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LAST week, I wrote about pain — the different kinds and what one should do. At the other end of the spectrum is insensitivity to physical pain.

While there’s a condition called congenital insensitivity to pain — a rare genetic disorder that makes one unable to feel pain — there are people who, to a lesser degree, don’t feel pain as acutely as they should.

They may feel pressure, but they can’t feel pain. This condition makes it dangerous for them.

The ability to feel pain, like fear, is the essence of our survival and self-preservation. Our instincts will make us recoil and avoid pain. This instinct keeps us somewhat safe.

It’s common for the elderly to complain of loss of sensation or numbness in their fingertips. They often say they can’t feel paper or coins when counting money, and sewing is out of the question. Tying shoelaces and typing or handling the phone is also challenging.

That’s why smartphones with small keypads can be a challenge to them with hilarious spelling mistakes.

With ageing, pain (or the lack of it) can swing to either extreme. Joints may hurt to the point of tears while other parts like extremities are numb.

Many years ago, my late father used to complain of itchy spots on his arms and back. Sometimes it was on his legs. As we went down the list of possible allergies to eliminate the causes, we also discovered that he was allergic to lanolin, a popular ingredient in some body lotions. He also couldn’t wear anything with wool.

After sorting that out, the itch started again. Dad thought he could get rid of the itch with some soap and warm water. I wasn’t aware of what had happened until I saw a bandage on his arm.

Being a doctor, albeit a vet, he tried to treat himself. A quick check revealed that he had scalded his arm and there were blisters on his red skin. He didn’t feel that the water had gone too hot. All he remembered was that the itch had subsided.

Apparently he had scrubbed that itch a bit too hard. Just those few moments of gratification of an itch well scratched under hot water went so wrong and he overdid it.

Going just minutes beyond what the skin could take caused a wound that took a long time to heal because he was diabetic, a double jeopardy.

Of course, we took him to the doctor for immediate attention and received the care he needed. Fortunately, the wound healed well but then the itch returned. We went from one dermatologist to another.

In the meantime, steroid creams prescribed to him had thinned out his skin after prolonged use. Dad was going out of his mind with the itch. No amount of antihistamines helped either. Dad had to learn to bear with the itch without further damaging his skin.

NO PAIN, NO COMPLAINT

My late mother had the other feature of not feeling pain in her extremities due to diabetes.

Her big toe had a small cut which became so badly infected that it swelled and the toenail actually moved! Of course we freaked out and sought immediate medical attention.

Her doctor told us that the cut could have been caused by anything from poorly fitted shoes, a small piece of grit in her socks, dry skin that broke and festered, or even accidently hitting something like a step or corner.

Mum didn’t feel the pain so she didn’t complain. She didn’t even feel the pain when it was red, swollen and infected.

Imagine if we hadn’t seen that. It could’ve gone septic and called for drastic measures. Foot care for diabetics is paramount, especially for the elderly who require assistance with personal necessities.

For some elderly people, sensations of pain, vibration, cold, heat, pressure and touch may have reduced. This was what happened to my parents who were both over 70 at the time these incidents took place.

While they couldn’t feel pain in their fingers and toes, their skin were more sensitive because it had thinned out with age. This also explains how and why bedsores can happen but they don’t feel the pain until it’s really bad.

They may be more sensitive to touch but not to hot or cold temperatures. It seems rather odd but both experiences taught us to be more aware of their condition. Is the room too hot or too cold? Sometimes even the fan feels too cold for them, let alone air-conditioning.

We also learnt not to assume that just because they don’t feel pain that the injury is insignificant. We sometimes can’t wait for them to complain because sometimes they just can’t.