthetic to become effective and educate our patients about the possibility that they may take a bit longer to recover and they may have higher discomfort levels. That's just good patient care. 

It's just nice to have some science to back up our own observations.  There's a gene gone crazy out there that makes us react differently.   So now I can't tease my husband about being a big baby when he walks barefoot over pebbles that I can run on. Same is true of his tolerance for botox or other aesthetic treatments.     He really doesn't feel things the same way I do.   When he asks for a back massage, I won't force him "grow up" and get a real massage  (deep massage)...I will just acknowledge that what feels deep and relaxing to me is like pushing hot pokers into him.

This study has brought to light the emphasis we need to place on treating each patient individually for pain.  Thankfully Dr. Kerr's background in anesthesia makes him very qualified to help clients remain as comfortable as possible during any cosmetic procedure.  Dr. Kerr just needs to clone himself like Michael Keaton in the movie Multiplicity so he can anesthetize himself!

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