Old Patriot's Pen

Personal pontifications of an old geezer born 200 years too late.

NOTE The views I express on this site are mine and mine alone. Nothing I say should be construed as being "official" or the views of any group, whether I've been a member of that group or not. The advertisings on this page are from Google, and do not constitute an endorsement on my part.

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Location: Colorado Springs, Colorado, United States

I've been everywhere That was the title of a hit country-and-western song from the late 1950's, originally sung by Hank Snow, and made famous by Johnny Cash. I resemble that! My 26-year career in the Air Force took me to more than sixty nations on five continents - sometimes only for a few minutes, other times for as long as four years at a time. In all that travel, I also managed to find the perfect partner, help rear three children, earn more than 200 hours of college credit, write more than 3000 reports, papers, documents, pamphlets, and even a handful of novels, take about 10,000 photographs, and met a huge crowd of interesting people. I use this weblog and my personal website here to document my life, and discuss my views on subjects I find interesting.

Sunday, April 24, 2005


The Food and Drug Administration has taken two COX-2 inhibiting pain medications off the market - Vioxx and Bextra. These medications increase the potential for patients to experience heart problems from 2% to 4% on average. This affects me personally, as I've been taking one or the other of them for almost five years now.

The biggest problem for me (and many people like me who have a chronic pain problem) is that these two drugs WORK - they significantly reduce overall pain levels by a substantial margin. In fact, they work far better than most other pain medications I've tried in the last fifteen years, and have fewer side effects that can make life almost as miserable as the pain they've been prescribed to treat.

It's hard to talk about pain. Each person has a different "pain threshold", and experiences pain differently. That means that what's a significantly painful episode for me may be a minor annoyance for someone else, or vice versa. I've been told that my pain threshold is quite high. It's hard to know exactly what that means, except that high or not, I hurt - a lot!

Pain thresholds are measured by a 0-to10 scale by most medical professionals today. Unfortunately, there's not much in the way of explaining and quantifying these experiences so that the scale relates equally to everyone. Currently, the "0" means "no pain", and "10" means "the worst pain you've ever experienced". Certainly, we've not all experienced the same "worst level of pain", so this isn't really a reliable scale. We need some better definitions of what those "0"-to-"10" levels mean. Is it a sliding-scale, or a logarythmic scale? I doubt it could be a log scale, since that would mean that "10" would have to be 10 to the tenth power, or about 1 TRILLION times worse than a "1". So let's assume the units of measurement are all equal, and level "2" is twice as painful as level "1", rather than ten times as painful.

"0" should indeed mean "pain-free". That's self-explanatory. Beyond here, however, we need some firm examples. We need to first define the WORST PAIN EVER EXPERIENCED, so we can determine the internal units, defining both the top and bottom of the scale.

I've experienced some "9+" pain in my lifetime, yet I don't think I've ever experienced a "10". The top of the scale is "so much pain you should have died, but somehow didn't". It's a burn victim who's body is covered with second- and third-degree burns over 75% of their body or more. It's a 90-pound woman in labor with a 12-pound child, in breach. It's an automobile accident victim who has had all his extremities broken, several ribs crushed, and significant other damage. It's an earthquake victim buried under tons of rubble, with half or more of his body crushed, and huge blocks of concrete and steel still weighing heavily upon his back. You NEVER want to experience this much pain, but that's the kind of pain we need at the top of our scale.

Let's now define the halfway-point of our scale, level "5". Level "5" is five times as bad as level "1", but only 1/5 as bad as level "10". Most of us have experienced a level "5" pain. Level "5" pain is the kind of pain you'd expect to feel during the first couple of days of having a broken wrist, or a cracked rib. It's the kind of pain you have with a headache bad enough to send you to bed, or a pulled large muscle. It doesn't keep you from functioning, but you're ALWAYS aware of it. It affects everything you do, from sleeping to eating to normal daily activities. It's TIRING, and you always feel drained of energy.

So now we have three points on our scale of 0 to 10 defined. It's possible to go back now, and complete our scale.

  1. 0 - No pain
  2. 1 - Very mild pain, light enough to be virtually ignored. A very mild sunburn, ant bite, or a small cut cause level-1 pain.
  3. 2 - Mild pain - the type of pain associated with a pinched finger, bumping into a wall (without bruising), an "almost-headache", a treated moderate sunburn, etc.
  4. 3 - Light pain - a bruised muscle, most headaches, a bee sting for an adult, a "twisted" ankle or sprained wrist. Light pain may last for an hour to several days, gradually fading and disappearing, even without treatment.
  5. 4 - Very moderate pain - a bad sunburn, deep bruises, a deep cut, an "easy" tooth extraction, a bad headache that lasts for several hours, stomach cramps caused by eating green fruit or too much spicy food, or first- or second-degree burns. People with very moderate pain can function normally, but require extra time and modifications to their routines.
  6. 5 - Moderate pain - the type of pain experienced from a broken wrist, cracked rib, pulled large muscle, or very bad headache. May not be able to function normally or do some tasks without pain relief.
  7. 6 - Moderately severe pain - migraine-type headaches, multiple bruises and contusions, extraction of wisdom teeth or impacted teeth, several broken bones without complications, second or third degree burns, or complications associated with other diseases such as viral or bacterial infections resulting is severe coughing, diarrhea, and vomiting. Require treatment. Usually cannot function without medical treatment, of which pain relief is only a part.
  8. 7 - Severe pain - Pain that lasts longer than twelve hours with or without treatment, pain caused by damage to major nerves or nerve groups, second and third degree burns over 20% or more of the body, severe (third-degree) sunburn, broken bones with complications, dislocation, severe back pain, multiple muscle cramps, multiple tooth extractions, major operations where muscle tissue was cut and stitched back together. Person cannot function without major medical treatment and/or significant pain relief.
  9. 8 - Debilitating pain - Pain severe enough to keep a person from being able to perform normal health and hygiene functions such as cooking and eating, dressing, bathing, normal household routines, and interaction with others. Large and frequent dosages of pain medication are essential for the person to do normal activities. Pain associated with most normal births.
  10. 9 - Very debilitating pain - Pain significant enough that the person must receive outside help to do even simple functions such as eating and dressing. The kind of pain that leaves a person bedridden. Very severe migraine headaches, pregnancy and birth with complications. People admitted to hospital Intensive Care Units from automobile or other accidents.
  11. 10 - The worst pain that could be experienced, as shown in the examples above.

My chronic pain problem has multiple causes. I've got a horrendously bad back. I had a two-level cervical (neck area) fusion in 1990. I've got at least one herniated disk in my lower back, and a deformed L-5 vertebra. I have myofascial pain problems in my mid-back, and pinched nerves, carpal tunnel, repetetive motion, and degenerative disk problems. I also have osteoarthritis in about 40 different joints, and a tinnitus and hyperaccusis problem. I KNOW pain, all too well.

The tinnitus problem keeps me from taking some of the high-end NSAID drugs (non-steroidal anti-inflamation drugs) such as Mobic, Ibuprofin, Feldene, and other medications in the same family.

With Vioxx/Bextra, my normal pain levels fluctuated between a "3" and a "5", with a few periods up to an "8" from time to time. I've been off these drugs for only a few days, and my pain levels have already increased. My "normal" pain level has increased to between a "4" and a "7", with occasional periods up to a high "9". I take Ultram (2x50mg) and Flexeril (10mg) for those occasions when the pain level goes above a "5". That's rapidly becoming the norm. Instead of taking these medications once or twice a day, I now seem to be taking them every four hours, and even wake up in the middle of the night needing them.

I know I'm not alone in this. I've heard from several of my friends that have been on Vioxx or Bextra for some time, as I have, who are also complaining that the "alternatives" they've been prescribed don't seem to work as well. Frankly, they - like me - would gladly trade a few years off the top of their lifespan for being able to function NOW.

The Food and Drug Administration owes us, bigtime!


Anonymous Anonymous said...

Hello again, I posted earlier today from work in your Arghhhhh post.

It's funny that you should mention pain scales, as what I do specifically is collect data from spine patients for an orthopedic spine surgeon for use in FDA regulated medical trial and in-house outcome studies.

You know, I have been doing this job for a while and you are the only person ever to question the pain scale. I keep wondering when someone is going to see what you just pointed out, but no one ever does. It's okay really, because pain cannot be measured objectively, so all of the pain questions have to be subjective, or the patient's own perception of their pain.

And you're right in that most of the people have no concept of what the worst possible pain might be, so they can only answer from their own limited experience, which makes the pain scale flawed as a diagnostic tool. When conducting serious research, we also use questionaires that ask questions about your ability to function within the boundaries of your normal activities of daily living. How long can you sit, stand, walk, lift, sleep? Can you enjoy your favorite activites or do your normal work? The system is still flawed overall as far as actually measuring pain, but you can compare one random set to another to see if there is an obvious difference between data sets.

I like your blog, Sir, and will happily send others to visit if it's okay with you. I am opinionated, but it should be okay. I think we tend to agree.

You probably have lots of anonymous comments, so you know it's me, I'll just sign this

- the SGMs Household 6.

5:22 PM  
Anonymous Anonymous said...

I'm a 29 year old woman who has both given birth, and had horrible kidney stones as a teenager, and I can testify that both are incredibly painful. (although the kidney stones were a bit worse, a lot sharper and searing.)

However, Neither of those came even close to the pain i felt when i was stung by an irukandji box jellyfish while snorkeling in Northern Australia a few years ago. The pain wasnt immediate at first, but by the time I got to the hospital, I was literally screaming and thrashing in pain for hours. Unlike childbirth and kidney stones(where you scream and writhe but still remain somewhat coherent).. with the jellyfish sting, I was absolutely incoherent I couldnt even talk or form a thought. All i could do was scream as loud as i could..
I didnt think that level of pain was possible without passing out or dying from heart failure, and the morphine they gave me barely made a dent. It took all day for the pain to subside. I got into the hospital around 1am, and i didnt stop writhing and screaming until almost 8 at night. the pain was brutally intense, and kept getting worse and worse, like another wave would come and bring the pain up another notch. The other thing about that pain that was weird was that it was all over. My arms and legs felt like they were being crushed, and there was an intense stabbing in my lower back that felt like i was being jabbed with a knife. And the skin on my arms and face felt like it had acid poured on it. Also, the migraine that came with it was unlike any migraine i ever felt. I seriously felt like my head was going to explode..

the really upsetting thing is that my daughter was there through the early part of the sting. she saw the first wave of pain.I've been hurt in front of my daughter before, but you keep it under control. This was beyond that. There was just no surpressing this stifling pain. unlike any other pain i ever felt, i actually wished i would die at some point because i just couldnt stand it any more. It was awful! i could do 3 days of kidney stones before i do another 6 hours of irukandji venom

theres an interesting article on irukandji on wikipedia that so nails it.

so heres my personal pain rating with a rating based on your scale...

1-Irukandji jellyfish sting (10+)
2-kidney stones (9)
3-childbirth (8)

6:38 PM  

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