Word: paines
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...Rotator cuff tears, herniated discs, torn knee ligaments and cartilages are just like this; the same abnormality that hurts some folks doesn't hurt others. Over 80% of asymptomatic adult volunteers (people with no pain at all) who let us do an MRI of their necks were found to have abnormalities - like disc herniations and bone spurs - that we commonly operate on in symptomatic patients. The rotator cuff, my particular expertise, is even more mysterious. When it's torn and symptomatic, there is measurable weakness. A big, symptomatic tear often makes it impossible even to raise...
...greatest mystery of my profession. As doctors, especially in my field of orthopedic surgery, we like to act as if we understand things like this - but we don't. It's a really interesting question because whoever answers it can turn a Sean into a Bob - getting the pain to go away without doing the operation - and this would be a minor miracle. We do have some tantalizing tips, though, about what makes things hurt...
...first is inflammation. An object lesson here was taught by an old drug. Those older than 50 might remember Zomax. It was an anti-inflammatory that was also an amazing pain reliever. I was just a medical student when it was pulled off the market because of side effects, but I clearly remember patients with broken legs or fresh post-ops who were treated for pain with Zomax alone. They were nearly pain-free and clear as a bell with no narcotic drowsiness. This "super Advil " worked along the same chemical pathways as all the other non-steroidal anti-inflammatory...
...quite familiar with the pain-inflammation connection. The most powerful anti-inflammatory drugs we have are the corticosteroids like prednisone. They have too many side effects to be first-line arthritis drugs but many folks have to take them for other reasons. These patients might find them actually too effective against pain. Appendicitis, gall bladder disease or even bowel infarctions can occur in these patients without them feeling any pain at all. This is very dangerous - the pain of early appendicitis is a good thing; it saves lives by bringing patients to the doctor before they start...
...biochemistry of the inflammatory process, which we recognize by an increase in local blood flow (more blood equals more heat equals inflammation) creates, among other things, molecules that sensitize pain-associated nerve endings. This process is very complicated but it's a good bet that sooner or later safe anti-inflammatory drugs will solve most of the pain problem. I, for one, am looking forward to a safer version of Zomax - both for my patients' sake and, in my creaking dotage...