When Is 0-2 Pain to be Ignored?

This patient is recovering from a serious injury, and at some point had to ignore my advice to create that 0-2 Pain Level for healing, and Push Through The Pain. When do we Honor, and when do we push through pain? Email discussion

Dr. Blake

Reading that advice to maintain 0-2 pain level concerns me a bit.  If I hadn’t pushed through the 7-9 pain I’m not sure I ever would have come back from my problems.  I think the first period I had to try to offload it to heal but once that time had passed I kept trying to keep the pain low and that I think attributed to the rest of my body breaking down.  The one thing that changed for me was the area of the pain changed over time. At one point or another, I had serious pain in about every part of my foot as I got my strength back.

Dr. Blake's comment: 

Hey, Yes, you are right. The 0-2 applies to typical orthopedic musculoskeletal pain, not the nerve pain you had. With nerve pain, there is a time to Honor the Pain and a time to push through the pain. You had to learn when to do both. It is very hard to tell someone to push through pain because you are not sure if they are hurting themselves. Physios with nerve training, and docs also, can help people but it takes awhile to get a sense from each person. You have to then test the experiment, push the envelope of pain, and see how you respond. Thank you for this very honest discussion. I truly appreciate this. Rich

And the Patient Responses: 

Agreed

Sounds like the guy needs to find a different doctor.  It really sounded like he's about to go down the path I did.  I went to 3 different Podiatrist and none of them knew what to do.  They all wanted to try to solve it with cortisone and I really think that is where my tears came from.  They didn't have those in the first MRI.   They would talk about surgery but I knew to go away at that point.   All Orthopedic surgeons I visited including Mayo, UAB, Andrews Sports Medicine and Birmingham Orthopedics said surgery was not a good idea for the situation I had.  The problem was they just didn't have a solution either!  

The more I think about it the more I think that shoes played a large role in my issues.  A Pedorthist told me that the New Balance shoes of all widths are now on the same footbed.  I believe that because I just can't wear them at all anymore.  If I put on shoes that put any pressure on the area I can immediately tell now that I need to stop wearing them.  Before I just thought it was "support".  Now I think it caused pressure on the area and caused at least part of the problem.  When the PT told me to get ASICS and I went with a larger size I could feel immediately there was not any pressure on the area.    I'm now getting into other shoes, boots etc and it takes quite a bit of time to find them wide enough but I know it when I find them.