Its lengthy subtitle notwithstanding, this new book makes its point succinctly: Pain is not a weakness of spirit, but a living, breathing, scientifically explainable beast.
The author, journalist Melanie Thernstrom, knows whereof she speaks. Injured almost offhandedly while swimming one day, she spends years bouncing from specialist to specialist for help with chronic shoulder pain. Such a narrator might easily fall into a trap of self-pity. Thernstrom does not.
Instead she presents an intermingling tale of the science and culture of pain, sure to be eye-opening to anyone who has not suffered chronically. Pain, it turns out, stems from the mind at least as much as it does the body.
In recent decades neuroscientists have chronicled how pain can feed on itself. Pain signals can essentially overload a person's central nervous system, so that the pain cannot be alleviated no matter what doctors try on the body.
Sound depressing? Thernstrom does offer hope at the cutting edge of biology and psychology. Some researchers are investigating the genetics of pain, hoping to unlock, for instance, why certain gene mutations appear to make people more or less sensitive to pain. Other scientists are working on cognitive control therapies, in which patients try to con their minds into accepting treatment that their bodies reject. In a pain clinic at Stanford University, Thernstrom submits to being burned on her wrist - yet, having established a trusting relationship with her doctor, she feels little pain even as her skin blisters up.
Science, though, has a long way to go in combating societal stigmatization. Fear of pain, and of those with pain, is overwhelming. During the Civil War, many injured soldiers refused surgery that could have saved their lives, dreading amputation more than death. Yet after anesthesia was developed, many doctors, including the head of the American Dental Association, spoke out against it - arguing that it blunted the true experience of "what God intended." Women giving birth were denied painkillers, not out of concern for the baby's health but because it was thought to be against the natural order of things.
Bias remains today. Patients who could benefit from high doses of opiates are often denied the drugs. Sometimes, doctors worry about prosecution; in 2005, a South Carolina physician received a 30-year sentence for drug trafficking after he reported suspicions that two of his patients were misusing their medications. Others simply do not consider opiates as an option, especially for minority patients. Black patients are routinely undertreated for pain, Thernstrom reports, to the point that their asking for relief is sometimes classified as "drug-seeking behavior." Such approaches sound almost medieval.
Thernstrom's narrative would be strengthened by a more international perspective, as European researchers are at the forefront of investigation along with Americans. She travels beyond the United States primarily to witness a Hindu ritual in Malaysia in which pilgrims pierce themselves with skewers without flinching.
Nevertheless, this journey into the world of suffering is enlightening.
Alexandra Witze, a contributing editor to Science News magazine, is based in Boulder, Colo.
The Pain Chronicles
Cures, Myths, Mysteries, Prayers, Diaries, Brain Scans, Healing,
and the Science of Suffering
(Farrar, Straus and Giroux, $27)