Tuesday, November 06, 2007

All About Pain

I've spent the past two days learning about pain, thinking about pain, and reading about pain, but luckily not experiencing too much of it, at least not physically. Yesterday, we had a PBL case and a seminar that were both about pain, and today we had an anatomy session about the trigeminal system. The trigeminal nerve is one of the cranial nerves that innervates the face. (It's the fifth cranial nerve, if you were wondering.) As you can see in the picture, the trigeminal has three branches that go to the forehead, cheeks, and chin, and they all detect pain in the face among other things. Pain is a very complex sense, because it has such a huge emotional component to it. If you're afraid of the pain, it can actually make your pain worse.

We had FCM this week, and it was about health care policy decisions. There were no small groups--we just had a speaker from the Case Business School for the full hour and a half. This same guy has spoken to us before. I think most of my classmates liked his talk, but I have to say that health care policy bores me to tears. It was, well, kind painful to sit through an hour and a half long lecture on it.

In clinic this afternoon, I had a patient who fit in with the whole pain theme perfectly--she has severe, chronic migraine headaches. There wasn't much for me to do about the migraines besides take the history because the patient was already being followed up at the CCF Pain Clinic. But still, we had quite a lengthy discussion about possible triggers, how the headaches affect her quality of life, and so on. I get an occasional headache myself every now and then, but nothing like this poor patient.

I meant to ask my preceptor today if patients who fit the topics we are covering in school are being booked this way on purpose. If not, this has to be the longest string of coincidences I've ever experienced. Or, maybe it's just that symptoms like pain and headaches are so ubiquitous and I haven't been keeping track of how many previous patients I've seen with headaches. Now that I think about it, patient complaints of headaches aren't exactly rare. If you go through the review of systems with a patient and ask them if they have this or that symptom, almost everyone will say yes to headaches. Who doesn't get a headache every now and then?

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