The Dark World of Chronic Pain

Melanie Thernstrom's pain began in her neck. It radiated down her right shoulder into her arm and, over time, became excruciating. "To be in pain is to find yourself in a different realm," she writes in her new book, The Pain Chronicles. "'Will you ever go home,' you begin to wonder, 'home to your normal body, thoughts, life?'" Part personal narrative, part sharp-eyed investigation of a disorder that affects 70 million Americans yet remains one of our most undertreated diseases, The Pain Chronicles blends cutting-edge research, cultural and medical history, and real people's stories to try to make sense of the suffering. We asked Thernstrom what she learned.

Q: Your book cites a terrifying statistic: Aging causes the brain to atrophy at a rate of half a percent a year, but chronic pain causes it to atrophy twice as fast.

That's true. What's even scarier is that doctors don't know why. In fact, most doctors still don't think of pain as a disease; they think of it only as a symptom of something else. Yet chronic pain actually causes pathological changes in a person's brain. For example, the pain pathways grow bigger, recruiting more and more nerves to their service, which explains why pain tends to worsen as time goes on.

Q: You spent a year and a half with chronic pain before you were diagnosed with nerve damage from osteoarthritis. Until that point, you say you actually believed the pain was in your head.

I wanted to believe it was psychological because that meant it lay within my power to cure it. I was devastated when the MRI showed that it wasn't.

Q: Had your doctors suggested that the pain wasn't real?

No, but many women I interviewed had that experience. In the book, I tell the story of Leigh Burke, who had chronic pain following a brain tumor operation. For seven years, she saw a nice doctor who told her she had tension headaches. In fact, a nerve in her head had been severed during surgery. When she finally saw another specialist, he prescribed medicines that actually helped. I asked the first doctor why he had diagnosed tension headaches, and he said, "I thought she was a tense person." Of course she was tense! She had blinding pain in her head!

Q: Is that kind of misdiagnosis typical?

Studies have shown that pain in women is viewed much more skeptically than in men. Men are more likely to be given physical exams while women are more likely to be prescribed psychotropic medication.

Q: And chronic pain is more common in women, right?

Yes, women generally have a lower pain tolerance. We're not sure why—maybe because pain sensitivity is influenced by genes that are linked to gender.

Q: What does the future of pain treatment look like?

We know that the brain can actually turn off pain. This happens with placebos, for example, and in life-threatening situations like a battle during a war. Once we have a better understanding of the brain's pain modulating system, perhaps we could train people to activate it themselves. Genetic research is another frontier. It could lead to, say, a drug that blocks the genes that are making you sensitive to pain. I've heard doctors say, "We're not about to cure cancer or heart disease any time soon, but there will be effective treatments for pain in the coming decade or two." We'll take it.