The Song of Our Scars: Exploring the Social and Scientific Fundamentals of Chronic Pain

Book Review by Vishal Khetpal
The Song of Our Scars: The Untold Story of Pain. Haider Warraich. Basic Books. ISBN 9781541675308.

Skim through any bestseller list in adult non-fiction these days and you will find books that grapple with pain and chronic illness. Bessel van der Kolk’s The Body Keeps Score maps the landscape of traumatic stress and ways to control it; Ross Douthat’s The Deep Places shares the aches and pains of chronic Lyme disease; Meghan O’Rourke’s The Invisible Kingdom (recently reviewed in this publication) explores one woman’s journey as she defines her own chronic illnesses. Haider Warraich, a heart failure specialist practicing in Boston, Massachusetts, offers another dimension to this ever-growing body of work in The Song of Our Scars. He tries, and arguably succeeds, in answering a seemingly simple question: What is pain?

In the first chapter of the book, Warraich observes that pain is personal. Understanding this truth, Warraich begins his exploration by sharing his own insidious journey with chronic pain that started in medical school, when he was triggered after hearing an ominous “click” while bench-pressing weights at the gym. Presenting his personal history of chronic back pain alongside annals of medical history and deep-dives into clinical research, Warraich walks his audience through what is and what is not known about this globally experienced, yet poorly understood sensation.

As one would expect from a physician, Warraich offers his readers a clinical definition of pain. Deconstructed, the word expresses a combination of nociception, or toxic physical stimuli to the body, and suffering, capturing the psychological distress that can result from repeated noxious stimuli or emotional trauma. As he does so, he impressively outlines decades of clinical research into the science of pain, dating back to ancient history and resurfacing in modern medicine. Scientific discoveries serve as signposts in his rendering of this history, such as researchers’ accidental discovery of the brain’s pain center after encountering a patient whose seizures were characterized exclusively by pain, and the development of nerve blocks by John Bonica, the father of modern anesthesia. Warraich also supplements this history with a visit to a pain laboratory at Brigham and Women’s Hospital in Boston, where he subjected himself to sterile stimulations of pain that served to further tease apart his clinical definition.

As a writer and social thinker, Warraich offers compelling, and often forgotten, dimensions of pain that also escape the clinical definition. The Song of Our Scars particularly excels in describing pain as a social phenomenon and a biopolitical construct that weaves its way through history and defines humanity’s core. As Warraich establishes at the outset of his book, pain is a fundamental truth, a spiritual force, and a teacher. Pain is a divider of people by race, class, and gender. And at its most elemental, pain has and will always be an arbiter of power.

The Song of Our Scars dedicates the majority of its focus to this last theme—pain as an arbiter of power—developing it alongside the complicated relationship that modern medicine has with chronic pain. Frequently perceiving chronic pain as an extension of acute pain, clinicians in the modern era have attempted to bring chronic pain back down to Earth from the heavens, transforming a metaphysical experience once governed by spiritual beings into a mechanical problem of the human body, solved by tweaks and manipulation. To do so, healers and apothecaries have recruited chemical compounds such as morphine, named for the Greek god of dreams, and heroin, derived from the German word heroisch (hero), to wage war against pain. In recent years, Warraich argues, through iatrogenesis, or the “medicalization” of chronic pain, pain has become corporatized through the sale and extensive marketing of OxyContin throughout the United States by Purdue Pharmaceuticals. Purdue’s wrongdoings as well as the social fallout of rampant OxyContin prescriptions that resulted in America’s continuing the opioid epidemic have been well-documented in a subgenre of medical humanities literature, led by texts such as Patrick Radden Keefe’s The Empire of Pain. Yet in telling this story, Warraich offers a grander, more direct criticism of modern medicine. The system fails the patients it purports to serve when it confronts hazy diseases that are difficult to characterize and comprehend.

In offering these perspectives, Warraich’s work validates the experiences of patients whose lives are governed by chronic pain, as well the experiences of clinicians like myself who frequently, and frustratingly, attempt to treat this disease. In medicine, it can be tempting to view clinical disease in a vacuum, as something physicians tease apart through a history of present illness and diagnostic tests and then treat with evidence-based interventions. Yet Warraich reminds us that the diseases we treat are fundamentally social, interacting with culture, community, and our environments. Right now, we live in a time of societal upheaval, which one could argue has birthed a type of social pain. Our society has been left physically and emotionally ravaged by a pandemic, which is caused by a disease that may be associated with long-term illnesses that we continue to learn more about every day. Wars are being waged; social inequities, by race, class, and gender, are increasingly recognized and yet persist; climate change looms over our society, inevitably rewriting its rules in the near future; and, at least in the United States, legal norms on abortion rights are shifting. Among the “haves” of our society, many of these changes in norms may have felt minimal, while for the “have-nots,” they have been (and will continue to be) seismic. In a time of social chaos contributing to the pain of many, The Song of Our Scars certainly feels prescient in this cultural moment.

Yet Warraich observes that the story of chronic pain has not been fully written. Modern medicine stands at a threshold moment in the journey to redeem itself in treating chronic pain, as well as other unknowable and unnamable diseases. For chronic pain in particular, both old and new approaches are gaining attention. Warraich discusses the use of ketamine, psychedelics, cannabis, pain acceptance, hypnotherapy, exercise, and acupuncture in treating chronic pain. However, he notes that, for chronic pain, no singular approach is complete. Treating chronic pain effectively, and other unknowable diseases, will have to depend on individual endeavors that meet patients where they are. Confronting chronic pain will ultimately warrant reimaging modern medicine.

 

Vishal Khetpal is an internal medicine resident physician at Brown University. His commentary, on medicine and society, has appeared in Slate, Undark, and other publications.

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