Chronicles of Pain

Why do some people do so well with intractable pain problems while others fall apart with ordinary ones? Nicole Krauss Great House

A few years ago during a period when I had the flu or worse, I sneezed too hard. At that moment I felt a piercing pain in my back. It was subsequently given the name of a spinal compression fracture. While the pain from that memorable sneeze has all but vanished, without going into the details, it has produced a milder form of pain in my leg.

When I talk to my doctor about this, he invariably asks me to rate the level of pain on a scale from one to ten. I find it impossible to do this. Is a six different from a seven and what does a seven mean anyway? Trying to describe to another person what it is that you feel when you hurt somewhere “…is like dancing about architecture.” [From the film Playing By Heart]

In The Pain Chronicles Melanie Thernstrom tries to create a vocabulary for understanding the experience of pain. She writes about her own chronic neck pain, the various pain clinics she has visited, and treatments she has tried to alleviate it. She also recounts in considerable detail the history of various conceptions of pain, the evolution of the disease model, and recent developments in neuroscientific fields.

At least ten percent of the population in the United States suffers from chronic pain. The rest of us live a relatively pain free life. She calls this the normal state; the second state occurs after a debilitating, pain-inducing event whose effects can last for months or many years. She writes, “When you’re in that second state, you hold on to expectations of that first life….But people have to let themselves die and lose their old expectations.” Oh, that it were so simple.

After reading Therstrom’s book and her exceptional review of the history and current research on chronic pain, I confess to no greater understanding of it. And it never seemed to me that Thernstrom did either. Yes, we are better informed about alternative accounts, but I am still at a loss to confidently put a number on the pain rating scale and, of course, do much of anything about the normal aches and pains that come my way now.

The book is organized as a collage or patchwork quilt with five separate parts—pain as metaphor, history, disease, narrative, and perception—each with a set of micro essays, almost blog-like on various related topics. And through all of this she interweaves accounts of her own chronic pain.

Thernstrom expresses skepticism about most current pain management techniques and suggests that any improvement from them is probably a placebo effect. She notes that the practitioner’s force of personality may be responsible for any derived benefits, rather than the treatment procedure itself. Therapists who appeared to be most effective “…all possessed some kind of personal power; they knew how to evoke belief, and their patients actually followed their suggestions.”

The mystery of resilience is a matter of so many factors—genetics, temperament, luck, will, neurotransmitters, etc—that it is impossible to predict who will fall apart and who will master the condition of chronic pain. As Therstrom puts it in her epigraph: Dolor dictat (Pain Dictates).