'The Pain Chronicles' explores the world of chronic pain

'The Pain Chronicles: Cures, Myths, Mysteries, Prayers, Diaries, Brain Scans, Healing and the Science of Suffering'

by Melanie Thernstrom

Farrar, Straus and Giroux, 328 pp., $27

Pain, most of the time, makes sense. It happens for a clear reason: Break a leg and it's going to hurt.

Even booming migraines and ruptured discs have a kind of logic. That's "acute pain," and it warns us something's wrong. When the broken things abate or mend, the pain quits.

Melanie Thernstrom is concerned with a very different animal: one that lives on long after it has served its purpose and "transforms into the pathology of chronic pain." That "pathology" bit is important, because this isn't just pain that lasts longer, it's the body's failure to return to normal.

Chronic pain, Thernstrom notes, is like a security alarm that never quits ringing, so itself becomes the problem.

She writes from personal experience, having suffered for years from pain of various intensities and locations, especially of shoulder and neck. Pain that imprisoned her and either baffled doctors or was shrugged off by them.

"The Pain Chronicles" presents a clear, useful analysis of this phenomenon along with (as the subtitle indicates) a bit too much interdisciplinary traveling through the history of human suffering.

While impressive in its scope of research into literature, history, art, religion and other disciplines, this book is strongest when it considers the science and present-day medical challenges of pain management. References from Thernstrom's "pain diary" keep it real and accessible.

Thernstrom is widely published in national magazines and has written two critically praised books, "Halfway Heaven: Diary of a Harvard Murder" and "Dead Girl."

She's a blessing for the layperson, cogently sorting out the many streams that can feed into a pool of pain: neuropathic (related to nerve dysfunction or damage); musculoskeletal (from muscles, bones, tissue); nociceptive (from tissue damage); psychogenic (caused or aggravated by emotional factors).

More than one factor is usually to blame for chronic pain. The backache thought to be musculoskeletal injury may have a "hidden neuropathic component" and is exacerbated by lack of sleep, anxiety and marital tension connected to a partner's long, unexplained suffering. That back pain may also be worsened by medical providers not trained, able or willing to fit the puzzle pieces together.

So, for example, irritable bowel syndrome might be miscast as a gut issue and left at that, instead of considering central nervous system causes. Or a patient complaining long after surgical pain would normally have subsided will be dismissed as a whiny drug seeker jonesing for narcotics.

To be fair, as the author says, "one of the limitations of pain treatment today is that pain presents the same symptom regardless of how or what type of pain it is," and technology such as brain scanning, while remarkable, is not yet able to solve these mysteries.

"The Pain Chronicles" may be bittersweet for its likely readers — those who have dealt with this issue in their own lives. I have watched two family members die after long struggles against chronic pain, and in both cases the diagnoses hindered recovery and the treatments hastened death.

The most shocking thing is how little gain was made in the understanding of debilitating chronic pain from the time of the first incident to the second — a span of 30 years.

It can be difficult to learn some of what "The Pain Chronicles" has to teach, realizing in hindsight how thoroughly doctors and family missed the boat. Thernstrom is pushing progress. It can't come fast enough.

Kimberly Marlowe Hartnett is a Portland writer who blogs at http://www.TypeLikeTheWind.com