An unflinching look at pain

Part memoir, part journalism, an examination of the history, causes, and treatment of the chronic suffering that plagues millions

By Alec Solomita
Globe Correspondent / August 22, 2010

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You don’t have to be a masochist to derive a great deal of pleasure from Melanie Thernstrom’s “The Pain Chronicles.’’ An ingenious mix of science, history, investigative journalism, and memoir, Thernstrom’s book attempts (mostly successfully) to pin down that mercurial moving target — physical pain, particularly chronic pain. If you’ve ever sat in a doctor’s office and tried to explain how, where, and when something hurts, you have some notion of the energy, precision, and diligence necessary to produce this masterful overview of the subject.

The book is artfully sectioned into five distinct yet supple parts: Pain as metaphor, history, disease, narrative, and perception. The flexible structure effectively carries the reader into and through the various countries of Pain, as Thernstrom puts it. And within each part, Thernstrom glides gracefully from discipline to discipline. But what fuels “The Pain Chronicles” is the narrator’s personal story. As a result of an ill-fated swim, Thernstrom has endured chronic pain for more than a dozen years, an unrelenting pain that “filled the house of my body like smoke.”

Thernstrom doesn’t suffer alone. She cites a 2009 report that estimates that “chronic pain afflicts more than 70 million Americans.” And chronic pain, unlike acute but temporary pain, is often as mysterious as it is widespread, resulting from a confusing variety of ailments (or sometimes, seemingly, no ailment at all). Thernstrom meticulously delineates the many causes of chronic pain, its legacy of misapprehension, and the latest advances in fathoming the condition. “[I]t is only in recent years that chronic pain has been understood to be a condition with a distinct neuropathology — untreated pain can eventually rewrite the central nervous system, causing pathological changes to the brain and spinal cord that in turn cause greater pain.” To better understand the phenomenon and its latest treatments, Thernstrom spends years talking to scores of researchers, practitioners, and patients at seven major pain centers. She makes sense out of strategies ranging from hypnosis to Tylenol to opioids like OxyContin to Botox injections to the latest experiments in functional magnetic resonance imaging.

The author also burrows into the history of attitudes toward pain, from ancient Babylon to the 21st century. Perhaps the most fascinating chapters describe the discovery of anesthetics like ether and chloroform and the astounding resistance to their use, especially within the medical community. Religion plays a not very salutary role. Thernstrom explains, for instance, that “the invention of surgical anesthesia (through the inhalation of ether gas) by an American dentist in the mid-19th century was controversial at the time. Many agreed with the president of the American Dental Association, who declared [in 1872], ‘I am against these satanic agencies which prevent men from going through what God intended them to go through.’ ” Women were especially vulnerable to 19th-century pigheadedness. “Many Christian churches strongly opposed using anesthesia during childbirth on the grounds that it contradicted God’s direct commandment to Eve [Gen. 4:16, “in sorrow you shall bring forth children”]. The entire city of Zurich banned anesthetics on these grounds.”

More than the fascinating and lucidly written science, the astonishing, gruesome history, the finely rendered tales of sufferers and researchers, it is Thernstrom’s personal narrative that keeps the reader turning pages into the night. Told through the haze of suffering and remarkable in its candor, Thernstrom’s story is moving, but also puzzling, frustrating, and occasionally enraging. A highly educated cosmopolitan with plenty of professional and academic friends, Thernstrom responds to her terrible pain with what she calls (in another context) “delay, defer, deny” syndrome. It takes her at least two years to get an MRI and find out why she’s in pain. She doesn’t even tell her boyfriend (one of a few startlingly callous men she is drawn to) about her pain for a year and a half.

After her diagnosis, Thernstrom rebels against treatments: “I had stopped in at the physical therapy department . . . and I didn’t want to go back. . . . I didn’t want to work with a broken body, I wanted my old, true body restored.” Indeed, several more years go by before Thernstrom accepts her predicament and, through a variety of practices and medications, assumes some control over it.

Some delay in seeking diagnosis and treatment is typical for a citizen of the country of Pain. But the stubborn intensity of Thernstrom’s denial, the length of her deferral to seek help, and her petulance in the face of treatment are extreme, and she fails to explore these phenomena with the insight she brings to subjects other than her own psyche. She makes a few tantalizing references to the Christian Science practiced by her paternal grandparents and its early influence, but goes no deeper into the subject.

Thernstrom has no use for the idea of pain as redemption. In fact, she angrily scorns the notion that chronic pain could have any use at all. But the energy and empathy generated by her ordeal and the book that resulted will bring comfort and real relief to thousands of fellow sufferers. Perhaps there’s some redemption there.

Alec Solomita, a fiction writer and critic living in Somerville, can be reached at alecsolomita

THE PAIN CHRONICLES: Cures, Myths, Mysteries, Prayers, Diaries, Brain Scans, Healing, and the Science of Suffering
By Melanie Thernstrom
Farrar, Straus and Giroux, 364 pp., $27