Most often, pain is classified as being acute or chronic. Pain can persist for days, months, or even years after an initial injury and can be difficult to treat. People with pain may experience anxiety, sleeplessness, and depression, all of which can compound the problem. In the first episode, we discussed what happened to me and how I could have dealt with my pain a little bit better. The second episode, we discussed how well our health system treats pain and last week we talked about pain myths and misconceptions, and I have been dying for this last episode where Dr. Kevin Cuccaro will give us the secret of why firefighters are better pain specialist than actual pain specialist.
We Are Behind the Science of Pain
Dr. Kevin Cuccaro said that the way they practice, teach, and talk to their patients is literally 50 to 60 behind the science of pain. That was difficult to overcome when it was Dr. Cuccaro going through that process and recognizing why people don't seem to get better with these pain injections.
Why is it that when doctors do more injections, they seem to lead to more injections? How come people have an injection and say they're better and yet the medications all seem to change or it seems like the pain move somewhere else. So, they went to get back pain injections in their back and now they have neck pain and they get injections in their neck and they get shoulder pain then they get the injection in their shoulder. They weren’t getting better. That was what started Dr. Cuccaro's journey when it came to actually going back to the research and science of pain. It also influenced him to be a better pain specialist.
Why Firefighters Are Better Pain Specialist
There are at least 3 major contributors that create or construct pain. You have that sensory aspect that's the sensation coming from the body. And then you have that cognitive element which is the attention, the beliefs, and expectations you have. The final element is the emotion, the memory mood, and the meaning that is associated with that sensation. All 3 of those components come together to construct and experience pain. Which means for any pain in any moment and any time to truly understand it, you have to be thinking on those 3 dimensions.
That becomes very difficult to explain to people, and it's difficult to think because we don't perceive our world that way. We think in cause and effect. That's the way the brain wants us to think because it's a survival-based mechanism. But, there's a community out there that has to think in 3 dimensions all the time to do what they do which is a public service, and that's the firefighter community.
What Makes Them a Better Pain Specialist?
You don't just go out there and say well we could throw water on it let's throw some more water on it let's keep throwing water on it and hope it gets better. Instead you go what's the fire in front of you, what's the therapy or what are the major contributors that I need to target with my therapies and so because firefighters are already thinking in 3 dimensions, with a little bit of basic pain science because they're already thinking in 3 dimensions they would be better pain specialist than pain specialists in most clinics out there because they already have the thinking down because they understand that pain is just like fires and the fire is similar to pain and has those 3 elements.
Fire triangle is a tool that firefighters use in order to fight fires and because fire is a dynamic process and in fire, there are always no matter how complex or simple the fire is there's always 3 elements that are that are there.
You have the fuel source. You have the heat element and then you have the oxygen supply and it is only when you have all 3 of those that come together that you construct fire in so what firefighters know is if you can see a fire and start deconstructing it into these 3 elements in seeing how these elements change or what the different contributors are you now know how to how to fight that fire and so there are some fires that you would not like most fire you put water on now what are water does is actually keeping the heat element of it and as it decreases the heat; It interrupts that process.
But there are some fires that you would not want to put water on. So if you have an oil-based fire, if you throw water on an oil-based fire, what happens? It kinda explodes, right? What firefighters recognize is that you can have different fires with different construction, but if you recognize what that these 3 elements are now, you can fight these fires effectively.
A Pain Specialist View
Fire has fuel, oxygen, and heat. Pain has sensation, cognition, and emotion. If you understand how those different elements can change and be in flux and can really be different within seconds or minutes, now we can recognize that every pain is unique but we can deconstruct it in those 3 key contributors and now we can start targeting those 3 key contributors safer and more effectively.
All pain is real. All pain is pain but what I think or what I say sometimes if people can get upset out is I do say pain can get better. Now whether you’ve had it for 40 years or you’ve had it just for 5 minutes. Pain can get better and how we typically will get better through things that aren’t typically prescribed or procedures that are done or surgeries.
About Our Co-Host
Dr. Kevin Cuccaro is a fellowship trained specialist and expert on the science of pain, trained in anesthesiology at The University of Chicago. After that, he completed his fellowship in Pain Medicine at the University of Michigan. Later road he served as associate program director of the Naval Medical Center San Diego’s Pain Medicine Fellowship program. If you’ve never been to San Diego you should go, it’s a beautiful place. He focuses on creating solutions for pain and pain-related topics important to healthcare systems, clinicians and the public.
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