Radio in Progress: One Upside of Aging

We’re working on a Freakonomics Radio episode about pain. One component is the very interesting research by Daniel Kahneman and Donald Redelmeier about how colonoscopy patients remember the pain of the procedure, and how that memory can be manipulated (to dim the memory of the pain) so that patients aren’t reluctant to return for their next colonoscopy.

Yesterday I had the chance to interview Redelmeier, a medical professor, clinician and researcher at the University of Toronto. This was a real treat. You may remember reading about some of Redelmeier’s quirky research on this blog; he was also profiled in the Times. Here’s one small portion of the interview that I found particularly compelling:

SJD: So, what are the characteristics of people who take pain poorly or well?

Redelmeier: Oh, that’s sort of a treacherous question for me to try to answer, Stephen. I’d say that the single biggest determinate is the patient’s age — i.e., young people just feel the pain a lot more intensely, whereas older people often are beguiling because they don’t have as much pain as would be normal under the circumstances. I think a lot of that is just related to age related deteriorations in the nerve fibers.

SJD: So their nerve endings just get dull? They’re just not feeling it?

Redelmeier: They’re just not feeling it. And so that you can miss some really big disasters like appendicitis, or gall stones, or other abdominal catastrophes when the patient is like 80 or 90 years old, because they say, ‘Oh, I just have a little bit of an upset stomach, Dr. Redelmeier, it’s really not that bad.’

SJD: So that’s one upside of aging, I guess, is you don’t feel the pain so much? I mean, it makes it harder for you to diagnose, but for the patients it’s a good thing?

Redelmeier: Yeah, it’s sort of like with the deadening of the nerves, which is sort of like a rather faulty adjective. So that it makes the pain less intense as we get older and older.

This episode should hit the stream in two weeks or so. In the meantime, we have a two-parter on food science coming up very soon. It’s called “Waiter, There’s a Physicist in My Soup.” We did a short piece on the topic on Marketplace last night; if all goes well, we’ll post Part 1 of the full podcast right here tomorrow.


Caitlyn

sounds awesome

Is there a way we can get transcripts of your podcasts? Since most of my browsing is done when the baby is napping there's a limit to the amount of video/audio stuff I'm willing to play, but I'd love to read the transcripts. (Actually, even without the napping baby, I'm a terrible auditory learner, so I've always appreciated transcripts.)

Ian Kemmish

You missed out the most important single part of the story. Has this "age related deterioration" been observed? in vitro? In patients? Has it been observed to affect transmission of pain?

If not, then this statement is nothing more than speculation. One might just as usefully speculate that the observed effect is because older people suffer from chronic pain a lot more than younger people. and either a) have trouble distinguishing the particular pain from the general, or b) get prescribed a lot of painkillers.

It should not be too onerous to devise a series of experiments to choose between these speculative hypotheses.

Once again, there seems to be a yawning gulf between economics and anything resembling science.

Bill Harshaw

Funny, I thought colonoscopies were done under sedatives. Mine was. Now my sigmoidoscopy wasn't, and that was painful.

James

Or is it perhaps that with age & experience we learn to tolerate pain?

(And let me add my voice to the first post: life's too short to listen to audio, or watch video.)

JimBob

Huh. I'm young and have had two colonoscopies and I don't remember any pain during the procedure. Now prior to, that's a different story.....

Doc

Having had both a sedated colonoscopy and a waking and sitting intubation, I'll take the sedated end every time.

Peter McCorison

Jolly good thing us older folks don't feel pain so much: there's a lot more of it!

hal

As one of the other readers noted, the colonoscopy itself is a trivial exercise with some discomfort and no pain under anesthesia. However, the prep leading to it is extremely discomfiting and uncomfortable.

Max

There's a rare disease where a person can't feel pain anywhere, and it's really bad, because they end up with a lot of bruises, burns, and worse. Pain is there for a reason. Of course, it would be nice to have an on/off switch. Like ok, I got the message, my leg is broken, I don't need a constant reminder.

Like others said, anaesthesia makes colonoscopies painless, especially general anaesthesia with propofol. If it's done right, you wake up refreshed, don't remember the procedure, and don't even need a painkiller. If it's done wrong, you don't wake up.

But man, are Americans wussies about pain and discomfort. Colonoscopy without sedation is common in Europe, and is usually tolerated. Not only does it eliminate the small risk of death from sedation, but it also cuts down the risk of perforation, because perforation is painful.

Here's one article about unsedated colonoscopy:
http://www.ama-assn.org/amednews/2009/01/12/hll20112.htm

Read more...

Nikki

Another vote for transcripts.

DavidK

You mis-transcribed. The word should be determinant, not determinate.

Felicia MD

@2 - In older patients in my hospital practice, I do occasionally see cases of perforated diverticulitis or ulcer that causes minimal or no discomfort--as well as minimal or no inflammation. These patients' severe problems can be missed, therefore, since they don't exhibit the "classic" signs of peritonitis like remarkable pain with a slight jostle of the bed, or a stiff abdominal wall. Older folks (and women too) are also more likely to have "silent" painless heart attacks. Younger patients really do seem to have a much stronger response to visceral pain; in other conditions, the difference might be less.

Kathy Potter

I heard from a wise woman that "pain is something that someone else feels".

I have had the procedure sedated and non-sedated. If the person doing it is an expert the non-sedated is just a little uncomfortable. I wouldn't call it painful. It's all in the mind and your perception of the procedure. I have had most of my small and large intestines removed. There are a lot more painful things to endure than a colonoscopy.