The Pain Chronicles

by Melanie Thernstrom

  pain four years after their surgery: Esther Dajczman et al., “Long-Term Postthoracotomy Pain,” Chest 99 (1991): 270–74.

  study by Dr. Anna Taddio: See Anna Taddio et al., “Effect of Neonatal Circumcision on Pain Response During Subsequent Routine Vaccination,” The Lancet 349 (March 1, 1997): 599–603.

  Botox: See Andrew Blumenfeld et al., “The Emerging Role of Botulinum Toxin Type A in Headache Prevention,” Operative Techniques in Otolaryngology—Head and Neck Surgery 15 (June 2004): 90–96.

  more troublesome side effects: See I. M. Anderson, “Selective Serotonin Reuptake Inhibitors Versus Tricyclic Antidepressants; a Meta-analysis of Efficacy and Tolerability,” Journal of Affective Disorders 58 (2000): 19–36.

  According to a 2002 study: See George Ostapowicz et al., “Results of a Prospective Study of Acute Liver Failure at 17 Tertiary Care Centers in the United States,” Annals of Internal Medicine 137 (December 2002): 947–54.

  as many as one-fourth of all patients: See Jay L. Goldstein and Russell D. Brown, “NSAID-induced Ulcers,” Current Treatment Options in Gastroenterology 3 (2000): 149–57.

  6,000 to 7,500 Americans die: See A. Lanas et al., “A Nationwide Study of Mortality Associated with Hospital Admission Due to Severe Gastrointestinal Events and Those Associated with Nonsteroidal Anti-inflammatory Drug Use,” American Journal of Gastroenterology (August 2005): 1685–93. These estimates were generated from Lanas’s statistics suggesting that the death rate attributed to NSAID/aspirin use was between 21.0 and 24.8 cases per million people, and then multiplying by the U.S. population.

  Women report more frequent pain: See L. LeReseche, “Gender Considerations in the Epidemiology of Chronic Pain,” in Epidemiology of Pain (Seattle: IASP Press, 1999), 43–52, or A. M. Unruh, “Gender Variations in Clinical Pain Experience,” Pain 65 (1996): 123–67. Also K. J. Berkley, “Sex Differences in Pain,” Behavioral Brain Science 20 (1997): 371–80.

  2003 Norwegian study: Anne Werner and Kirsti Malterud, “It’s Hard Work Behaving as a Credible Patient: Encounters Between Women with Chronic Pain and Their Doctors,” Social Science & Medicine 57 (2003): 1409–19.

  2005 Stanford University survey: See “Broad Experience with Pain Sparks a Search for Relief,” ABC News/USA Today/Stanford University Medical Center Poll, May 9, 2005.

  A 2008 survey: See Charles B. Simone et al., “The Utilization of Pain Medications and the Attitudes of Breast Cancer Patients Toward Pain Intervention,” 2009 Breast Cancer Symposium.

  “the paradox of patients’ satisfaction”: See Ree Dawson et al., “Probing the Paradox of Patients’ Satisfaction with Inadequate Pain Management,” Journal of Pain Symptom Management 23 (March 2002): 211–20.

  single most important factor: L. M. McCracken et al., “Assessment of Satisfaction with Treatment for Chronic Pain,” Journal of Pain Symptom Management 14 (1997): 292–99.

  2004 study at the University of Milan: E. Vegni et al., “Stories from Doctors of Patients with Pain: A Qualitative Research of the Physicians’ Perspective” Support Care Cancer 13 (2005): 18–25.

  one-third and one-half: See Thorsten Giesecke et al., “The Relationship Between Depression, Clinical Pain, and Experimental Pain in a Chronic Pain Cohort,” Arthritis & Rheumatism 52 (2005): 1577–84 and studies discussed in Jeffrey Dersh et al., “Chronic Pain and Psychopathology: Research Findings and Considerations,” Psychosomatic Medicine 64 (2002): 773–86.

  Stanford University study of major depression: Alan Schatzberg et al., “Using Chronic Pain to Predict Depressive Morbidity in the General Population,” Archives of General Psychiatry 60 (2003): 39–47.

  review study led by Dr. David A. Fishbain: See D. A. Fishbain et al., “Chronic Pain Associated Depression: Antecedent or Consequence of Chronic Pain? A Review,” Clinical Journal of Pain 13 (1997): 116–37.

  a common genetic vulnerability: See, for example, Dan Buskila, “Biology and Therapy of Fibromyalgia: Genetic Aspects of Fibromyalgia Syndrome,” Arthritis Research & Therapy 8 (2006).

  Brain imaging scans reveal similar disturbances: Thorsten Giesecke et al., “The Relationship Between Depression, Clinical Pain, and Experimental Pain in a Chronic Pain Cohort,” Arthritis & Rheumatism 52 (2005): 1577–84.

  abnormalities in the neurotransmitters serotonin and norepinephrine: See Matthew J. Bair, “Depression and Pain Comorbidity: A Literature Review,” Archives of Internal Medicine 163 (2003): 2433–45.

  depleting serotonin increases their pain responses: See L. D. Lytle et al., “Effects of Long-term Corn Consumption on Brain Serotonin and the Response to Electric Shock,” Science 190 (November 14, 1975): 692–94.

  not above growing and selling: See Jung Chang and Jon Halliday, Mao: The Unknown Story (New York: Knopf, 2005), 276.

  “prolific in caresses and betrayals”: See Charles-Pierre Baudelaire, “The Double Room,” in Baudelaire in English (New York: Penguin, 1998), 238.

  2003 study led by Dr. Kathleen Foley: See Kathleen Foley, “Opioids and Chronic Neuropathic Pain,” New England Journal of Medicine 348 (2003): 1279–81 and M. C. Rowbotham et al., “Oral Opioid Therapy for Chronic Peripheral and Central Neuropathic Pain,” New England Journal of Medicine 348 (2003): 1223–32.

  slightly above 3 percent: D. A. Fishbain et al., “What Percentage of Chronic Nonmalignant Pain Patients Exposed to Chronic Opioid Analgesic Therapy Develop Abuse/Addiction and/or Aberrant Drug-related Behaviors? A Structured Evidence-based Review,” Pain Medicine 9 (2008): 444–59.

  moral equivalent of inflicting pain: See Morris, The Culture of Pain, 191. “The crucial point,” he writes, “beyond showing how fears of pain can destroy a person as effectively as cancer, is that not relieving pain brushes dangerously close to the act of willfully inflicting it.”

  higher than 80 mg: See Table 2 in “Interagency Guideline on Opioid Dosing for Chronic Non-Cancer Pain,” Washington State Agency Medical Directors’ Group, March 2007.

  fifteen such specialists: See “Pain Management Specialists Directory,” Washington State Agency Medical Directors’ Group, March 17, 2008.

  action plan on OxyContin: See “Action Plan to Prevent the Diversion and Abuse of Oxycontin,” Office of Diversion Control, U.S. Department of Justice, February 8, 2001.

  Tina Rosenberg: See Rosenberg’s excellent article, “When Is a Pain Doctor a Drug Pusher?” New York Times Magazine, June 17, 2007.

  women are given psychotropic medications: Cited in Jeffrey F. Peipert, Primary Care for Women, 2nd Edition (Philadelphia: Lippincott Williams & Wilkins, 2004), 51.

  “drug-seeking behavior”: See R. Payne, “Sickle Cell–Related Pain: Perceptions of Medical Practitioners,” Journal of Pain Symptom Management 14 (1997): 168–74.

  2005 study: See Ian Chen et al., “Racial Differences in Opioid Use for Chronic Nonmalignant Pain,” Journal of General Internal Medicine 20 (July 2005): 593–98.

  blacks as less compliant: Michelle van Ryn and Jane Burke, “The Effect of Patient Race and Socio-economic Status on Physicians’ Perceptions of Patients,” Social Science and Medicine 50 (March 2000): 813–26.

  invisible hierarchy of pain sensitivity: Pernick, A Calculus of Suffering, 157. Pernick details how theories of pain sensitivity were used in the decades after anesthesia’s discovery as a basis for prescribing appropriate doses.

  Greek physician Galen: Galen attributed pain to two disparate causes: dissolution of continuity in tissues, such as cuts or burns, or violent commotion in the humors. Harmony of the humors could be achieved through drugs or bloodletting and purgation.

  “a subjective matter”: Fülöp-Miller, Triumph Over Pain, 397.

  “The savage does not feel pain as we do”: Silas Weir Mitchell, Characteristics: A Novel (New York: The Century, 1913), 13.

  Cesare Lombroso: Cesare Lombroso, Criminal Man, ed. and trans. Mary Gibson, Nicole Hahn Rafter (Durham: Duke University Press, 2006), 63, 69.

  Slaves’ animal natures dulled them to pain: God supported the social structure, Reverend Thomas
Morong argued in his 1858 treatise The Beneficence of Pain, by endowing pain sensitivity according to circumstances—mitigating slaves’ lots with an extra capacity for endurance. See Pernick, A Calculus of Suffering, 156.

  “will bear cutting”: See Dr. James Johnson in The Medico-Chirurgical Review and Journal of Medical Science 9 (Burgess and Hill, 1826): 620.

  “the Negro . . . has a greater insensibility to pain”: A. P. Merrill, “An Essay on Some of the Distinctive Peculiarities of the Negro Race,” Southern Medical and Surgical Journal 7 (1856). Merrill writes:

  But slaves are submissive, and effective laborers, under very different treatment [from being treated with a “spirit of kindness”]. They submit to and bear the infliction of the rod with a surprizing [sic] degree of resignation, and even cheerfulness; and indeed manifest in many cases a strong and unwavering attachment to the hand which inflicts the punishment, particularly if it be the hand of the owner, or some person who has the right to exercise government over them. They are a submissive and yielding race, wholly incapable of bearing malice on account of their degraded condition as slaves; and equally incapable of forming and maintaining, an effective and permanent organization among themselves, to assert their freedom, or to avenge their wrongs. They differ from their white masters in no one particular more than this. (pp. 35–56)

  James Paget: James Paget, “Experiments on Animals,” in Selected Essays and Addresses (New York: Longmans, Green, and Co., 1902), 338. This comment occurs in the context of a discussion of the justification of pain inflicted on animals based on utility to humans, evoking Pernick’s notion of a hierarchy of pain sensitivity.

  Sims obtained several Alabama slaves: See J. Marion Sims, The Story of My Life (New York: D. Appleton and Co., 1894), 222–46.

  White children were subject to similar debate: Educational theorists such as Horace Mann prescribed vigorous physical education as an antidote. See Horace Mann, Lectures on Education (Boston: Ide & Dutton, 1855), 313–14; Herbert Spencer, Education: Intellectual, Physical, and Moral (New York: D. Appleton and Co., 1901), 39; and Pernick, A Calculus of Suffering, 152.

  “With her exalted spiritualism”: John Gideon Millingen, The Passions; or Mind and Matter (London: J. & D. A. Darling, 1848), 157.

  “exceedingly painful”: Pernick, A Calculus of Suffering, 153.

  variations of which are found in classical India: See Antti Aarne, The Types of the Folktale, trans. Stith Thompson (Helsinki: Suomalainen Tiedeakatemia, 1964), 240.

  1835 Andersen version of “The Princess and the Pea”: See Hans Christian Andersen, “The Princess and the Pea,” in The Annotated Classic Fairy Tales, ed. Maria Tatar (New York: W. W. Norton, 2002), 284–87.

  well-known study of housewives in the late 1960s: R. A. Sternbach, “Ethnic Differences Among Housewives in Psychophysical and Skin Potential Response to Electric Shock,” Psychophysiology 1 (1965): 241–46.

  tolerance markedly increased for Jewish subjects: See E. Poser, “Some Psychosocial Determinants of Pain Tolerance.” Read at the sixteenth International Congress of Psychology, Washington, D.C., 1963.

  hold their hands in painfully icy water: Richard Stephens et al., “Swearing as a Response to Pain,” NeuroReport 20 (August 5, 2009): 1056–60.

  benchmark 1972 Stanford University study: Kenneth M. Woodrow et al., “Pain Tolerance: Differences According to Age, Sex and Race,” Psychosomatic Medicine 34 (1972): 548–56.

  blacks showed more tolerance than Asian Americans: The Asian group mixed subjects of Japanese and Chinese descent.

  women are more responsive to kappa-receptor drugs: See H. L. Fields et al., “Brainstem Pain Modulating Circuitry Is Sexually Dimorphic with Respect to Mu and Kappa Opioid Receptor Function,” Pain 85 (2000): 153–59, and Jon D. Levine et al., “Kappa-Opioids Produce Significantly Greater Analgesia in Women Than in Men,” Nature Medicine 2 (1996): 1248–50.

  drug had opposite effects on the two sexes: See J. D. Levine et al., “The Kappa Opioid Nalbuphine Produces Gender- and Dose-Dependent Analgesia and Antianalgesia in Patients with Postoperative Pain,” Pain 83 (1999): 339–45.

  MC1R: See J. S. Mogil et al., “The Melanocortin-1 Receptor Gene Mediates Female-Specific Mechanisms of Analgesia in Mice and Humans,” Proceedings of the National Academy of Sciences 100 (April 15, 2003): 4867–72.

  2003 study . . . of postsurgical pain following: M. Soledad Cepeda and Daniel B. Carr, “Women Experience More Pain and Require More Morphine Than Men to Achieve a Similar Degree of Analgesia,” Anesthesia & Analgesia 97 (2003): 1464–68.

  men receive more analgesic benefit: See, for example, J. S. Walker, “Experimental Pain in Healthy Human Subjects: Gender Differences in Nociception and in Response to Ibuprofen,” Anesthesia & Analgesia 86 (1998): 1257–62.

  20 percent more general anesthesia: See E. B. Liem et al., “Anesthetic Requirement is Increased in Redheads,” Anesthesiology 101 (August 2004): 279–83.

  2006 Ohio State University study: See Lee Bowman, “Obese People More Sensitive to Pain, Study Finds,” Scripps Howard News Service, March 1, 2006.

  little or inadequate anesthesia: See Philip M. Boffey, “Infants’ Sense of Pain Is Recognized, Finally,” New York Times, November 24, 1987, and Helen Harrison, “Why Infant Surgery Without Anesthesia Went Unchallenged,” New York Times, December 17, 1987.

  editorial in The New England Journal of Medicine: See A. B. Fletcher, “Pain in the Neonate,” New England Journal of Medicine 317 (November 19, 1987).

  study led by Dr. Robert R. Edwards: Robert R. Edwards, “Individual Differences in Endogenous Pain Modulation as a Risk Factor for Chronic Pain,” Neurology 65 (2005): 437–43.

  subgroup of African Americans: See M. McNeilly, “Neuropeptide and Cardiovascular Responses to Intravenous Catheterization in Normotensive and Hypertensive Blacks and Whites,” Health Psychology 8 (1989): 487–501.

  A 2005 study at the University of North Carolina: M. Beth Mechlin et al., “African Americans Show Alterations in Endogenous Pain Regulatory Mechanisms and Reduced Pain Tolerance to Experimental Pain Procedures,” Psychosomatic Medicine 67 (2005): 948–56.

  Ethiopian Jews have a gene variation: H. R. Lou et al., “Polymorphisms of CYP2C19 and CYP2D6 in Israeli Ethnic Groups,” American Journal of Pharmacogenomics, Genomics-related Research in Drug Development and Clinical Practice 4 (6:2004), 395–401.

  article by Dr. Robert R. Edwards: Robert R. Edwards, “Individual Differences in Endogenous Pain Modulation as a Risk Factor for Chronic Pain,” Neurology 65 (2005): 437–43.

  victims of childhood sexual abuse: See E. Walker et al., “Relationship of Chronic Pelvic Pain to Psychiatric Diagnoses and Childhood Sexual Abuse,” American Journal of Psychiatry 145 (1988): 75–80.

  2005 study published in Human Molecular Genetics: See L. Diatchenko et al., “Genetic Basis for Individual Variations in Pain Perception and the Development of a Chronic Pain Condition,” Human Molecular Genetics 14 (2005): 135–43.

  Another recent study: Frank Reimann et al., “Pain Perception Is Altered by a Nucleotide Polymorphism in SCN9A,” Proceedings of the National Academy of Sciences 107 (March 16, 2010): 5148–53.

  Danish survey: See E. Aasvang and H. Kehlet, “Chronic Postoperative Pain: The Case of Inguinal Herniorrhaphy,” British Journal of Anaesthesia 95 (2005): 69–76.

  British study found that 30 percent: A. S. Poobalan et al., “Chronic Pain and Quality of Life Following Open Inguinal Hernia Repair,” British Journal of Surgery 88 (2001): 1122–26.

  One of Dr. Apkarian’s studies: See A. Vania Apkarian et al., “Chronic Back Pain Is Associated with Decreased Prefrontal and Thalamic Gray Matter Density,” Journal of Neuroscience 24 (November 17, 2004): 10410–415.

  a quarter or more of Americans: See “Health, United States, 2006: With Charts on Trends in the Health of Americans,” Centers for Disease Control, p. 74.

  for a quarter of those: Ibid., 86. “Overall, 28% of adults with low back pain said they had a limitation of activity caused
by a chronic condition.”

  The amount of gray matter: See Richard J. Haier, “Structural Brain Variation and General Intelligence,” NeuroImage 23 (September 2004): 425–33.

  losses amounting to between 5 and 11 percent: See Apkarian et al., “Chronic Back Pain Is Associated with Decreased Prefrontal and Thalamic Gray Matter Density,” Journal of Neuroscience 24 (November 17, 2004): 10410–415.

  1.3 cubic centimeters: Ibid.

  IV. FINDING A VOICE: PAIN AS NARRATIVE

  “Physical pain has no voice”: Scarry, The Body in Pain, 3.

  treat the patient rather than the disease: See Owsei Temkin, The Double Face of Janus and Other Essays in the History of Medicine (Baltimore: Johns Hopkins University Press, 2006), 454.

  “What is the matter with you?”: Foucault, The Birth of the Clinic, xxi.

  Kitchen Table Wisdom: See Rachel Naomi Remen, Kitchen Table Wisdom: Stories That Heal (New York: Riverhead, 1997).

  “the factors that convert”: Eric J. Cassell, The Nature of Suffering and the Goals of Medicine (New York: Oxford University Press, 2004), 46.

  Chosen integrative pain: For a discussion of integrative vs. disintegrative pain, see Glucklich’s Sacred Pain, 33–34 and David Bakan’s Disease, Pain, and Sacrifice: Toward a Psychology of Suffering (Chicago: University of Chicago Press, 1968), 31–38, 67–85.

  “One word frees us”: See Sophocles, The Oedipus Cycle (Boston: Houghton Mifflin Harcourt, 2002), 165.

  recruited Stanford students: Data taken from Jared Younger, Sean Mackey et al., “Passionate Love Reduces Pain Via Activation of Reward Systems.” (Prepublication copy sent to author by Sean Mackey.)

  Researchers at Oxford University: See “Pulling Together Increases Your Pain Threshold,” University of Oxford press release, September 28, 2009.

  telic centralizing: See Bakan, Disease, Pain, and Sacrifice, 31–38, 67–85.

  “whoever was tortured”: Jean Améry, At the Mind’s Limits (Bloomington, Ind.: Indiana University Press, 1998), 34.