‘What doesn’t kill you makes you stronger’

Pop culture has a number of fascinating and enduring stereotypes about pain and the experience of pain. A lot of those stereotypes perpetuate dangerous attitudes which have real-life implications for people out in the world, and these often go unexamined, including by people who struggle with both acute and chronic pain. What we accept, culturally, about pain is that while it’s bad, enduring pain makes you a stronger person. Pain is a purifying, one might even dare say scourging, experience that must be experienced to be a better, bigger person, particularly among men. Complaining of pain or asking for pain management is a sign of weakness; you are not being manly.

As sasha_feather pointed out to me recently, the idea that using pain management ‘clouds your mind’ is widespread in pop culture. Characters in pain don’t ask for pain management or refuse it because they want to keep a clear head. She argues that, as anyone who has experienced pain knows, pain also clouds your mind, making it difficult to focus. You can become consumed by the pain, which makes it almost impossible to function. As the pain eats you, you may become short-tempered and frustrated with the world around you.

See House, where the titular character struggled with chronic pain that often made him snappish and irritable. This was frowned upon because he was supposed to suffer in silence, and the use of pain medication was also frowned upon because he was supposed to be a man and handle the pain without the assistance of vicodin or any other drugs. Gregory House wasn’t playing the expected pop culture role, one where he’s strong, silent, and heroic for enduring pain without comment or any attempt at pain management.

Aside from the fact that this depiction just isn’t reflective of the actual experience of people who have known pain, particularly persistent chronic pain, it sets some very dangerous precedents. People with acute pain may think they need to grit their teeth and bear it because that’s what pop culture tells them to do; I have a strong memory of trying to sit still for a tooth extraction without novocaine, for example[1. My dentist prevailed in the end.]. This can be critically damaging in the wake of surgery, where good pain management can improve healing times by keeping the patient comfortable. People who experience more pain after surgery tend to have more complicated recoveries. There’s no medical necessity for allowing a patient to remain in pain, and patients should be encouraged to discuss pain levels frankly and accurately because they will actually heal more quickly.

In the wake of my own recent surgery, the nurses regularly checked on my pain levels in recovery. As soon as I expressed any kind of discomfort, they gave me more medication, which initially surprised me; I, too, have bought into the message that pain should be endured rather than treated. The goal was not to keep me doped up, but to ensure that my pain levels remained stable, to get meds on board before I experienced a spike of pain. And it worked; the medication kept me comfortable and helped me get mobile very quickly. I was reminded to continue aggressive pain management at home to maintain my progress.

Chronic pain becomes even more complex, because of the severe social stigma surrounding chronic pain patients, tangled with attitudes created through pop culture. Chronic pain sucks, and there is no way around that. One of the ways to manage it is to use pain medications, which contrary to social attitudes don’t get people high, nor do they eliminate pain. They help people manage the pain. Yet, many chronic pain patients manage their pain poorly because they have been socialised to believe that using any kind of pain management is not acceptable. And their own clinicians may repeat some of this harmful messaging, unless they are pain specialists who specifically focus on cases of chronic pain.

That means more breakthrough pain, it means more stress on the body, and it means more social problems related to pain. As sasha_feather says, pain clouds the mind, and when your mind is clouded, it’s hard to complete basic tasks, let alone think of the people around you. Pain can make you a jerk, and it can force you to retreat into yourself so you don’t read the consequences of your actions. The enemy here is the pain, not the pain management medication or the person in pain, and yet, people in pain who express frustration or get snappy are blamed for it as though they have some kind of personality flaw. They are unworthy because they can’t just grin and bear it, can’t put a face on the pain and be pleasant.

Yes, pain management medications can have cognitive effects. But faced with the choice of a mind dulled by pain, plus the pain itself, or a mind dulled by appropriate pain management with much lower pain levels, patients should feel comfortable asserting their right to pain management. Until pop culture changes the way it depicts heroes, and until we stop shaming patients with menacing stories about addiction to pain management, people won’t be able to do that, because managing pain will be considered wrong.

Pain management medication is not an enemy. It is a tool, which can be incredibly valuable in the right hands when used well. Much like a shovel, pain management medication can change the world, and it can also be used to hit someone over the head. Don’t blame the shovel for the way it’s sometimes misused.