THE SONG OF OUR SCARS

An investigation of a little-understood sensation.

After suffering a back injury at his gym in 2008, physician Warraich became one of an estimated 1.5 billion people affected by chronic pain. In a wide-ranging overview, the author draws on scientific and medical studies, his work at the Pain Management Center of Brigham and Women’s Hospital, and his clinical practice to examine the history, physiology, biology, and treatment of pain. Acute and chronic pain, he asserts, are “entirely distinct phenomena, and there is no justification for treating them the same way.” Acute pain, incited by a physical trauma, ascends up the spinal cord to the brain, whereas chronic pain “descends down from the brain, often with no need for an incitation from below.” Recurrent and invisible, chronic pain frustrates physicians. “If doctors didn’t learn about it in medical school or cannot make it go away,” writes Warraich, “it must not be real.” Patients, forced to doubt themselves, become frustrated as well, and “their lack of conformity to the rules of medicine can turn the healthcare system into an agent of persecution rather than therapy.” In the U.S., medical response to chronic pain has resulted in an opioid epidemic “carefully orchestrated [and] intentionally designed” by the Sackler family, which developed OxyContin through their company Purdue Pharma. A physician who had worked in advertising, Arthur Sackler brought his expertise to pharmaceuticals, redefining the patient as a consumer. From their use in alleviating the pain of dying patients, opioids, Sackler saw, could be sold to customers who would be alive longer and who could be convinced that they could live without pain. Coming from medical training in Pakistan, Warraich was shocked at American patients’ demands for opioids and doctors’ complicity in prescribing a medicine proven ineffective against chronic pain. He has been shocked, too, at the underlying racism, sexism, and ageism that affects how the medical community treats patients in pain.

A clear and timely examination of the complexities of pain.