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Wednesday, May 18, 2011

How do you know the wind blows?

I was watching an episode of House. He believed a patient had a growth so immensely tiny that it did not show up on any tests. House wanted his team to remove the unseen growth. (Let's act as though the show makes sense.) Dr. Foreman, his associate, responded "How can we remove something that we don't know is there and is so small it cannot be seen?" House replies "How do you know the wind is real?" Foreman: "You see the effects of it blowing."

I immediately thought of the analogy to those of us who live with chronic pain.

"Doctor, I fell and hurt my leg." "I saw the x-ray, the bone is broken." "Doctor, I am always thirsty and always having to urinate." "I saw the test results, you have diabetes."

vs.

"Doctor, I have pain all the time in my leg and arms." "Your tests show nothing wrong." "Doctor, I have horrendous facial pain. It is there all the time plus it comes on for no reason at all." "I see nothing when I examine you. All your tests are normal."

Lupus, multiple sclerosis, rheumatoid arthritis, among others, do have tests available that will provide objective results. Other pain disorders, like fibromyalgia, or RSD (CRPS) do not. (There is some controversy over whether a fibromyalgia body point tenderness scale is valid or not.)

I do not blame the doctors, at least for the first reaction of 'I cannot help what I do not see is there.' I do blame them when they ignore the effects of the invisible complaint.

People with RSD (CRPS) and fibromyalgia may limp, or have fatigue to a higher level than most, they cannot do what they used to do. Those are symptoms.

I could not touch or tolerate any touch to the area of my face involved in the pain. I flinched when there was any possibility of touch to the pained area. Unable to wash, dirt built up around the eye and on the forehead. I had a dirty orangish brown 1/2 inch mass of soap residue and environmental dirt. (The latter not subjective but the result of my 'subjective' complaint that touch was inordinately painful.)

Yes, sometimes a limp can be faked. Sometimes, a person is dirty. Sometimes fatigue is the result of depression or burning the candles at both ends. But sometimes the limp is protecting the leg from pain, the dirt crusting from being unable to touch, the fatigue because pain refuses to allow for rest or sleep.

How do you know the pain is there? How do you know the wind blows? Look at the effects.

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