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Moaning Works for Me: Why It's a Good Gauge of Pain

Diane M. Goodman, BSN, MSN-C, APRN

Disclosures

November 17, 2022

Unfortunately, this blog is not about intimacy, but it is about a personal topic: pain. I have been away from writing for a period, recuperating from two joint surgeries. During convalescence, I fell and fractured my dominant arm. (Insert many curse words here!)

It has been every bit as dreadful as you might imagine, which brings me to the point of this blog.

Moaning (groaning, grunting, sudden bursts of inappropriate language) absolutely works for me. Not all day every day, but often too much for my behavior to go unnoticed by those around me. I was asked recently if the moaning had become habit. I realized that my vocalizations were not habitual but necessary. There are certain movements, OK —  most of them, that require sound when I move. It is not that I am a wimp, far from it. Instead, I have grown to believe this is normal human behavior.

According to the National Institutes of Health, over 50 million Americans live with chronic pain. That is, pain reported daily or on most days, lasting greater than 6 months' duration. People may have various painful conditions: back pain, migraines, cardiovascular/peripheral vascular disease, osteoarthritis, rheumatoid arthritis, gastrointestinal disease, and cancer, to name a few. Some unfortunate souls may suffer from multiple conditions simultaneously (dear God). 

Pain management is a multibillion-dollar business. But if you query most chronic pain patients, they will swear that few treatment modalities really work or improve quality of life over time.

One of the medication groups used for severe pain, opioids, has ceased to be used for chronic pain, except in rare instances. Not only are opioids less effective for pain lasting greater than 6 months' duration, but opioids have come under fire as causing an increasing amount of overdose deaths in the United States. Consequently, opioids are rarely used without stringent monitoring, even for acute on chronic pain. For example, surgical pain compounded by osteoarthritis or additional chronic disease.

Which brings me back to the subject of moaning. As a nurse with decades of experience in nearly every realm possible, from intensive care and maternity care to nursing homes and home health, I have assessed many types of pain. I have been educated to assess pain according to criteria: Wong-Baker Faces, numerical scales, and visual analog scales, among others.

When patients are unable to express pain in words (the incredibly young, old, disabled, intubated, etc.), nurses are taught to use nonverbal cues to find pain. We assess vocalizations, facial expressions, crying out, moaning, weeping, and body posturing to decide the severity of pain. Infrequently, we used withdrawal from care and failure to take nutrition. All proved useful in evaluating the success of interventions to control pain.

The same can be said for veterinary medicine because we cannot ask the family kitty or dog if they are in pain. Well, we could ask, but it is unlikely we would get a verbal response, although language boards are now available for the most sophisticated Fido. Anyone with an ailing or aging pet wishes quality of life decisions could be easier, especially when a pet cries out with pain. Their vocalizations prove even more painful for the human trying to decide if urgent help is needed.

But, I digress. I was discussing why moaning works. Moans, groans, and crying out could have been the earliest effort of humans to make language. Historians studying Neanderthal man and Homo sapiens have discovered these creatures may have had acute hearing and bandwidth capabilities that would have allowed them to develop rudimentary speech. They are also hypothesized to have used sound to alert others that danger was present or when an injury had occurred.

Centuries later, vocalizations of pain remain a common bond among humans, although cultural differences exist. The sound of a baby crying unites parents everywhere and gains immediate attention, as does the sound of a postoperative patient grunting in pain. We know how to react to those sounds. What we are not taught is that moaning and other vocalizations serve a purpose.

The sudden sound causes a release of breath, an exhalation, and the noise resonates in the brain, potentially increasing serotonin. Believe it or not, research has proved that cursing may increase pain tolerance! One study proved that individuals who swore during an exercise could keep their hands submerged in ice water longer than those who did not. People who cursed often seemed to improve their ability to withstand extreme discomfort. I have not consistently tested this theory, although I may start.

What does this mean? For nurses, it could mean that expecting patients to be stoic or silent while suffering is wrong. The patient who yells, grunts, or even cries may heal faster and cope better than do those with a stiff upper lip. For myself, whether it appears habitual or not, I have learned that persistent, moderate pain leads to moaning. It absolutely works for me.

It is not simply a bad habit. But it is and will continue to be entirely human. Moaning works. It may work for you as well, particularly after a long, stressful day at work, or after an interminable committee meeting. If not, try cursing once or twice (in private) and see if it makes you feel better, honestly.

Have you been expressing pain in a noticeable way? Please share.

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About Diane M. Goodman
Diane M. Goodman, BSN, MSN-C, APRN, is a semi-retired nurse practitioner who contributes to COVID-19 task force teams and dismantles vaccine disinformation, as well as publishing in various nursing venues. During decades at the bedside, Goodman worked in both private practice and critical care, carrying up to five nursing certifications simultaneously. Yet she is not all about nursing. She is equally passionate about her dogs and watching movies, enjoying both during time away from professional activities. Her tiny chihuahuas are contest winners, proving that both Momma and the dogs are busy, productive girls!

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