Real vs. Anticipitory Pain and Relief

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Posted by Bill McCuistion ( on October 07, 1999 at 18:14:28:

In Reply to: Help Me Open My Mind posted by Bob P on October 07, 1999 at 15:12:03:


During the build-up phase of an attack, I draw lines on a graph which depict (1) the real underlying pain and (2) the total pain.

Total pain is the sum of real pain and anticipitory pain. Anticipitory pain is the fear-induced pain, like you get when you see the car door shutting on your finger. It hurts before it is hurt. Anticipitory pain is controlled by knowing that the pain will only reach a certain level and that it will end soon.

During the wind-down phase of an attack, I again draw two lines: Real pain and anticipitory relief. If I have treated the real pain, by way of abortive medication, then an anticipitory relief line subtracts from the real pain and serves to shorten the experienced pain of the cycle. I know that the real pain is there and what it is doing, but knowing that relief is on the way eases it. Stadol NS masks the pain, anticipitory relief is mind-control over the pain. Two different things. This is a conditioned response because my attacks respond predictably, most of the time, to abortives. However, not all attacks have exactly the same profile, so that choosing the right abortive for the specific attack is key. For example: Imitrex tablets for the 2-hour wake-up calls do no good; those take an injection. Daytime attacks can be aborted with the Imitrex Nasal Spray. The tablets are good for those little teasers.

Real may not be best word for the biologic pain, but it the term I have used in my journals. Perhaps "real" and "nominal" would be better terms. Remember, I am an accountant, so my vocabulary is limited.

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