11 ms·

“Babies feeling pain is something that should be self-evident, shouldn't it?” I have yet to understand the historical underpinnings of this phenomenon, but as

by jnovek 4y ago

“Babies feeling pain is something that should be self-evident, shouldn't it?” I have yet to understand the historical underpinnings of this phenomenon, but as someone who deals with chronic pain, doctors don’t seem to be aware that people feel pain _in general_. I’m being sort of facetious, but any chronic pain community is full to the brim with stories of various medical professionals being skeptical of patients’ pain reports or treating pain like it’s not a particularly important quality of life concern. I have my own stories about this, of course, and some of them are pretty horrible. It doesn’t surprise me, then, that we assumed at some point that infants don’t feel pain: after all, if we don’t take the pain of adult humans seriously, then why would we consider the pain of a creature who cannot even directly complain about it?

Spooky23 4y ago
The likelihood of someone understanding something is inversely proportional to the impact on their ability to pay the mortgage. Pain is recognized as “bad” innately. So if you can assert that no pain exists, you’re not accountable for causing, preventing or doing anything about it.
- pwillia7 4y ago
  Doctors caring at all about pain is relatively new. When medicine started it was just about keeping you alive not keeping you out of pain.[1] There is a fantastic book that is half about the history of pain medicine and half about a small region in mexico that distributes a lot of the heroin in the US. Dreamland[2] [1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6311547/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6311547/ [2]:https://www.amazon.com/Dreamland-True-Americas-Opiate-Epidemic-ebook/dp/B00U19DTS0 https://www.amazon.com/Dreamland-True-Americas-Opiate-Epidem...
politician 4y ago
Individual doctors are rarely deserving of the implicit trust and praise they receive from proximity to the stereotypical hero doctor on this season's popular medical drama. I went from a general naive faith in the profession to caveat emptor.
- iratewizard 4y ago
  It is truly insane the things that doctors routinely recommend without doing any sort of real review. Get any of the asleep-at-the-wheel health organizations to support your finding and plenty of doctors will recommend even the laziest of new ideas with passion. General downward trend in SIDS over a decade? It's probably because babies that wear footie pajamas are less likely to get bad humors. You're a bad parent if you don't get Shekol brand sleepers.
  - sumy23 4y ago
    I don’t think the AAP recommends footie pajamas to prevent SIDS. What you say may or may not happen, but your point would be a lot more poignant if you used a real example rather than contrived nonsense. If the issue you're talking about is widespread, then it should surely be easy to use a real example.
    - iratewizard 4y ago
      Criteria for c-section. Rates among doctors is 1/3 vs the 8% among midwives. Baby in bassinet and baby on back. SIDS is linked to improper sleep hormone regulation, not sleeping on your stomach. Breastfeeding only once every 4 hours during the day and giving a bottle the rest of the time. Supplimenting formula when mothers are trying to exclusively breastfeed. Waking the baby up to breastfeed despite no weight concerns. Circumcision. Prescribing amphetamines to prepubescent children. Prescribing hormone blockers to prepubescent children. Prescribing thalidomide to pregnant women. Continuing to gamble with mass casualties by railroading experiments that have not been adequately tested relative to the subject size (like Tdap for pregnant women or the COVID jab you probably got). Doctors as a whole are not given the allowances they need to think about what they're doing. Today, they are little more than billable entities that follow someone else's flow chart to serve you McHealthcare as "efficiently" as possible.
daniel-cussen 4y ago
The whole medicine industry in America is based on denying, not supplying. Cornered market.
WarOnPrivacy 4y ago
Even worse for you is how concerns about fentanyl are now a defacto war on pain relief. States have demonized long lists of pain meds, driving people in chronic pain to buy much riskier drugs on the street (something I witness fairly regularly). States used to blame today's bans on the pill mill problem that was addressed over 20 years ago - but now don't even bother to do that. Now the argument reads like 'because fentanyl exists, you must live the rest of your life in pain'.
- jnovek 4y ago
  Yes. To make matters worse, the opioid epidemic is real; regardless of the cause, it’s not just war on drugs hysteria. It ends up that opioids are terrible drugs. Aside from the obvious habit forming stuff, there’s things like hyperalgesia and central sensitization — long-term opioid use can screw up how your brain processes pain. I witnessed the decline of opioids in the latter-half of the 2010s firsthand from the patient’s perspective. The response to these problems from the medical community was _sheer panic_. No one was concerned with “what are we going to do next”, it was just “we have to get these patients off of opioids”. Lots of people suffered. There were suicides. There were, as you mentioned, people who moved to street opioids. The whole thing was a fucking travesty. Rolling up on a decade we’re just finally _starting_ to get a handle on this thing with responsible alternatives for pain management. The stench lingers; I think we will look back on this era with a similar lens to how we see surgeries before the work of Joseph Lister.
  - WarOnPrivacy 4y ago
    > It ends up that opioids are terrible drugs. Opioids ruin lives. Opioids restore lives. People die from taking them. People are functionally dead when they're unobtainable. The most false thing about opioids is that they are any one thing. I've used hydrocodone for months at a time. It's addictive so there are protocols that need to be followed. Stick with the dose and taper when done. However, that was in the past. For severe pain, legal pain relief is no longer available - to me and to millions of others. My state now has a hard 3 day limit and few Dr.s are willing to write even that. What has become routine everywhere is being Rx'd Tylenol for moderate to severe post-op surgical pain. I personally had to beg for tramadol following abdominal surgery. I recently had to enter into a protracted negotiation with my Dr - again, for tramadol - so I could exercise and get a little more life out of my failing knees. The pendulum has swung way too far and the number of lives that are being ruined by that is nearly incalculable.
themitigating 4y ago
Should knowledge ever be considered self evident especially if it's possible to experiment?
Wowfunhappy 4y ago
> as someone who deals with chronic pain, doctors don’t seem to be aware that people feel pain _in general_. I don't know your situation, but I wonder if it seems this way because doctors don't have many options for treating chronic pain. There are medications for acute pain, but when you use them chronically over many years—well, that's how we ended up with the Opioid epidemic.
- whatshisface 4y ago
  That's not how we ended up with the opioid epidemic. We ended up with the opioid epidemic when doctors working in concert with drug companies engaged in criminal fraud to prescribe medication far beyond its normal dosages and in cases where it was not necessary.
  - Wowfunhappy 4y ago
    It was all of the above. Some doctors were prescribing them at higher doses than necessary; others were prescribing them in normal doses for longer than is safe. I am sure that at least some of these doctors were driven by compassion for their patients.
  - junofan 4y ago
    There was a massive push, “pain is the fifth vital sign” and all that. You were made to feel like a bad doctor if you weren’t in on it.
- asdff 4y ago
  At least its changing these days now that THC is increasingly legal. Boomers have proved you can take it for six decades straight and be fine. Pro sports players are using it after getting beat up in games or practices too.
  - saiya-jin 4y ago
    I am taking it for cca 25 years and I am fine too... sort of. It can still become addictive, after tremendous amounts consumed over long time that don't make sense unless you just want to fuckup yourself as much as possible. But plenty of folks still end up there. But its one of the easiest addictions to shed off, compared to say cigarettes, alcohol or well anything else (I would say even sugar is more difficult to wean off since its everywhere, joints not so much for now). It has positive effects - pain management I guess especially with edibles, but for me its change of perspective/mindset on life matters, much higher creativity, michelin star level of taste experience even from relatively cheap food, and that sweet sweet high that is just so relaxing. But it will make you overall less patient, which sucks. For parenting, for work, for life in general. Also, morning after is much better than alcohol binge night, but mental gears running on 20% isn't something that helps produce quality in your work. Plus most consumption methods mess up your lungs pretty badly, but quality vaping is I think cca good enough to not shorten your life considerably.
deleted 4y ago
[deleted]
kumarvvr 4y ago
The roots of the practice are not very clear, but it seems that for operating on infants, risk of death from Anesthetic is very high. And historically, anesthetics were given to induce muscle numbness (so they don't thrash around).
elevaet 4y ago
> then why would we consider the pain of a creature who cannot even directly complain about it? As a parent of two of these creatures, I assure you they definitely do directly complain about pain!
tomcam 4y ago
My stock joke is that if the doctor or nurse says it won’t hurt, it will hurt at least a little. If they say it will hurt a little, it will hurt a lot. If they say it will probably hurt, time for serious anesthesia. Also, there’s pretty much no such thing as minor surgery except maybe skin tag removal.
- dotancohen 4y ago
  The book Enders Game opens with this premise.
  - tomcam 4y ago
    Had completely forgotten about it. Rings so true: https://www.orbitbooks.net/orbit-excerpts/endersgame/ https://www.orbitbooks.net/orbit-excerpts/endersgame/
- thisNeeds2BeSad 4y ago
  Lucky you, if you dont have genetics were anesthesia do not work properly. Then find a doctor, who accepts that problem and gets it over with painful but fast. The hardest part is if you have a dentists that insist on anesthesia must work, but it wont, so you must act your ass off to prentend to not be in pain, so he wont push syringe after syringe, doing nothing and waiting for 15 minutes in between while your tooth is already open with the root canal drills in.
  - tomcam 4y ago
    So you’re one too. No dental anesthetics work on me. I have to go under general anesthesia, where you’re knocked out so deep a machine has to take over your breathing. So every procedure starts at about $10,000 and that’s not counting the dental work. All out of pocket. No insurance coverage.
    - andi999 4y ago
      Did you try nitrous oxide?
mrtweetyhack 4y ago
Auracle 4y ago
The same goes for fatigue or anything else they can’t actually test for. I would guess it mostly stems from them not having a way to objectively judge it. My pain tolerance is way higher than my wife’s, in part because I suffer from cluster headaches. 8/10 for me might be a broken bone. For her it might be a relatively superficial cut. So what’s a doctor supposed to do when someone says something really hurts? Hell if I know.
- bowsamic 4y ago
  It’s because they don’t want to admit they don’t know, so it’s easier to blame the patient
bergenty 4y ago
It’s because people lie for many reasons. To get out of work, get disability, make a claim, to get opioids because they’re addicted to them etc. As a doctor, you’re probably going to become cynical after a while. This is very different from a baby because they have little motivation to lie and you can see them reacting to simple painful situations like bumping their head.
- encryptluks2 4y ago
  And if doctors are worried, the first step should be doing actual tests to see if people are experiencing pain. Not making some judgement based on their cynical bias whether someone is lying or being truthful. It is amazing how much of the medical community states they believe in science, yet they seem entirely disconnected from it at times.
  - vkou 4y ago
    How can you, with an objective test, determine whether or not I am experiencing chronic pain, or if I'm just pretending to be experiencing chronic pain?
    - encryptluks2 4y ago
      Brain imaging would be a good example, but there is cortisol screenings among several other tests that can help determine that someone is actually in pain.
      - vkou 4y ago
        I could be wrong, but don't people with long-term chronic pain have normal cortisol levels?
        encryptluks2 4y ago
        I'm sure they can, but it can be a very indicator as well: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4263906/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4263906/ https://www.practicalpainmanagement.com/pain/cortisol-screening-chronic-pain-patients https://www.practicalpainmanagement.com/pain/cortisol-screen...
HighlandSpring 4y ago
My cynical explanation is that babies don't vote
- Sharlin 4y ago
  And they mercifully don't remember what happened to them once they're older.

by jnovek 4y ago

Spooky23 4y ago

The likelihood of someone understanding something is inversely proportional to the impact on their ability to pay the mortgage. Pain is recognized as “bad” innately. So if you can assert that no pain exists, you’re not accountable for causing, preventing or doing anything about it.

pwillia7 4y ago
Doctors caring at all about pain is relatively new. When medicine started it was just about keeping you alive not keeping you out of pain.[1] There is a fantastic book that is half about the history of pain medicine and half about a small region in mexico that distributes a lot of the heroin in the US. Dreamland[2] [1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6311547/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6311547/ [2]:https://www.amazon.com/Dreamland-True-Americas-Opiate-Epidemic-ebook/dp/B00U19DTS0 https://www.amazon.com/Dreamland-True-Americas-Opiate-Epidem...

politician 4y ago

Individual doctors are rarely deserving of the implicit trust and praise they receive from proximity to the stereotypical hero doctor on this season's popular medical drama. I went from a general naive faith in the profession to caveat emptor.

iratewizard 4y ago
It is truly insane the things that doctors routinely recommend without doing any sort of real review. Get any of the asleep-at-the-wheel health organizations to support your finding and plenty of doctors will recommend even the laziest of new ideas with passion. General downward trend in SIDS over a decade? It's probably because babies that wear footie pajamas are less likely to get bad humors. You're a bad parent if you don't get Shekol brand sleepers.
- sumy23 4y ago
  I don’t think the AAP recommends footie pajamas to prevent SIDS. What you say may or may not happen, but your point would be a lot more poignant if you used a real example rather than contrived nonsense. If the issue you're talking about is widespread, then it should surely be easy to use a real example.
  - iratewizard 4y ago
    Criteria for c-section. Rates among doctors is 1/3 vs the 8% among midwives. Baby in bassinet and baby on back. SIDS is linked to improper sleep hormone regulation, not sleeping on your stomach. Breastfeeding only once every 4 hours during the day and giving a bottle the rest of the time. Supplimenting formula when mothers are trying to exclusively breastfeed. Waking the baby up to breastfeed despite no weight concerns. Circumcision. Prescribing amphetamines to prepubescent children. Prescribing hormone blockers to prepubescent children. Prescribing thalidomide to pregnant women. Continuing to gamble with mass casualties by railroading experiments that have not been adequately tested relative to the subject size (like Tdap for pregnant women or the COVID jab you probably got). Doctors as a whole are not given the allowances they need to think about what they're doing. Today, they are little more than billable entities that follow someone else's flow chart to serve you McHealthcare as "efficiently" as possible.

daniel-cussen 4y ago

The whole medicine industry in America is based on denying, not supplying. Cornered market.

WarOnPrivacy 4y ago

Even worse for you is how concerns about fentanyl are now a defacto war on pain relief. States have demonized long lists of pain meds, driving people in chronic pain to buy much riskier drugs on the street (something I witness fairly regularly). States used to blame today's bans on the pill mill problem that was addressed over 20 years ago - but now don't even bother to do that. Now the argument reads like 'because fentanyl exists, you must live the rest of your life in pain'.

jnovek 4y ago
Yes. To make matters worse, the opioid epidemic is real; regardless of the cause, it’s not just war on drugs hysteria. It ends up that opioids are terrible drugs. Aside from the obvious habit forming stuff, there’s things like hyperalgesia and central sensitization — long-term opioid use can screw up how your brain processes pain. I witnessed the decline of opioids in the latter-half of the 2010s firsthand from the patient’s perspective. The response to these problems from the medical community was _sheer panic_. No one was concerned with “what are we going to do next”, it was just “we have to get these patients off of opioids”. Lots of people suffered. There were suicides. There were, as you mentioned, people who moved to street opioids. The whole thing was a fucking travesty. Rolling up on a decade we’re just finally _starting_ to get a handle on this thing with responsible alternatives for pain management. The stench lingers; I think we will look back on this era with a similar lens to how we see surgeries before the work of Joseph Lister.
- WarOnPrivacy 4y ago
  > It ends up that opioids are terrible drugs. Opioids ruin lives. Opioids restore lives. People die from taking them. People are functionally dead when they're unobtainable. The most false thing about opioids is that they are any one thing. I've used hydrocodone for months at a time. It's addictive so there are protocols that need to be followed. Stick with the dose and taper when done. However, that was in the past. For severe pain, legal pain relief is no longer available - to me and to millions of others. My state now has a hard 3 day limit and few Dr.s are willing to write even that. What has become routine everywhere is being Rx'd Tylenol for moderate to severe post-op surgical pain. I personally had to beg for tramadol following abdominal surgery. I recently had to enter into a protracted negotiation with my Dr - again, for tramadol - so I could exercise and get a little more life out of my failing knees. The pendulum has swung way too far and the number of lives that are being ruined by that is nearly incalculable.

themitigating 4y ago

Should knowledge ever be considered self evident especially if it's possible to experiment?

Wowfunhappy 4y ago

> as someone who deals with chronic pain, doctors don’t seem to be aware that people feel pain _in general_. I don't know your situation, but I wonder if it seems this way because doctors don't have many options for treating chronic pain. There are medications for acute pain, but when you use them chronically over many years—well, that's how we ended up with the Opioid epidemic.

whatshisface 4y ago
That's not how we ended up with the opioid epidemic. We ended up with the opioid epidemic when doctors working in concert with drug companies engaged in criminal fraud to prescribe medication far beyond its normal dosages and in cases where it was not necessary.
- Wowfunhappy 4y ago
  It was all of the above. Some doctors were prescribing them at higher doses than necessary; others were prescribing them in normal doses for longer than is safe. I am sure that at least some of these doctors were driven by compassion for their patients.
- junofan 4y ago
  There was a massive push, “pain is the fifth vital sign” and all that. You were made to feel like a bad doctor if you weren’t in on it.
asdff 4y ago
At least its changing these days now that THC is increasingly legal. Boomers have proved you can take it for six decades straight and be fine. Pro sports players are using it after getting beat up in games or practices too.
- saiya-jin 4y ago
  I am taking it for cca 25 years and I am fine too... sort of. It can still become addictive, after tremendous amounts consumed over long time that don't make sense unless you just want to fuckup yourself as much as possible. But plenty of folks still end up there. But its one of the easiest addictions to shed off, compared to say cigarettes, alcohol or well anything else (I would say even sugar is more difficult to wean off since its everywhere, joints not so much for now). It has positive effects - pain management I guess especially with edibles, but for me its change of perspective/mindset on life matters, much higher creativity, michelin star level of taste experience even from relatively cheap food, and that sweet sweet high that is just so relaxing. But it will make you overall less patient, which sucks. For parenting, for work, for life in general. Also, morning after is much better than alcohol binge night, but mental gears running on 20% isn't something that helps produce quality in your work. Plus most consumption methods mess up your lungs pretty badly, but quality vaping is I think cca good enough to not shorten your life considerably.

deleted 4y ago

[deleted]

kumarvvr 4y ago

The roots of the practice are not very clear, but it seems that for operating on infants, risk of death from Anesthetic is very high. And historically, anesthetics were given to induce muscle numbness (so they don't thrash around).

elevaet 4y ago

> then why would we consider the pain of a creature who cannot even directly complain about it? As a parent of two of these creatures, I assure you they definitely do directly complain about pain!

tomcam 4y ago

My stock joke is that if the doctor or nurse says it won’t hurt, it will hurt at least a little. If they say it will hurt a little, it will hurt a lot. If they say it will probably hurt, time for serious anesthesia. Also, there’s pretty much no such thing as minor surgery except maybe skin tag removal.

dotancohen 4y ago
The book Enders Game opens with this premise.
- tomcam 4y ago
  Had completely forgotten about it. Rings so true: https://www.orbitbooks.net/orbit-excerpts/endersgame/ https://www.orbitbooks.net/orbit-excerpts/endersgame/
thisNeeds2BeSad 4y ago
Lucky you, if you dont have genetics were anesthesia do not work properly. Then find a doctor, who accepts that problem and gets it over with painful but fast. The hardest part is if you have a dentists that insist on anesthesia must work, but it wont, so you must act your ass off to prentend to not be in pain, so he wont push syringe after syringe, doing nothing and waiting for 15 minutes in between while your tooth is already open with the root canal drills in.
- tomcam 4y ago
  So you’re one too. No dental anesthetics work on me. I have to go under general anesthesia, where you’re knocked out so deep a machine has to take over your breathing. So every procedure starts at about $10,000 and that’s not counting the dental work. All out of pocket. No insurance coverage.
  - andi999 4y ago
    Did you try nitrous oxide?

mrtweetyhack 4y ago

Auracle 4y ago

The same goes for fatigue or anything else they can’t actually test for. I would guess it mostly stems from them not having a way to objectively judge it. My pain tolerance is way higher than my wife’s, in part because I suffer from cluster headaches. 8/10 for me might be a broken bone. For her it might be a relatively superficial cut. So what’s a doctor supposed to do when someone says something really hurts? Hell if I know.

bowsamic 4y ago
It’s because they don’t want to admit they don’t know, so it’s easier to blame the patient

bergenty 4y ago

It’s because people lie for many reasons. To get out of work, get disability, make a claim, to get opioids because they’re addicted to them etc. As a doctor, you’re probably going to become cynical after a while. This is very different from a baby because they have little motivation to lie and you can see them reacting to simple painful situations like bumping their head.

encryptluks2 4y ago
And if doctors are worried, the first step should be doing actual tests to see if people are experiencing pain. Not making some judgement based on their cynical bias whether someone is lying or being truthful. It is amazing how much of the medical community states they believe in science, yet they seem entirely disconnected from it at times.
- vkou 4y ago
  How can you, with an objective test, determine whether or not I am experiencing chronic pain, or if I'm just pretending to be experiencing chronic pain?
  - encryptluks2 4y ago
    Brain imaging would be a good example, but there is cortisol screenings among several other tests that can help determine that someone is actually in pain.
    - vkou 4y ago
      I could be wrong, but don't people with long-term chronic pain have normal cortisol levels?
      - encryptluks2 4y ago
        I'm sure they can, but it can be a very indicator as well: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4263906/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4263906/ https://www.practicalpainmanagement.com/pain/cortisol-screening-chronic-pain-patients https://www.practicalpainmanagement.com/pain/cortisol-screen...

HighlandSpring 4y ago

My cynical explanation is that babies don't vote

Sharlin 4y ago
And they mercifully don't remember what happened to them once they're older.