Why write about pain?

I was thinking that one of the simple motives that took me down this path was curiosity. DO other people experience pain the way I do? It was like being curious about all the other big stuff - how did it feel when you first fell in love, how did it feel when someone close to you died, and so on. Is my pain like your pain? I was being nosy - curious about this intimate experience that doesn't often get shared in detail. Reference: Introduction pp 5-7

Pain is our secret life.

We all have a secret relationship to pain. Pain is the one intimate area we're not used to admitting to or talking about. It's almost as if we have an illicit relationship with pain - there’s a bit shame involved in it, as if we should be 'rising above it'. It's not just a medical symptom - it's this hidden aspect of the self. That's why it was so exciting to research - it felt like I was probing right into the deepest darkest parts of people's lives.

Real Audio Sound clip: Pain is our secret life

Pain always comes with a story.

One of the fastest ways to get to really know someone is to hear him or her talk about whatever pain they're in, and have suffered. The book allowed me all these intimate connections with people. The book is full of juicy human stories, as well as history and science.

Pain is as individual as a thumbprint.

Some pain is genetic, and the future of pain treatment will lie in gene research and custom-tailored medication. Pain is related to gender, and a predisposition to some kinds of pain – migraine, for one – is also inherited. Pain is as individual as a thumbprint. Reference: Chapter One, pp 22.

Sound clip: Pain as a thumbprint

Don’t blame the doctors.

The reason doctors can’t treat pain is because they are not taught about pain in medical school. Most medical doctors receive no more than four hours of instruction about pain.

Sound clip: Don't blame the doctors

How did pain come to be known as "the fifth vital sign?"

In America, there has been a recent campaign to treat pain as the fifth vital sign. The idea was launched in 1995 by James Campbell, the president of the American Pain Society. Just as the four traditional vital signs, temperature, respiration, pulse and blood pressure, must be charted, American hospitals are now obliged to assess pain in their patients, too. Reference: Introduction “The Sting."

Why doctors don’t treat pain.

Treating pain requires a more patient-focused approach, and right now medicine is more about doctors and money than patients and their suffering. Pain is hard to measure, AND it’s subjective. To treat pain, you must trust the patient and what s/he says. Doctors have been taught to pay attention to symptoms and disease, rather than the patient’s story and how s/he lives. But this is changing, thanks to a revolution in the way science NOW understands pain. Reference: Chapter One “A Microhistory of Pain,” for history of understanding pain. Reference: Chapter Seven “Hardwiring, Gene Mapping, and Brain Imaging: Descartes Never Dies,” for discussion of scientific advances in the context of culture.

Why not treat pain properly?

The stigma and fear attached to the use of opiates have many people suffering unnecessarily.Reference: Chapter 28 “The Politics of Pain” pp. 283 - 296

Mind over matter – false distinctions in emotional and physical pain.

There is an artificial distinction between emotional and physical pain. It is one of the major stumbling blocks in making progress in the treatment of pain. Reference: Chapter Four “Various Sorts of Living Hell”

Sound clip: Pain is in the brain

Toughing it out can lead to chronic pain.

Ignoring acute pain or toughing out the pain of an injury or sprain can “hardwire” the body and lead to chronic pain. In other words, being brave can end up making your pain worse. Reference: Chapter Four “Various Sorts of Living Hell,” pp.56-59

How to measure your pain.

Ranking pain in terms of “dreadfulness” is pointless since each person’s pain response is different and pain is relative. However, the McGill Pain Questionnaire measures pain intensity and helps make pain visible. Most specialists agree that these pain conditions (in no particular order) would make most top ten lists. Reference: Chapter Three “Catching Pain,” pp. 33-34

Is it fibromyalgia – or depression?

Fibromyalgia is one of the best examples of the black-sheep status of many chronic pain conditions: It is invisible; no one knows what causes it; no clear treatment for it exists; it is not life-threatening; and it can derail your life in almost every important way. Reference: Chapter Ten “Alice,” pp. 33-34

Sound clip: Depression

The Buddhist approach to managing chronic pain.

Dr. Paul Kelly is one of a number of practitioners who is trying to take the suffering out of pain. The technique recognizes the concept of three levels of pain: sensory, cognitive and affective or emotional combined with the tenets of Buddhism. Meditation helps a person feel the distinction between the levels of pain, and gain some control over the anguish and fear of loss of control that accompanies chronic pain. Reference: Chapter Five “Taking the Suffering Out of Pain,” pp. 60-70

Sound clip: Buddhist view on pain

What can chronic pain sufferers do to address their pain?

Patients and doctors must become partners in the treatment of pain, and take a multidisciplinary approach.Reference: Chapter Four “Various Sorts of Living Hell,” pp.44-46

Hollywood is also pain central.

The history of pain is stashed away in a secret archive in a library at UCLA, part of the buried past that THE AUTHOR uncovered in the course of researching. This is where the work of pain pioneers such as William Livingston and Silas Weir Mitchell, the father of modern neurology, is kept. Reference: Chapter Twenty “Pursuing Pain in LA,” pp. 189-218

Who are the real pain experts - doctors, or artists?

At the World Pain Congress in Vienna: how science sees pain, and how artists see pain. Reference: Chapter Eleven “A Spy in the House of Pain,” pp. 114-131

There are different types of pain that demand different types of treatment.

All pain is not created equal. Acute pain is the pain of cracking your knee on the coffee table. Chronic pain is the pain that remains long after the bruise has healed.

Masochists and cutters want to control their pain.

The act of cutting can be a survival strategy. And Bob Flanagan, Supermasochist, made pain a source of pleasure - and humor - to gain control over the affliction of cystic fibrosis. Reference: Chapter 18 “Cutter” and Chapter 19 “Bob Flanagan, Supermasochist”

Hangover Pain

The technical term is brain edema, the swelling and lurching of the tapioca with which you think. Reference: Chapter 26 “The Hangover” pp. 270-273

The Decade of Pain undercut by Bush’s policies

Bill Clinton initiated the signing of a congressional bill that declared the first ten years of this century the “Decade of Pain Research and Awareness.” But pain patients will be the first to be dumped in Bush’s vision of health care. There are things you can do about it.

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