The Pain Chronicles (41 page)

baby before age twenty
: See U.S. Department of Health & Human Services, “Breast Cancer: Risk Factors and Prevention,”
http://www.womenshealth.gov/breast-cancer/risk-factors-prevention
, accessed October 21, 2009.

“Dealing with Difficult Patients”
: See Ajay D. Wasan et al., “Dealing with Difficult Patients in Your Pain Practice,”
Regional Anesthesia and Pain Medicine
30 (March/April 2005): 184–92.

a large study at a primary care clinic
: The cited study is J. L. Jackson and K. Kroenke, “The Effect of Unmet Expectation Among Adults Presenting with Physical Symptoms,”
Annals of Internal Medicine
134 (2001): 889–97.

30 to 50 percent of chronic pain patients
: Wasan, “Dealing with Difficult Patients,” 188.

same kind of pathological pain sensitivity
: See L. F. Chu et al., “Opioid-Induced Hyperalgesia in Humans: Molecular Mechanisms and Clinical Considerations,”
Clinical Journal of Pain
24 (July/August 2008): 479–96.

patient’s relationship with his or her doctor
: See, for example, John D. Piette et al., “The Role of Patient-Physician Trust in Moderating Medication Nonadherence Due to Cost Pressures,”
Archives of Internal Medicine
165 (2005): 1749–55.

low rates of response to a placebo
: See Harriët Wittink and Theresa Hoskins Michel,
Chronic Pain Management for Physical Therapists
(Boston: Butterworth-Heinemann, 2002), 295. The authors say that reaction to a placebo is closely correlated to whether the patient expects positive outcomes.

“Build . . . an illness narrative”
: Arthur Kleinman,
The Illness Narratives
(New York: Basic Books, 1988), 54.

“Even comparatively well-adjusted patients”
: Wasan, “Dealing with Difficult Patients,” 185.

At the Will of the Body: Arthur W. Frank,
At the Will of the Body
:
Reflections on Illness
(Boston: Houghton Mifflin Harcourt, 2002).

higher rate of them on Vioxx
: See Robert S. Bresalier, “Cardiovascular Events Associated with Rofecoxib in a Colorectal Adenoma Chemoprevention Trial,”
New England Journal of Medicine
355 (March 17, 2005).

poses some cardiovascular risks for the same population as Vioxx did
: Celebrex is a Cox-2 inhibitor like Vioxx, but “the literature concerning the [cardiovascular] risk with the use of celecoxib is more heterogeneous” than that of Vioxx. See “Cardiovascular Risk Associated with Celecoxib,”
New England Journal of Medicine
352 (June 23, 2005): 2648–50.

reduced the risk of breast cancer by 71 percent
: Randall E. Harris et al., “Reduction in the Risk of Human Breast Cancer by Selective Cycloxygenase-2 (COX-2) Inhibitors,”
BMC Cancer
6 (2006).

A 2005 study
: David W. Dodick et al., “Botulinum Toxin Type A for the Prophylaxis of Chronic Daily Headache: Subgroup Analysis of Patients Not Receiving Other Prophylactic Medications: A Randomized Double-Blind, Placebo-Controlled Study,”
Headache
45 (2005): 315–24.

“How high that highest candle”
: This is from the Stevens poem “Final Soliloquy of the Interior Paramour.” See Wallace Stevens,
The Collected Poems of Wallace Stevens
(New York: Knopf, 1954), 524.

“Filled with a sense of injustice and self-pity”
: See Remen,
Kitchen Table Wisdom
, 115–18.

V. TO CURE THE MIND: PAIN AS PERCEPTION

As Wittgenstein observes
: Ludwig Wittgenstein,
Philosophical Investigations: The German Text, with a Revised English Translation
(Oxford: Wiley-Blackwell, 2001), 84.

For Hippocrates, pain was a physical sensation
: For Hippocrates, pain as a sensation is physical and overwhelming, while for Aristotle pain as an emotion is cerebral and thus controllable. Pain, for Aristotle, seems largely an internal or mental affair, that might be overcome with willpower or the dominance of reason over bodily functions. At times Aristotle writes of pain (and pleasure) as
perceptions
of emotions (which appear to be akin to sensations—the
aisteta
of emotions come from the verb
aistanomai
, “to perceive or apprehend with the senses”). Aristotle writes, “Let the emotions be all those things on account of which people change their minds and differ in regard to their judgments,
and upon which attend pain and pleasure
, for example anger, pity, fear, and all other such things and their opposites” (emphasis added). Cited in David Konstan,
The Emotions of the Ancient Greeks
(University of Toronto Press, 2006), 33.

“we may sometimes suffer”
: René Descartes,
The Philosophical Writings of Descartes
, volume 1, ed. John Cottingham (Cambridge: Cambridge University Press, 1985), 361.

“I had never been shot”
: See Wall,
Pain
, 7.

“Pain is whatever”
: Margo McCaffery,
Nursing Practice Theories Related to Cognition, Bodily Pain, and Man-Environment Interactions
(Los Angeles: UCLA Press, 1968), 95.

“An unpleasant sensory and emotional”
: See Chryssoula Lascaratou,
The Language of Pain: Expression or Description
(Amsterdam: John Benjamins, 2007), 15.

Each of these regions
: For an excellent technical account of how pain works see Michael J. Cousins, Philip O. Bridenbaugh, Daniel B. Carr, and Terese T. Horlocker, eds.,
Cousins & Bridenbaugh’s Neural Blockade In Clinical Anesthesia and Management of Pain
, 4th ed. (Philadelphia: Lippincott Williams & Wilkins, 2009), 693–751. This is widely considered the most authoritative academic textbook on pain medicine for health professionals, edited by the leading figures in the field.

“thousands of spirit limbs”
: Robert Fitridge, Matthew Thompson,
Mechanisms of Vascular Disease: A Textbook for Vascular Surgeons
(Cambridge: Cambridge University Press, 2007), 302.

studies at Oxford University
: See Irene Tracey et al., “Imaging Attentional Modulation of Pain in the Periaqueductal Gray in Humans,”
The Journal of Neuroscience
22 (April 1, 2002): 2748–52.

Ordinary distraction
: Susanna J. Bantick et al., “Imaging How Attention Modulates Pain in Humans Using Functional MRI,”
Brain
125 (February 1, 2002): 310–19.

Even smells influence pain
: Chantal Villemure et al., “Effects of Odors on Pain Perception: Deciphering the Roles of Emotion and Attention,”
Pain
106 (November 2003): 101–8.

the brains of men were imaged
: Jon-Kar Zubieta et al., “Placebo Effects Mediated by Endogenous Opioid Activity on µ-Opioid Receptors,”
The Journal of Neuroscience
25 (August 24, 2005): 7754–62.

“the contemplation of divine things”
: Cited in Fülöp-Miller,
Triumph Over Pain
, 19.

The patients at the hospital
: Wall,
Pain
, 71–72.

The theory of learned helplessness
: See Martin Seligman and Steven Maier, “Failure to Escape Traumatic Shock,”
Journal of Experimental Psychology
74 (1967): 1–9.

1930s Thai Buddhist monk
: Kamala Tiyavanich,
Forest Recollections: Wandering Monks in Twentieth Century Thailand
(Honolulu: University of Hawaii Press, 1997), 111. Also cited in Glucklich,
Sacred Pain
, 20.

theorizes that intense pain
: Glucklich,
Sacred Pain
, 30.

“
neurosignature”
: Ronald Melzack, “Pain and the Neuromatrix in the Brain,”
Journal of Dental Education
65 (December 2001): 1378–82.

“either terrifying or exhilarating”
: Glucklich,
Sacred Pain
, 60.

This learning effect
: Christopher deCharms et al., “Control Over Brain Activation and Pain Learned by Using Real-time Functional MRI,”
Proceedings of the National Academy of Sciences
102 (December 20, 2005): 18626–31.

London cabdrivers
: Eleanor Maguire et al., “Navigation-Related Structural Change in the Hippocampi of Taxi Drivers,”
Proceedings of the National Academy of Sciences
97 (April 11, 2000): 4398–4403.

learning to juggle creates visible changes
: See Bogdan Draganski et al., “Neuroplasticity: Changes in Grey Matter Induced by Training,”
Nature
427 (January 22, 2004): 311–12.

ACKNOWLEDGMENTS

In the eight years I was working on this book, there were many helping hands.

I was honored to work with Eric Chinski, who has the three qualities an editor needs: keen insight, steady kindness, and extreme patience. Thanks to Eugenie Cha for invaluable assistance in the publication process, to Chris Peterson for copyediting, to Rebecca Saletan for her early support, and to Sarita Varma for publicity. My wonderful agent, Henry Dunow, came through for me at every stage.

Ilena Silverman at
The New York Times Magazine
not only worked with me on pain-related articles, but lent her talents to crafting the manuscript. Huge thanks to her. Thanks to Gerry Marzorati for giving me a journalistic home and to Dean Robinson, who first gave me an assignment to write about chronic pain. I cannot thank Charles Wilson enough for the scrupulous fact-checking and research assistance that rescued me from mortifying misconceptions and mistakes, both large and small. Sara Brumfield lent her expertise in Near Eastern languages and civilizations, as did Elisha Cohn with Victorian history, Joy Connolly and Ben Platt with ancient Greek and Roman civilization, and James Mickle with medical expertise.

I am blessed to have a circle of gifted and giving writerly friends who took time away from their own work to improve mine. Cynthia Baughman, Brian Hall, Julie Hilden, Tom Reiss, and Michael Ryan read multiple drafts and drew me a new map each time I was lost in the thicket of the subject. Deborah Baker, Jeff Dolven, Jascha Hoffman, Robert Klitzman, Dani Shapiro, and Joshua Wolf Shenk also offered valuable guidance and moral support along the way. Mark Woods meticulously polished countless sentences, and Kristin Thiel provided crucial assistance in the final stages. Thanks, too, to Kevin Baker, Max Berger, Susan Cheever, Nicholas Dawidoff, Richard Halpern, Oliver Hobert, Dan Kaufman, Bonnie Lee, David Lipsky, Amanda Robb, and David Shaffer.

In researching this book I had the opportunity to observe the practices of some extraordinary physicians. Through the years, conversations with and observations of the practices of Daniel Carr, Scott Fishman, John Keltner, and Sean Mackey stamped my understanding both of pain and of how good pain medicine can be. Scott Fishman lends his talents as president to a valuable pain-advocacy organization for patients, the American Pain Foundation, that has helped me as a patient as well as a researcher. I owe a profound intellectual debt to Daniel Carr, whose insights about pain are drawn on throughout this book.

While researching the book and pain-related articles, I was grateful to observe the practices of or interview many leading clinicians, researchers, and scholars, including Allan Basbaum, Pamela Bennett, Charles Berde, David Borsook, Bertie Bregman, William Breitbart, Kenneth Casey, Eric Cassell, Richard Chapman, Rita Charon, B. Eliot Cole, Ray D’amours, Christopher deCharms, Stuart Derbyshire, Richard Deyo, Steven Feinberg, Philip Fisher, Kathleen Foley, Arthur Frank, Rebecca Garden, Ariel Glucklich, Christine Greco, Geoffrey Hartman, Craig Irvine, Jean Jackson, Donald Kaminsky, Peter Koo, Lynda Krasenbaum, Paul Kreis, Kathryn Lasch, Sophie Laurent et Nuno de Sousa, Alyssa Lebel, J. K. Lilly, John Loeser, Alexander Mauskop, Michell Max, Patrick McGrath, Jacques Meynadier, Christine Miaskowski, David Morris, Jeffrey Ngeow, Richard Payne, Clint Phillips, Russell Portenoy, Joshua Prager, Ali Rezai, Daniel Rockers, Alain Serrie, Mark Sullivan, Irene Tracey, Dennis Turk, Vijay Vad, Frank Vertosick, Seth Waldman, and Clifford Woolf, among others. Apologies to anyone I may have omitted! I also benefited from observing the excellent Tufts University program in pain research, education, and policy, and from participating in a conference at the Rockefeller Foundation Bellagio Center in Italy, “Narrative, Pain, and Suffering,” organized by Daniel Carr, John Loeser, and Davis Morris (writing from which is collected in the volume
Narrative, Pain, and Suffering
, published by IASP Press).

Few writers in history, apart from members of royal families, have been granted more pleasant circumstances in which to slave over an impossible subject than I was when Ellis Alden allowed me to live in his marvelous hotel, the Stanford Park, for several months while researching pain at Stanford University, and then went on to offer extensive comments on my draft. Myriad thanks to him and his wife, Karen. Crucial work on this book was also done at Yaddo, as well as the Writers Room and Paragraph. Thanks to Jeffrey and Rachel Selin for creating the Writers’ Dojo in Portland, where I wrote the final draft of my book.

Thanks to all the patients in this book who allowed me to observe their appointments and shared their experiences with me over the years. Particular thanks to Danielle Parker and Holly Wilson, whose stories I hope the reader will find as inspiring as I do.

Finally, I am lucky to have an extended family who includes editing among their familial duties. Many thanks to my parents, Stephan and Abigail; my father-in-law, Jim; and my mother-in-law, Felicity, who showed forbearance when I continued to split infinitives. My deepest intellectual and emotional sustenance came from my husband, Michael Callahan. I knew he had read too many drafts when he looked up and commented, about a single sentence, “Why did you drop the eel image?” Love and thanks to him for not only improving my prose, but for giving my story a happy ending in the deepest sense of the word. I cannot imagine a better partner. I hope that by the time our children, Violet and Kieran, are old enough to read this book, they will find it antiquated, as we do conditions that afflicted earlier generations and which we no longer can—or wish to—fully imagine.