(or, How do I know YOU are in pain if you are asleep and can’t tell me?)

Ahh. There’s the rub.

YOU talked to me when we met. We talked all about your anesthetic. YOU made a few jokes; I smiled and understood. I seemed like a nice person to you - reasonable, not crazed or callous or sadistic. But what’s gonna happen when it’s lights out time? How will YOU be able to tell me you’re in pain???  EEEEK!

Pain is your body’s way of saying that something is terribly wrong, a boundary has been violated. Your body talks to your brain. The pain message travels from its point of origin through sophisticated pathways up to your higher centers, and tells you OUCH!!!!

You can’t have surgery without pain - don’t let anyone tell you otherwise! That’s because surgery is an invasion into YOUR territory. So anesthesia takes away the pain, but denies you the ability to say ouch in the conventional manner. 

Say what?

When YOU are asleep, you can no longer speak to me, of course; but you do communicate to me through your body. You speak in a whole different language, the universal language, if you will. We all speak it; it’s encoded in the human condition. Hemodynamic parameters like heart rate, blood pressure, respiratory rate - all respond to painful stimuli on the most primal of levels. But only your anesthesia provider can interpret it and understand it. It’s cryptic, it’s enigmatic; it’s subtle, it’s brazen; it’s science and it’s voodoo. It’s hieroglyphics on a computer screen and a symphony of beeping noises. It’s a bead of sweat on your brow; it’s a tear.

That’s right. Anesthesia can totally blunt your response to pain. The drugs are that potent. Being educated in what to expect in the course of each and every operation is one of the things that makes giving anesthesia such an immediately satisfying and gratifying calling. It’s not enough to “chase” the pain - - - - the art of pain intervention in anesthesia is in the anticipation of YOUR pain. What that means is: all operations have what we call “flow.” There is a beginning, a middle and an end. There are certain stages of every procedure that are more “demanding” on YOUR NERVE ENDINGS, causing more pain, than others. By pumping in the various analgesics at our disposal during your surgery, anesthesia providers can 1) pre-empt your pain triggers, 2) treat new pain as it arises, and 3) provide a longer lasting analgesic for your wake-up that will stay with you long after your anesthesia drugs wear off.

What’s that you say? Yes, when YOU talk to me, I hear you. Loud and clear. And that’s no joke.