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Pain =/= Broken

Acetaminophen: Proof God Loves Us and Wants Us to Feel Better--image by Molecool

My friend and physician/coaching colleague Dr. Austin Baraki has recently made some wonderful contributions at the Starting Strength website on the subject of pain. First he put up this terrific article, and followed through with this provocative interview with Rip.

You really should check them out. In both contributions, Austin correctly points out how healthcare providers frequently fail patients with acute and chronic pain, how our classical ideas about the biology of pain are incomplete, the oft-neglected cognitive and emotional components of pain, and the power of the medical approach to promote a catastrophic perception of pain by the patient, absent proactive interventions to reassure him that he is not, in fact, broken.

Strength and conditioning coaches are familiar with pain, both in their clients and in themselves, because nobody trains for performance without encountering the occasional tweak or injury. Pain is part of every life, which means it's part of an active, healthy life. But pain is a challenge to training and to health, and as Austin points out, pain can become its own problem, long after the inciting event has passed and the tissue is healed.

The good news is that most pain is both transient and tractable, especially when it's approached properly and put into the correct perspective. Once a serious underlying etiology has been ruled out, exercise, diet, avoidance of exacerbating factors, stress reduction, sleep, and judicious use of non-narcotic analgesics and anti-inflammatory medications can get patients and athletes through the crisis of pain and back to living life.

That's assuming that the provider, the coach, and the patient himself cooperate. I'd be remiss if I didn't point out that I share Austin's frustration with how both providers and patients approach the problem of pain, and one of my pet peeves is the dismissal or even demonization of commonly used analgesics.

Damn, but I'm so grateful I live in a world with acetaminophen and ibuprofen. In 2012, in an article for the SS website, I inveighed at length against those who continue to assert that these medicines, by suppressing inflammation and pain, will somehow stunt our ability to progress in training. This has never been shown to be the case, and in fact there is considerable evidence to the contrary. And as Rip has intimated in a recent article, soreness is not the point. Pain is a primitive response to insult, and not terribly discriminating. The back pain of a minor tweak can feel a lot like the back pain of a kidney infection or an abdominal aortic aneurysm. Serious, persistent, or unusual pain, or pain associated with systemic symptoms (fever, nausea, shortness of breath, etc) is a reason to seek medical attention. That all being said and done, the proper response of the 21st century human to pain is to make it go away, or at least control it. As Austin points out, that's properly done with active rest, early return to mobility and exercise, and refusing to succumb to the idea that our pain means we are somehow "broken."

And I would just add that, yes, it means taking the damn Tylenol and Motrin, which helps with all of the above. Which helps prevent the pain from digging in and becoming its own problem. Which helps you get on with your life.

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