What’s the Worst Pain?
Some people say that life is pain. Those people are optimistic: life isn’t pain, it’s pains, plural—tooth pain, back pain, breakup-pain, the pain of watching your parents grow old and die, the pain of downwardly adjusting your expectations for life, stomach pain and sinus pain, pain you can’t quite trace to any one single source—a thousand different strains of this stuff, some not-insignificant percentage of which you’ll almost certainly experience before your (likely painful) death.
But which of these pains—limiting things to the physical—hurts the worst? To find out, for this week’s Giz Asks we reached out to a number of pain doctors and researchers, whose answers twisted and problematized the very concept of pain, and the function pain serves biologically.
David C. Yeomans
Associate Professor, Anesthesiology, Perioperative and Pain Medicine, Stanford University
The type of pain that quite a few people consider the worst is something called trigeminal neuralgia.
The trigeminal nerve provides all the pain information from the head and the face. If you have tooth pain, face pain, eye pain, whatever, it’s coming in through this trigeminal nerve. And what happens in some people is that a blood vessel gets dilated or hypertrophied, and it pushes against the trigeminal nerve. Often, patients describe the resultant pain as being like a bolt of lightning hitting the side of their face. The attacks don’t last long—maybe up to two minutes—but someone might have a hundred of these in a day, triggered by very mild stimulation: a puff of cold wind, for example, or brushing your teeth, or shaving. A lot of these time people with trigeminal neuralgia stop brushing their teeth for that reason, and so they get teeth problems.
Pain specialists use something called the numeric pain scale to rate a patient’s pain. The scale goes from 0-10, and virtually everyone with trigeminal neuralgia will rate their pin as a 10—the worst pain imaginable.
It is to some extent treatable: there is a drug called tegratol that was designed for epilepsy, and it helps many people, at least at first. But it has side effects that people hate: it kind of lowers your IQ, and makes you spacey and somewhat dysphoric.
There’s are also two different types of surgeries that some people end up getting. In one of them, they actually go in and open the skull and put in a little pillow between the nerve and this blood vessel. The release is usually immediate, but something like 50% of patients eventually need to get it again. Or the patients will get very focused ionizing radiation—targeted towards a site that’s deep in the body, frequently in the head—and kind of cook the system. That usually helps too, but it takes a while to work.
Many mothers will say that childbirth is the worst pain they’ve ever experienced, and it usually is. But someone whose had a baby, and then has trigeminal neuralgia some point later in their life, will tell you that the trigeminal neuralgia is worse.