Acute Pain is More Functionally Disruptive than Chronic Pain.
Disruptive Pain: Toe stubbing example
Stubbing your toe is not very painful. Almost no one would say that stubbing their toe is high up on the list of things that cause them large amounts of pain.
Yet if you are having a conversation with someone and you stub your toe you will almost always stop talking and go "ouch!" If you are carrying something you might drop it. If you are trying to remember something you might forget it.
This is because while stubbing your toe is not very painful, it is very disruptive. It is unexpected.
Chronic pain shows this paradox in reverse. It is constant, it is extremely expected. So even when it is very painful, it is not very disruptive.
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More disruptive chronic pain is often less consistent.
Some of the forms of chronic pain that are often most disruptive include:
Cluster Headaches
Endometriosis
Trigeminal Neuralgia
CRPS
All of these conditions share a common feature of sharp sudden increases in pain. Cluster headaches are short-lived despite their extreme pain levels.
While endometriosis causes severe cramping pains it also causes sharp electric shock-type pains that cause patients to gasp aloud.
Trigeminal neuralgia similarly causes sharp nerve pain in response to stimulation, and likewise, CRPS causes extreme hypersensitivity in the affected body parts that makes small stimuli produce massive pain responses.
When a pain condition has these sorts of triggers and sharp pains it is more disruptive because there is no way to prepare. No way to brace yourself.
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Fibromyalgia, Arthritis & More
Fibromyalgia is also an extremely painful condition. Yet they are often far more underestimated. I believe this is because of the misbelief that disruptive pain is more painful.
Fibromyalgia, arthritis, chronic migraine, severe ME, and many other chronic illnesses produce a consistent level of pain that fluctuates gradually.
But people in severe pain still break down. For people with fibromyalgia, this often occurs when the mental strain of hiding our pain becomes too much. This can lead to the misconception that these tears and curses are not due to pain but due to depression.
As many say, living with this sort of pain our thoughts often sound like: "I'm fine... I'm fine... I'm fine... OMG, I'm in so much pain I'm dying... I'm fine..."
These thoughts do not always correlate with increases in pain, they often correlate with our ability to distract ourselves and push through the pain.
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Personal Experience
I have rarely never gasped aloud from musculoskeletal fibromyalgia pain. It can get to the point where I moan or cry, but there is no single moment that causes an uncontrolled reaction. A "sudden" increase in this pain normally refers to something that takes place over hours or days. If I am not somewhere I feel safe expressing pain I am capable of mostly hiding my fibromyalgia pain, even when it is extremely severe.
In contrast, when I have a sharp nerve pain like an electric shock period pain, I gasp aloud outside my control. When I first got cluster headaches I would scream, pace, cry, and curse like a sailor. I still do the last few. Perhaps with enough time, I could learn to suppress this response and indeed my reactions now are much less than they once were. But it is nothing compared to how little I react to my consistent pains.
I believe that to the people around me this is often interpreted as my sharp pains being "worse." But in reality, they are just more visible.
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Consistent Pain Is Worse Pain
Of course, the irony is that consistently being in pain is of course worse than experiencing a short period of pain. If I asked you if you would rather get stabbed with a needle once or get stabbed with a needle all day you would certainly say the first.
But the disruptiveness of unexpected and unprepared pain means that you would likely be more able to carry out a conversation without dropping a word or saying ouch if you were at the end of the day being stabbed all day than while you are getting poked once.
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How It Harms
The belief that disruptive pain is worse pain is immensely harmful to chronic pain patients. Even though it should be intuitive that the lack of surprise around chronic pain will make patients less likely to experience disruption, this is not widely translated into the understanding that chronic pain patients are fully functional at levels of pain that would completely incapacitate a healthy person.
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Capitalism & Functional Pain Assessment
Functionality is not a good measure of pain. So why do we believe it is?
The main reason I believe we are so adamant to believe that functionality is a good measure of pain is that to a capitalist system that values material output above human suffering someone who is functional despite chronic pain is just as good as someone with no chronic pain.
As humans, we don't want to believe that someone who is talking, working, and otherwise contributing to our lives and society as a whole is in a large amount of pain. Because if we did we would have to consider whether they should be doing those things or we should be providing them with pain relief that is likely to lower their functionality.
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Chronic Pain Stats
1 in 5 people live with chronic pain
In a 2022 survey of chronic pain patients by the US Pain Foundation
52% had an average pain level of 7/10 or higher
63% feel stigmatized by their providers
77% said pain medication is their most effective treatments
72% identified as disabled
49% said the leading barrier to treatment was cost
24% said no side effect would stop them from trying a medication to relieve their pain
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Chronic Pain Awareness is incredibly necessary. Pain hurts, it hurts us physically, mentally, and even slowly takes unmeasurable toll on our body through higher blood pressure, disregulation of the HPA axis and more.
With Myalgic Encephalomyelitis or MECFS the pain we feel can often be incredibly hard to describe especially in severe ME and very Severe ME patients for whom the pain can be unrelenting. On a cellular level, our cells have been deprived of ATP as though we have been poisoned by cyanide. Our muscles filled with lactic acid from even the smallest effort (I can feel my forearms cramping as I type). Burning neuropathic pain. Pulsing, stabbing migraine, shooting nerve pain, aching crushing joint pain, cramping muscle spasms. Deep indescribable bone pain from MCAS. Stabbing and jackhammering pain from lights to bright and noise too loud.
I often find when doctors ask me to say how my pain feels in a given moment my first response is "oh god I don't want to think about that." Because the truth is while my pain has been continuously severe (7-9) for the past 3+ months I expend almost all my energy not thinking about it. Distracting. Meditating. Dissociating. Anything but feeling my body.
This is the only way to live with Severe Chronic Pain. We must at least to some extent tune it out. Focus on avoiding focusing on it. pain demands to be felt and yet everyday people with chronic pain fight that demand.
But disruptive pain, when you stab your toe, when you cut your finger, that you cannot ignore because you could not expect it. It is functionally disruption, it will make you exclaim even if it barely hurts
Doctors must learn that these two responses: surprise/concern and being in pain are two drastically different processes and mean very different things.
Finally, chronic illness warriors remember that we don't always have to be. We are allowed to cry to curse and to feel our pain. We are allowed to take our painkillers and pass out. We are allowed to live in our bodies even if we often choose not to for survival.
