Examining the Mysteries of Pain

The Pain Chronicles: Cures, Myths, Mysteries, Prayers, Diaries, Brain Scans, Healing and the Science of Suffering Melanie Thernstrom Farrar, Straus and Giroux 2010 _______________________

Like the rising and setting of the sun or the change of seasons, the occurrence of pain inspired much mythology and speculation in ancient times. Early civilizations attributed pain to evil spirits or divine punishment. Some mythologies assigned specific demons to toothache, foot pain, or sore throat. Even the word "pain" itself comes from the name of Poine, the Greek goddess of revenge. Theology and the concept of pain were so intertwined that when early anesthesias such as ether and chloroform first arrived on the scene, some clergy forbade its use, believing pain relief to be against divine will.

For healers through the ages, pain has presented a fundamental problem: unlike a broken leg or swollen tonsils, pain itself cannot be seen. The healer must rely exclusively on the patient's description—and pain is notoriously difficult to describe to someone who isn't experiencing it!

Yet as much as any other disabling condition, pain has a tremendous negative impact on quality of life. Pain management is a growing concern of experts on ageing, who recognize that pain control helps keep seniors active and independent. Statistics Canada reports that up to 38% of seniors routinely experience pain to a degree that affects sleep and the activities of daily living.

For author Melanie Thernstrom, the quest for answers was personal. At the age of 29, she developed sudden shoulder and neck pain after a casual afternoon swim. This was her entrée into the world of chronic pain. Eventually diagnosed with a form of degenerative arthritis, Thernstrom set off on her own personal search for pain relief. She brought the empathy born from her own experience to her research for The Pain Chronicles.

Thernstrom first discusses pain in an historic and cross-cultural setting, examining the history of how humans have treated pain—and how they have tried to understand and make sense of it. Her travels took her everywhere from Kuala Lumpur (where she witnessed a religious ceremony which includes painful rituals) to the laboratories of leading pain specialists. The experts' findings are illuminating; their philosophical musings sometimes equally so.

In the course of her inquiry, Thernstrom discovered:

The important contrast between acute and chronic pain. Acute pain, from an injury or temporary illness, usually abates when the underlying problem is solved. But chronic pain from conditions such as arthritis, diabetes, osteoporosis or MS, results in pain of long duration. And in some cases, patients have pain for no apparent reason. Chronic pain is now often described as a disease in its own right.

The old admonishment "pain is all in your head" is being turned upside down by modern brain imagery. Today, neurologists can witness—and begin to understand—how pain really works. Watching patients undergo brain scans, Thernstrom realizes that their pain is "a complex aspect of consciousness," which involves several areas of the brain at the same time.

Prompt treatment is vital. "Toughing it out" may allow a pain pattern to establish itself intractably. To ignore chronic pain makes it more likely that it will persist.

Pain medication can make the difference between intolerable pain and a reasonable quality of life. It can also prevent the development of long-term pain. Some patients, especially seniors, are reluctant to take opioid analgesics. Some doctors are reluctant to prescribe them. But studies show that these medications are safe and effective when used correctly.

The experience of pain varies from person to person. Pain specialists now know the old idea of a "low pain threshold" is to an extent true. The intensity of an individual's pain may be partly determined by gender, age, even genetics: certain genes are related to greater sensitivity to pain.

Pain specialists offer an array of treatment options. Medication is only the beginning. Pain sufferers have received relief from physical therapy, meditation techniques, electrostimulation, biofeedback, surgery on the nerves, even innovative treatments based on brain imaging. New understanding of the mechanism of pain has also caused specialists to discard some old treatments. For example, for some patients, the old standby of distraction proves less effective than directed focusing on the pain.

Treatment will become more targeted. Knowing the underlying cause of a patient's specific pain helps determine the best course of treatment. Brain imaging offers intriguing hope. One optimistic researcher tells Thernstrom, "In five to ten years we will be able to put someone in a scanner and say 'Your pain comes 10 percent from hypervigilance [paying too much attention to the pain], 20 percent from catastrophizing [excessive worry], 20 percent from peripheral input [from the original injury or disease], and 50 percent from brain circuit dysfunction.' "

Don't give up. Thernstrom describes the experiences of patients who have moved from doctor to doctor in an effort to be taken seriously. She emphasizes that just because a treatment fails, this does not mean the patient has failed. Patients should seek treatment from a physician who is fully trained in pain management.

The Pain Chronicles aims to help patients navigate the healthcare maze to find the best possible pain management. And for readers whose loved ones are in pain, or whose profession calls upon them to care for people in pain, the book offers new insights and understanding. The last thing people in pain need is to be discounted, or to be told to "just deal with it." Instead, they should be empowered by support as they recognize pain management as an integral part of their healthcare.

See "Managing Chronic Pain While Maintaining Independence at Home" in the July 2010 issue of Choices to learn how home care helps seniors support pain management.