Those with low pain thresholds are not wimps. We just act like wimps. I am thinking of starting a support group for us and perhaps offering some sensitivity training for all who think crying in agony is a bit too drastic a response to a paper cut.

As an Italian physician, I know about pain thresholds and make a sincere effort to analyze patient complaints that involve pain tolerance. There are three major classes of complainers in most medical practices. I like to refer to them as the Singular Saints, the Random Rantors, and the Prophets of Doom.

The Saint simply says, “Doc, it hurts here,” pointing to the mid chest. I can ask if the pain gets better with Maalox or gets worse when lying flat and he or she will answer only “I’m not sure.” They will not offer any additional characterization of the pain. This leads to a short visit, and it can be difficult to tell what is actually ailing the Saint.

The Random Rantor will offer complaints of heartburn, odd taste in the mouth, nighttime chest pain, food sticking in the esophagus, periodic cough, relief with Tums, and that spicy foods and alcohol make the problem worse. Mr. or Ms. Random has done fine. I know what he has without a doubt. Just as I am confidently beginning to write a prescription and demonstrate my medical genius, the patient adds, “By the way Dr. C., I forgot to mention that I have headaches, backaches, nose bleeds, dizziness, leg pains, and an odd pain that starts in my groin and works its way up to my left ear.” For good measure, he or she then adds that these same pains have been in the Random family for generations. This leads to a long visit and multiple suggestions by yours truly.

Finally, Prophet of Doom enters with a long face and a worried look. He or she glumly but confidently says, “I have chest pain and I know I’m going to die. I ate pizza last night and I wanted to die because the belching and heartburn kept me up all night. The Pepcid and Axid stopped the pain just in the nick of time!” Members of the Prophet clan end up in the emergency room frequently, and it can take some time to convince them that heartburn can feel like a heart attack. However, unlike the “Big One” that Red Foxx of Sanford & Son fame worried about, acid reflux responds nicely to avoiding aspirin, alcohol, fatty foods, and smoking. I believe Prophet of Doom may have a very low pain threshold, drinks too much, is over-weight, and will respond nicely to changing these lifestyle activities and to adding some acid-reducing medications.

When you have a health complaint consider if you are a Singular Saint who suffers in silence, an offspring of the Random Rantor who possibly complains about too many things, or a Prophet of Doom who thinks death is only a pepperoni pizza away. In fact, your physician considers all of these when you come for a visit. In my home, I am considered an odd form of hypochondriac – I don’t complain often, but when I do I complain bitterly about almost nothing. Such is the life of one very brave Italian physician. Be kind to me in my misery. I was just wounded by a sand gnat. Have a nice day.