WARNING: you may have a low tolerance to views within this blog! Read on at your own discretion!
We all have different tolerances to different things, such as how long we can concentrate, or exercise, or put up with some people. I have a very low tolerance for many things such as those who wear toe/finger shoes, anything with avocado in it, and those in our profession who like to slag others off behind their back rather than to their face.
Our levels of tolerance to things both physically and psychologically are due to many reasons such as previous exposure, experience, or education. For example, some people can tolerate exercise more than others simply because they do more of it. Some people can tolerate certain stressors in life better than others due to previous experiences with them. And some can tolerate other peoples views and opinions better than others due to being taught patience and open-mindedness by their parents.
However, it is clear that human beings are becoming less tolerant of everything, with more and more having lower and lower tolerances to foods, textiles, medications, and even opinions. More people are now less tolerant of change, diversity and difference, and many are less tolerant of any difficulty or discomfort.
Our World Today
Most of us living in the developed world now have a life of convenience and comfort. A world where we have ample access to food, water, shelter, and wifi. A world where you have technology and gadgets to make your life easier and effortless. A world where you can buy a device to put your socks on in the morning, or a duvet that makes your bed, or a machine that opens your jars. We don’t even have to go to the supermarket anymore to lift our jars off shelves and carry them in a basket a few hundred yards.
We are living in a world where effort and exertion have been mostly removed, where any struggle or strain is considered unnecessary and often avoided. This lack of hardship and difficulty however does has many positives, I for one am not complaining about my wifi, or my central heating, or my online grocery deliveries. But the sheer amount of convenience and ease we have in our lives today also has many drawbacks that most don’t appreciate.
Many of us have lost sight and recognition of what is tough, hard, or inconvenient these days. What we consider difficult hard challenging these days simply is not. Missing a meal, power cuts, cancelled buses, having to walk a bit further are simply not serious issues yet our lifestyles and lack of exposure have made them appear so.
Our Pain Today
And this is no different for our experiences with pain today. Having a sore knee, an irritated shoulder, or some low back pain with no significant issues or unusual symptoms is not a medical issue that needs to be treated. Many things just hurt from time to time which is not serious and tends to improve with nothing more than time and getting on with it. But many have lost sight of this.
If we were to look back just 1 or 2 generations you would see that most of our ancestors with a sore knee, an irritable shoulder, or some back pain would NOT seek medical attention. This may be due to access to medical services was different back then, but I also think it was due to a different culture and attitude towards pain back then. I often ask myself when I have pain, what would my great-grandad do with this issue… and most of the time it would be to just crack on!
I see day in day out how our species and society is becoming less tolerant of things that hurt. I see many people with some pain, an ache, or a niggle that clearly is not serious, life-threatening, or disabling, that has a favourable natural history of resolving on its own. It is these things I don’t treat anymore.
Don’t Treat It!
When I say I don’t treat it, I actually mean I do. I listen to the patient’s history and concerns about their pain, do my examination and exclude any serious issues. I then give the individual some simple, clear, honest, compassionate, reassuring advice that they have nothing to be worried about, and explain that this issue will resolve in time and doesn’t need any further treatment or investigations.
I will then answer any further questions or concerns they may have and give some advice about modifying some activities for a little while to ease or help natural history along. But mostly I tend to advise people that they should continue on as normally as they can as often as they can. However, in this world of low tolerance, many don’t like to hear this, both patients and healthcare professionals.
Many think that being in any pain or discomfort is not acceptable and that it should be reduced or eliminated immediately. I disagree. I think many things that hurt from time to time need to be tolerated and endured more. I believe that reducing and removing pain too soon, too quickly, too unnecessarily is contributing to us becoming less tolerant and resilient to pain.
Earn Your Health
If you want your body to look after you, you need to look after it. Many think being healthy is an automatic right. It’s not. Good health throughout life has to be earned with hard work, self-control, and some discipline. Of course, it also relies on some things you can’t control such as good genes and good luck, but that aside many painful musculoskeletal conditions are often the consequences of our modern easy convenient lifestyles.
Regardless, of why things hurt from time to time the key point again is that often nothing needs to be done other than reassuring the individual that its not serious, it will ease with time, they will not harm themselves if they feel pain on movement, and they should try to carry on as normally as possible.
However, as much as patients don’t like hearing this, healthcare professionals don’t like doing this even more. Many healthcare professionals don’t feel comfortable telling people in pain that nothing needs to be done for either financial or egotistical reasons. Personally, I think many musculoskeletal conditions are over-treated with healthcare professionals pandering to patients while natural history makes them look good.
Now, this is not me being cold, uncaring, or discompassionate, this is me being open, honest, and frustrated at a system and society that I think is going the wrong way and screwing things up royally when it comes to many musculoskeletal pains. Healthcare has undoubtedly helped humanity hugely by reducing disease and pathology and increasing our lifespans. But healthcare has also inadvertently caused harm to humanity by making it less resilient and less tolerant to pain due to its over-treatment of it.
If you look at the BMJ global burden of disease studies you can see that low back pain now consistently causes more disability and costs society far more than any other medical condition across the world, and this is despite advances in our so-called pain management treatments.
What healthcare is currently doing for musculoskeletal pain just isn’t working and something needs to change. Personally, I think this should start with more healthcare professionals recognising that they over treat it, and all humans recognising that pain in life is inevitable, suffering is optional.
As always thanks for reading