The Pain Chronicles: Cures, Myths, Mysteries, Prayers, Diaries, Brain Scans, Healing, and the Science of Suffering
Melanie Thernstrom
Farrar, Straus and Giroux, 364 pp.

I have been to a hospital in many capacities – patient, visitor, volunteer, sleep study subject – but it was the first time I was there as a tourist. “The Ether Dome is on the fourth floor,” said the receptionist handing me a pamphlet on the Walking Tour of Massachusetts General Hospital. The Ether Dome is the site of the first public demonstration of surgery with anesthesia in 1846. On the recommendation of a neurologist-professor, I was there with Melanie Thernstrom’s The Pain Chronicles in tow. “We have conquered pain” read a plaque from the 150^th anniversary of the Dome’s painless surgery. A bold proclamation, and as Thernstrom convincingly argues in her book, much too bold. For if the plaque had been telling the truth, her chronicle of pain that begins with ancient, spiritual understandings of pain would have ended in 1846. Instead, the story promises to extend far into the future.

Thernstrom likens pain to an alarm system and she makes the distinction between two types of pain: acute pain, which is acts as an alarm for real tissue damage, such as a broken arm or a scalpel cutting into flesh, and chronic pain, which persists without injury. The damage is in the alarm system itself, and therein lies the difficulty of treating chronic pain. As chronic pain is a disease of the nervous system, it is, to some extent, “just in your head.”

How is it that two patients who look the same on a MRI scan will have such different levels of pain? Or that devotees during a religious ceremony can pierce their flesh with fish hooks and feel no pain? Although there is no such thing as wiling pain away, chronic pain is intrinsically tied to both biological and psychological states. The book delves into the known science of pain while also searching for the spiritual meaning of it in art and religion.

Interwoven with pain through an objective lens is pain through a personal lens. Thernstorm’s interest in the subject stems from her own chronic shoulder and neck pain, which first developed when swimming with a former lover. Consequently, her physical pain and emotional pain over that relationship are entangled. Thernstrom’s previous books have also taken a personal, reflective approach. The Dead Girl is about the unsolved murder of her best friend and Halfway Heaven: Diary of a Harvard Murder deals as much with the murder-suicide committed by a Harvard student as Thernstrom’s own struggles to report a story Harvard wanted kept quite. Vignettes of her relationships and a “pain dairy” are interspaced through The Pain Chronicles. The personal thread is an effective technique-wouldn’t you rather listen to a friend talk about romantic foibles than complain about pain?—but Thernstrom is never the chatty, oversharing narrator. She doles out every detail with intent, such as the giant, heart-shaped soap, a gift from a former boyfriend, that she drops and breaks her toe. Her personal journey underscores how easily pain is invested with emotional resonance.

Thernstorm is never able to rid her pain completely, but she comes to better terms with it. The unfulfilling relationship that developed in tandem with her pain is replaced with a nurturing marriage by the end of her book. As the personal narrative wraps up though, the scientific narrative is not so satisfying. In the last chapter, she undergoes a novel neuroimaging therapy technique in which one learns to control activation of the rostral anterior cingulated cortex (rACC), a region of the brain that putatively gives pain its emotional value. As difficult as pain is to understand using words, it is even harder to understand in terms of neural networks. According to Dr. John Keltner, a pain doctor at the University of California San Francisco, “We naively believed that pain is simple—it hurts or it doesn’t hurt—so there should be a single brain state we could see every time someone is in pain. But what we’ve stumbled into is the discovery that there’s relative universe of hurt—that hurting is an immense, rich, and varied human experience, associated with an unknown number of possible brain states.”

Although the Ether Dome is given only a passing mention in her book, Thernstorm describes in detail a memorial erected for that same event in Boston Public Garden. She notes that, unusual for a memorial, it honors neither heroes nor wars but a medical breakthrough. It seems that solving the mystery of chronic pain should merit a similar celebration, but it also seems unlikely that any one chemical, as in the case of ether gas for anesthesia, would hold the key. Chronic pain is too complex, involves too many systems, and varies too much from individual to individual.

A prescient, if only coincidental, detail stood out to me when I left the Ether Dome: located directly below this site of the first public demonstration of painless surgery is the department of psychiatry.

Sarah Zhang writes and works in a neuroscience lab in Cambridge, MA.