#026 - Project Pain Management: The Good, The Bad and the Useful

Gazza's Corner Podcast

Definition of PAIN
a : a state of physical, emotional, or mental lack of well-being or physical, emotional, or mental uneasiness that ranges from mild discomfort or dull distress to acute often unbearable agony, may be generalized or localized, and is the consequence of being injured or hurt physically or mentally or of some derangement of or lack of equilibrium in the physical or mental functions (as through disease), and that usually produces a reaction of wanting to avoid, escape, or destroy the causative factor and its effects

b : a basic bodily sensation that is induced by a noxious stimulus, is received by naked nerve endings, is characterized by physical discomfort (as pricking, throbbing, or aching), and typically leads to evasive action

Source: Miriam-Webster (http://www.merriam-webster.com/medical/pain)

Everyone has experienced pain of some kind. Most project managers have experienced pain on projects as well - and if you haven't yet, you must be just getting started in your career. Pain can come in many forms - physical pain, mental distress, concern and worry over things that you may (or may not) have any control over. In fact, pain can be good for you, as it is principally designed as a protection mechanism. Brush your hand against a hot frying pan? Your body quickly tells you to get yourself away by triggering pain sensors. Step on a nail or cut yourself? Pain tells you to stop doing what you are doing and take care of your injury.

But not all pain is the same. Some pain says "Stop that!" and yet some pain you need to ignore, like runners pushing through to get their second wind.
In early 2005, I damaged my right knee - I tore my meniscus. The pain while walking right after the injury was quite bad - but of course, I still had to walk. Before I could start Physio, I had to take a flight back to the head office. Walking from the farthest gate to the main terminal was a very, very long and painful process. From there I caught one of those courtesy trams that go from gate to gate. The entire trip was measured in short walking distances and rest spots, and Naproxen was on the daily menu for a while.

I returned from the trip to my project in the US and started Physio, which helped a lot, but I still had regular pain through the next year, if I overdid it or stood too long in one position. Once the inflammation settled down, walking was Ok - but standing was not, as it put pressure in mainly one spot. But I managed, and started to get better and much more mobile - once again measuring walks in miles/km instead of dozens of feet or minutes standing up.

In 2006 I twisted my left knee when I fell into a hole, damaging it as well. You think I would have been smarter and re-injured the bad knee, but no. The pain from this injury was quite different - and worse. Walking or standing was painful for any duration or distance. But I got along, by not walking too much and avoiding standing still for very long. I went to the doctor - and was put on a waiting list for an MRI in Vancouver. I waited for 14 months, and finally had the scan. Then I had to wait a few more months to see the specialist who went over the results. The whole time my knees (both of them acting up in sympathy for each other) limited my freedom of movement as a result of the annoying pain.
At one point I actually bought a folding cane to carry in my bag, and had to use it a few times.

When I finally met the specialist, he went over the results with me, discussed "pain management" as the only near-term option and then sent me to physio. He also gave a picture of the long-term prospects which I was not terribly happy about. I left the office feeling quite discouraged. Osteochondrital impaction? Big words for "can't fix it".

So I started physio. It made things hurt more, frankly - for a while. Then it hurt a bit less. But at the same time we were preparing to sell our house prior to moving - so I found myself up on the stepladder and tall ladder (generally, just plain upright for long periods), standing and moving as I repainted the entire inside of the house, including ceilings.

During the several weeks of prep and painting in the evenings and weekends my knees were on fire, but the job had to be done. However, after the third week I began to notice something interesting.

1) There were actually two types of pain, not just one.
2) I was hurting a bit less and less every day as I forced myself onto the ladders to paint.

By the time I went in for my followup visit with the specialist who had had little hope for me other than pain management, I was walking nearly pain-free, and not only that - I was able to stand in place for long periods as well.

Over two years of suffering, and nobody told me I just had to get off my butt and move!

Sometimes, pain is a sign to stop doing what you are doing or you will further damage things (pain #1), such as actual joint pain.
Other times, it is simply a message that you need to persist, and things will get better if you push through and keep going (pain #2). This tricky type of pain was merely muscle fatigue - a sign that my knees were growing a little bit stronger again, and the next day would be a little bit better than today.

In the case of my knees, the odd bit I learned about joint mechanics is that when you exercise your muscles and tone them up, they actually pull your joints apart - reducing wear and pressure on the cartilage between the bones. If you let things go and rest because it hurts, you lose muscle tone and your joints experience more direct pressure from the weight of your body. Weird, but true.

On your projects, you will also experience two types of pain - good pain and bad pain. The key is learning to identify each type of pain and then respond to them appropriately.
Listen to the podcast, or read the full article on Gazza's Corner blog.