Posted on: July 26, 2007
How Much Will It Hurt?
Maybe your fear of a painful colon exam is just in your imagination. Maybe that flu shot won’t hurt as much as you think. Doctors decode the science of pain in this by-the-procedure guide
By Afi-Odelia E. Scruggs
CTW Features
Take it from a doctor: no remedy is pain-free.
“Everything in medicine hurts somewhat,” says Dr. Michael P. McNamara, Jr. of Cleveland, Ohio. McNamara is chief of breast imaging and medical intervention at the city’s Metro Health Medical Center.
Still, some procedures and tests are more painful than others. And fear of physical discomfort can keep some folks from undergoing crucial screenings.
Dr. Eugene Lipov, director of Alexian Brothers Hospital Network pain research program in Elk Grove Village, Ill., sees that mindset in some of his patients.
“They’re scared of everything,” he says.
Pain includes emotional as well as physical distress, according to the International Association for the Study of Pain. The association defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”
So yes, when your stomach flips at the thought of the flu shot, you are in pain.
Of course, the term is relative. While there seems to be no single medically accepted scale for measuring pain, several methods do exist. The Mayo Clinic, for example, uses a rating that goes from zero to 10, with zero being no pain, and 10 being an unbearable sensation. Ranking pain is subjective; what’s mildly uncomfortable to one patient could be moderately painful or extremely troublesome to another.
So how should you expect to feel during a colonoscopy or a mammogram? Since studies show the fear of pain can be more disabling than pain itself, it helps to be informed. With many procedures and tests, there are steps you can take to alleviate possible discomfort. Here’s the word on discomfort associated with some medical practices and procedures.
Injections
They only hurt a little bit.
Don’t believe it? Dr. Jim King, who practices family medicine in Selmer, Tenn., isn’t surprised. When the needle is only inches away, who hasn’t shut his or her eyes or turned to look away?
“Nobody likes stainless steel,” Dr. King quips.
But King says the injection is just a prick. Any pain probably comes when the body reacts to the medicine itself.
Thick medicines are more likely to hurt because the body doesn’t absorb them quickly, King explains. And large injections are more painful than smaller ones.
So why bother with shots at all? Sometimes, there is no alternative.
Some medicines can’t be absorbed into the blood stream, or taken by mouth,” King says. “To get that medicine into the system, you have to give a shot.”
In other cases, the patient may be too ill to swallow or keep the medicine down. Sometimes an injection is more efficient than a pill or an oral application. “The other thing is that patient can be treated with one injection, while they may have to take medicine for seven to 10 days,” he says.
If your stomach flips at the thought of a shot, try taking a deep breath to settle yourself. Some of King’s patients numb their skin with ice before an injection.
But King says he’s met very few people who will refuse a shot. “Most people don’t care if it’s the most effective way to treat them.”
Prostate exam
It shouldn’t hurt at all, according to Dr. E. P. Barrette, who practices general internal medicine in Cleveland, Ohio.
“Some people get nervous about it, but it shouldn’t hurt more than moving the bowels, says Barrette, an associate professor at Case Western Reserve Medical School. “People do have trouble relaxing, but there’s nothing special to prepare for.”
The exam is relatively straightforward. The patient leans over a table, or lies on his side and tucks in his knees. Donning a lubricated glove, the doctor inserts his or her finger into the patient’s rectum to palpitate the prostate.
Although the exam is extremely safe, it’s still controversial.
“The controversy comes because not all experts recommend it should be a routine test for cancer,” Barrette says, noting the evidence is still out on the effectiveness of digital and blood tests as screening tools.
The American Cancer Society suggests doctors “offer” patients the exam during the annual physical.
Liposuction
You won’t feel much during the procedure, but expect bruising afterward.
During liposuction, the doctor makes uses a tube called a cannula to suck unwanted fat from the body.
“It’s a thin tube – almost like as straw – that you hook up to a vacuum,” explains Dr. Charles Crutchfield III, a board-certified dermatologist in Eagan, Minn. After making an incision, the doctor inserts the tube into the body and moves it around to get fat from specific areas. Most patients have liposuction on their legs, back or abdomen.
Anesthesia reduces pain during the process. Still, liposuction carries the same risks as any other surgery: bleeding, bruising and infections. Swelling is normal and patients wear special garments to reduce the amount of it.
“It’s a traumatic procedure, you’re going to get lots of bruising and swelling,” Crutchfield warns. “Usually after that things settle down and turn out fairly nicely.”
Colonoscopy
It can be uncomfortable, says Dr. Roy Ferguson, the head of endoscopy at Cleveland’s Metro Health Medical Center, but the discomfort can be avoided with correct preparation and adequate sedation.
During the exam, the patient lies on his or her side so the doctor can guide a colonoscope into the rectum and the colon. The thin, flexible tube lets physicians see the entire colon and search the lining for polyps. Small growths can be removed, while samples of larger growths are removed and biopsied.
Risks range from bleeding to a perforated colon, which could require surgery. The exam takes between 20 to 40 minutes. Because they are sedated, most patients remember little of the experience, Ferguson says.
The exam will go smoother if patients prepare correctly. Ferguson tells his patients to have a bowel movement early in the evening, so they can get a good night sleep and be relaxed during the exams.
There are some dietary restrictions, too. Patients should avoid nuts and salads for 48 hours before the procedure because they “tend to hang around and are hard to clear out” of the colon, he says.
“Sesame seeds are just the right size to plug up the scope,” he notes. The day before a colonoscopy, patients should only drink liquids.
There are no prohibitions against drinking coffee or tea, but Ferguson warns about consuming red liquids like punch, juice or even Jell-O. “They look like blood in the colon,” he explains.
Patients should avoid alcohol as well since they’ll be mildly sedated during the test. Afterward, they should lay off soda. The test blows some air into the colon and the combination of residual air and carbonated beverages can cause discomfort. Otherwise, Ferguson tells his patients to eat wisely; no heavy meals like steak.
Cesarean section
Expect some pain and a couple days bed rest for this major surgery.
Women undergo a Cesarean section, also known as a C-section, when the baby is delivered abdominally instead of through the vagina. The operation has become more common over the last three decades, says Dr. David Burkons, who has an obstetrics and gynecology practice in Cleveland.
“When I started out in training in 1973, the C-section rate was about 6 percent, by the time I finished [medical school] in 1977, it was 12.5 percent,” Burkons notes. Now, he estimates the procedure accounts for about 30 to 40 percent of all deliveries.
Risks include complications from anesthesia, blood loss and general infection. If the operation isn’t an emergency procedure, the risks are not much greater than those associated with a vaginal delivery, Burkons says.
Women who have the procedure can expect to spend about three days in the hospital. He notes the anesthesia helps women get through the first 24 hours.
“Usually after the 24-48 hours, the discomfort is a pulling or tugging type of thing,” he says.
When a mother returns home, she should take it easy for a couple of weeks – advice that’s admittedly hard to follow when there’s a newborn in the house.
“If you don’t have complications, most women are getting around after the second or third week,” Burkons says.
Mammogram
Doctors say this test can hurt a bit, but the long-term benefits outweigh the discomfort.
“[A mammogram] is the single most effective way of detecting early breast cancer,” explains Michael P. McNamara Jr., the chief of breast imaging and intervention at Metro Health Medical Center in Cleveland.
A mammogram is simply an X-ray that helps doctors see the internal anatomy of the breast.
“In essence, we take a three-dimensional person and end up with a two-dimensional picture, so there’s superimposition of tissues.” Ferguson explains. “So that’s the reason why we do two views – one from side to side and the other up and down.”
Most of the discomfort associated with the exam comes when the breast is flattened between plates of the x-ray machine. Some patients just experience a tug or push, while others find the test downright painful, he says. But women can avoid some of that pain by watching the calendar when they make an appointment for the test.
“Schedule the screening for a time of the month when you know that you’re going to be less full and tender,” Ferguson advises. “Many folks know that there will be time when they will be particularly sensitive.”
He suggests women take a mild analgesic like Tylenol or Motrin about 60 to 90 minutes before the appointment. Avoiding caffeine for a couple of days before a mammogram may reduce discomfort, too.
Most of all, Ferguson wants women to understand that enduring the tugging and pulling associated with the X-ray is a small price to pay for such a crucial screening.
“People should understand that the discomfort and the efforts that we make are beneficial in the long run because [the mammogram] helps detect cancer earlier,” he says.
