“You are Sensitive and Tough”
Among my patients, I have come to recognize that there are some who are more sensitive than others. Sensitive patients often have low pain thresholds and feel things more than others including emotions and sensations and react more to their environment. Some of those patients are more tough and some are not so tough. On the other hand, some patients are less sensitive. They usually have high pain thresholds and feel things less. There is real science behind this difference in how patients perceive and react to pain and environmental stimuli. Patients with a rare condition called erythromelalgia have a genetic defect in the sodium channels of their neurons that makes them exquisitely sensitive. For example, if warm air from a heater touches their skin, it causes excruciating pain. On the other hand, patients with a different defect in their sodium channels have a rare condition called congenital insensitivity to pain. They feel no pain and get injuries, including fractures, without realizing it. Complex circuitry in the brain colors our experience of painful stimuli even if we don’t have one of these rare genetic mutations.
Many of my patients with common neurological conditions like migraine, vertigo, dizziness, fibromyalgia, and chronic neck and back pain fall into the category of more sensitive. And some are more tough, and some are less tough. Of course, the degree of toughness can vary over time. For example, my nurse and I have the same trait that if we are mildly ill, we are huge babies. But if we are more seriously ill, we become quieter and braver.
Over the years I have noticed that patients often do not like to be considered sensitive or delicate. The negative connotation of these labels seems to be in part because society has somehow decided that these traits are weaknesses, and because patients do not realize that they can be sensitive and tough at the same time. I see this combination in a lot of my patients. For example, every day I see several migraine patients who “push through” their day with a migraine headache or migraine associated vertigo wearing multiple hats successfully and looking after everything and everyone around them beautifully but not looking after themselves. They are eager to believe in their tough side but do not embrace their sensitive side. They may even be initially offended when I tell them that I think they are sensitive or delicate. But letting them know that I see their tough side eases the tension.
Every day I am amazed at the strength of the human spirit that carries people through health-related adversity. I see this strength in people of all walks of life. My sensitive patients are far from weak in this regard. They are often the ones who help others through their struggles at the expense of their own health. They may juggle caring for ailing parents with managing a business or home and family. I encourage them to recognize and embrace their sensitive side just as they do their tough side. I believe this acceptance will achieve as much or more than any medication I can prescribe.