By John McElligott, MD
with Jeffrey Heinrich, Ed.D., PA-C
Pain is a symptom, not a disease. The underlying disease or process, not just the symptom, needs to be found and treated.
In many situations, the doctor may never look for and uncover the real problem. If the real problem that is causing the discomfort is not found, then you could be in for a life of drugs, drugs and more drugs.
There are three basic types of pain:
Acute pain comes from a process or injury that one can identify with a fair degree of accuracy, such as a back injury due to lifting or a fall, a pain in one’s abdomen, or a headache.
Chronic pain can be from a multitude of problems that are related to injuries, chronic diseases and complications of an acute disease process (for example, appendicitis).
Psychogenic pain is caused by a mental or emotional problem that can be very difficult to separate from acute and chronic pain.
Each of these pain categories plagues professional drivers day in and day out. Put simply, pain is part of the business of life, so most of you will have pain at some point in your career.
If you are a driver and experience an injury, try to make the following assessment.
- Mechanism of injury (the circumstance in which an injury occurs; e.g., sudden deceleration, wounding by a projectile, or crushing by a heavy object);
- Severity of pain on a 1-10 scale, 10 being the worst;
- Does the injury involve your airway, breathing, hemorrhage, dizziness or near blacking out?
If the answer is dangerous mechanism of injury (such as motor vehicle accident, fall); pain on the scale of 8-10; or any of the items in No. 3, call 9-1-1 and get to the nearest medical facility.
If the mechanism is obvious and the pain scale is bearable with no respiratory or hemorrhagic effects, then one can follow basic over-the-counter treatment for the following pain conditions:
- Headache that is recurrent and not new. It has not changed in character and is predictable with stress or long hours of service.
- Stiffness in the neck, with no radiation to the arms or chest.
- Upper back or lower back stiffness with no radiation to the lower abdomen or below the knees.
- Leg, calf or foot pain that is not associated with unexplained swelling with pain and increased temperature of the leg. Especially if there is tenderness/pain is located on the inside of the leg or calf.
Rib or chest wall tender to touch, or discomfort at the shoulder, elbow and wrist with simple tasks like picking up a coffee mug or combing your hair.
The remedy for routine aches and pains is effective and safe if you have no underlying medical problems that prevent you from taking acetaminophen (Tylenol) in combination with ibuprofen (Advil gel caps). Taking two of each (four total) every eight hours with food is as effective as 7.5 milligrams of hydrocodone (a Schedule III narcotic). The every 8-hour recommendation is to prevent overdosing of the acetaminophen part of the combination.
The second recommendation is ice. Always start with ice and not heat. Heat dilates the blood vessel, increasing swelling and releasing substances that increase inflammation. Once inflammation is in motion, it is hard to stop without more advanced treatment by a medical person. With ice, more is better – which is not the case with medications.
The most important guideline is “Don’t do what makes it hurt!”
Chronic and psychogenic pains are a more difficult problem than acute pain. They may be the beginning of disability if not addressed systematically by a medical provider.
Remember to treat the “cause” and not the “brain.” Dulling one’s senses to pain may be the beginning of the end. In the U.S. we have the highest rate of addiction to prescription medication in the world, so be careful what you let a doctor prescribe for you. Explain that you are a professional driver. LL
Editor’s note: John McElligott is an M.D. and Fellow of the American College of Physicians. Jeff Heinrich, who serves as the column’s medical editor, has a Doctor of Education degree and PA-C, which means Physician Assistant, Certified.