Evaluation and Management of Pain Related Medical Problems of Diving

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Sarah Fischer
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Pain is one of the most frequent reasons patient’s seek help from their care providers. This holds true for the Medical Problems of Diving (MPD), also. I am unaware of any publication in diving medicine that is devoted solely to the subject of pain, although pain is typically described in association with the signs and symptoms of many of the MPD. Hence, this chapter is a new and novel undertaking. Pain as a consequence of MPD has many unifying factors. It is typical acute and has an identifiable cause. This facilitates evaluation and management with usually excellent responses to management. This contrasts to chronic pain presentations where symptoms linger and resolution of pain is often incomplete and/or unsuccessful.

In keeping with the organization of Diving Science...Revisited, the pain presentations for MPD of diving are discussed by the phases (i.e., pre-dive & surface, descent, bottom, and ascent & post-activity) of the dive in which they are most likely to occur. The wide variety of causes of pain from MPD leads to a multitude of treatment interventions. They can range from topical analgesics for sunburn to hyperbaric oxygen recompression treatments for decompression sickness.

Each pain problem associated with a MPD is considered from the perspectives of causes, mechanisms causing the pain, severity (using the author’s “Pain Profile”), mangement, and possible complications. This combined with phases of the dive in which the pain arises, provides a logical and comprehensive approach to pain associated with the MPD.


Challenges of Pain Evaluation Pain has been referred to as the “fifth vital sign” after pulse rate, blood pressure, respiratory rate and temperature. This elevates pain to a position that is unwarranted.1 Pain is not a sign; it is a symptom. A sign with respect to medicine is a finding that can be described or quantified by examination, measured with instruments (such as pulse and blood pressure), confirmed with laboratory studies and/or described with imaging methods. A symptom is something of which the patient complains. Consequently, this makes pain evaluation subjective as compared to the objectivity of signs. Patients demonstrate a wide range of interpretations of their pain symptoms. The adage of “One man’s meat is another man’s poison” has clear-cut analogies to pain. This provides challenges to the care provider with respect to interpretation of the severity of the pain as well as what is the optimal management.

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Complementary Selections Introduction.

The Complementary Selections span the time frame from my 1971 mammalian diving paper to a yet-to-be-published writing on pain causes associated with diving. In between are papers on Decompression Science and Disordered Decompression. This latter paper is particularly noteworthy since it explains why decompression sickness occurs at the sites it does—something not well elaborated in the diving medicine literature.

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