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'Pain Chronicles': Understanding Pain As A Disease

Aug 19, 2010 (Talk of the Nation)

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Most people think they understand pain: An injury hurts, but it eventually heals and the pain fades away. But chronic pain, author Melanie Thernstrom tells NPR's Neal Conan, is different. It's a disease, she says, and more than 70 million Americans live with it each day.

Thernstrom's own journey with chronic pain began years ago when she developed persistent pain in her neck after swimming. The pain quickly spread to her shoulder and eventually her hand.

Thernstrom sought relief from multiple doctors but was frustrated to find they preferred to focus on pain management rather than a cure for her condition.

"I would think, well, you're not the doctor for me," she says, "because I'm not interested in managing my pain, I'm interested in having my pain cured."

It was not until Thernstrom, a journalist, was assigned to write an article about chronic pain that she began to understand she would never find a cure. She talked to doctors and scientists in pain clinics across the country, and learned that chronic pain was not a temporary condition but an actual disease that requires daily management.

Thernstrom says that ordinary pain, such as the kind that results from an injury, will eventually fade.

"The difference with chronic pain is that it actually worsens over time," she says. "Patients have this eerie experience that pain begins to lead a life of its own."

According to Thernstrom, ordinary pain has served a critical function in human evolution by providing negative feedback when a person touches a hot flame or hyperextends a joint. But chronic pain, she says, is not protective: "Chronic pain doesn't actually serve any function; it's simply the pain system itself going haywire."

A common misperception about pain, Thernstrom explains, is that it originates in the body. In reality, pain is a perception in the brain, which explains why many amputees experience "phantom" pain in a missing limb.

But while misfires in the brain may cause chronic pain, Thernstrom stresses that the brain also has the ability to control pain. She says the brain has its own "internal pain modulation systems" that can relieve painful sensations, and finding ways to tap into those systems can make living with pain more manageable.

One of the best ways to tap into the system is through distraction. Many people suffering from chronic pain have an impulse to withdraw from day-to-day life, Thernstrom says, but withdrawing often makes the pain worse.

"Trying to focus on other things and trying to go about your life — even when you feel like you're pretending — really is the best pain treatment," she says. Distracting the mind "literally keeps your brain from generating pain."

Thernstrom adds that medication, surgery and alternative therapies — like hypnosis or meditation — can also work for many pain sufferers. What's important is for each individual to find a treatment that reduces his or her pain to a manageable level.

"When pain is the first or second thing in your mind, life just isn't worth living," she says. "When pain is the fifth or sixth thing in your consciousness ... It's in the background of your thoughts and no longer drives you crazy."

Copyright 2014 NPR. To see more, visit http://www.npr.org/.

The Pain Chronicles: Cures, Myths, Mysteries, Prayers, Diaries, Brain Scans, Healing, and the Science of Suffering
By Melanie Thernstrom
Hardcover, 384 pages
Farrar, Straus and Giroux
List price: $27
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