“Pain Chronicles” takes your mind off those little aches (and on to the big ones)

There is so much in this book that it is hard to begin. The story part of the book centers on the main character, a young woman who suddenly becomes acquainted with pain after a day of swimming with a new romantic interest. While there may have been some guilt involved in precipitating the pain, it becomes undeniably a physical problem that she begins to deal with every day. Only after a year and a half does she get a proper diagnosis that this is a degenerative disease. Along the way we are educated on approaches to pain going back to the Egyptian era. The modern era is not a whole lot better, where doctors are afraid to prescribe enough painkillers so that victims can get at least some of their lives back. Docs would rather sacrifice patients' stomachs and/or livers on NSAIDs rather than prescribe opiates or other drugs. Which brings to mind the fact that many docs prescribe Wellbutrin, a drug normally given to depressed patients, because it has the side effect of reducing pain. The author, Melanie Thernstrom, works in a great deal of research into pain, some of which may or may not be useful to the reader. Such as, do you know that cursing (with the curse word of your choice) tends to allow people to tolerate pain or discomfort longer than not cursing? Do you know that chronic pain tends to shrink the brain mass? The latter conclusion comes from a study at Northwestern University (under Dr A V Apkarian) which found “death of neurons owing to excitotoxicity and inflammatory agents” and that “chronic pain appears to diminish cognitive abilities and interfere with parts of the brain that are involved in making emotions assessments, including decision making” among other things. That is disturbing enough, to think that chronic pain is in effect, making people dumber – or at least making them make poor decisions – and that people who do not have their pain controlled by proper medications or other treatments cannot give their best at work or in their private lives. The good news is that this damage is not permanent. Brain scans showed that chronic pain had “dramatically” reduced the amount of gray matter in patients' skulls, with the loss averaging about 1.3 cubic centimeters for every year of unrelieved pain. Even more alarming is that the loss occurred in parts of the brain that were normally able to moderate pain. However, a German research study found that patients who had chronic hip pain but got a hip replacement, their gray matter regenerated. Upon reflection, this study poses hope not only for sufferers of chronic pain but victims of brain degenerative diseases of all kinds. Other techniques offer hope for modulating or controlling pain. A study found that electrical stimulation of parts of the brain that modulate pain, produced not just modest pain reduction but total analgesia. Another approach is similar to biofeedback, in which people watch a picture of their brain function as they learn to to either increase pain or block pain. In other words, their thoughts controlled how much pain they felt at any given time. There is much reason to hope that medicine's failure to conquer pain, the final medical frontier, may finally yield to the insights produced by modern research. In the mean time, let's hope that physicians can learn to be merciful and prescribe proper doses of effective pain medications. THE PAIN CHRONICLES, by Melanie Thernstrom, Farrar Straus and Giroux, New York, 2010, 329 pages not including notes and index.