Pain

Kim du Toit
May 7, 2008
11:00 AM CDT

“You need to be able to tell the difference between pain and injury.”—Charles Durning, North Dallas Forty

I have always been able to endure pain. As a teenager, I sprained my ankle severely during a field hockey match—it blew up like a balloon in seconds, and it’s been weak ever since. A week later, I was back on the field. I once landed awkwardly in the high jump, and “spiked” myself, the spikes on my track shoes puncturing the skin and driving into my ACL. Three days later, I came third in a competition.

I thought I had encountered pain before, until the Demon Gout came to stay with me.

My recent gout flare-up (caused by a course of antibiotics) seems to have died down a little, to where I can tell the difference between discomfort and pain again, to paraphrase the quotation above. In the case of gout, discomfort means stiffness in the joint, coupled with the occasional sharp stab of pain when you extend the joint a little enthusiastically. Discomfort is the stage I’m in at the moment. Walking is slow, but manageable. I can even get around the supermarket for a brief trip, but that causes greater discomfort when I get home.

Gout pain, on the other hand, means agony which does not go away, which cannot be subdued by any drugs (short of general anesthesia), and which leaves even a strong man like myself absolutely helpless. It is intolerable pain made worse by movement, any movement, and it turns a journey of (say) a dozen steps to the toilet into a five-minute trek of excruciating agony. From my bed to the bathroom is about a dozen steps—and I’ve had to stop on the way, sit on the edge of the bathroom, and wait, bladder bursting, while the pain subsided enough for me to make the last five steps.

I’ve been in pain too severe to stand up and urinate, and have had to sit down like a woman.

I’ve had to stop on the pathway to the car (to visit a doctor) while my daughter saw me weeping helplessly from the pain.

My wife has had to move my guns out of reach.

The doctor’s scale of pain for acute gout is 7 out of 10, where 8 is hysteria, 9 dementia and 10, coma with brain damage. (Childbirth is about 6, and lasts for a few hours. My first severe gout attack lasted for over three weeks, and put me in a wheelchair.)

The worst thing about pain this severe (apart from the pain itself) is that it’s debilitating. You cannot relax, you cannot sleep, and the exhaustion just adds to your debilitation. At the end of the day, you are tired beyond words. In the morning, after a mostly sleepless, pain-filled night, you are tired beyond words. The slightest exertion is exhausting, because you have no reserves. You eat, but still you have no energy. You cannot think properly, you cannot concentrate, and you cannot even follow a train of thought or construct a coherent sentence.

Colchicine will eventually reduce the pain—for some people—but the lovely little side-effect of colchicine is diarrhea, and the side-effect of diarrhea is dehydration, which (you guessed it) exacerbates the pain of gout.

Codeine doesn’t really help—at least, it doesn’t help me much—and it also causes the other extreme, constipation (and a host of other ills, if you take it long enough). Stronger pain drugs are habit-forming—but I have to tell you, there were times when I would have risked addiction, just for eight hours’ pain-free existence so I could sleep.

I thought I’d write this piece while the memory of this most recent gout flare-up was still fresh in my mind. I could write another page on the explanation and description of pain, but you’ve probably got the picture by now.

Last night was my first complete, uninterrupted night’s sleep for four weeks. I slept from about 1am until about 8am, an unthinkable luxury only a week ago, and now, at last, I’m starting to feel a little like my old self.

The gout should be completely gone by next week, and then I’m going to start taking Allopurinol. (You can’t take Allopurinol during a gout attack.) In one of those wonderful little twists of irony, however, Allopurinol has been known to cause cataracts if taken for a lengthy period. It’s also like a turbocharger for your kidney function, revving it higher and higher to process the uretes in food which cause gout, and so it can cause eventual kidney failure.

I’ll take those risks. I’m sick of being in pain.