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Warraich eventually comes to the origins and current state of the US opioid epidemic. Even female rodents tend to experience more pain than male ones. In general, women (including trans women taking oestrogen) experience more pain than men, and are more sensitive to it. A section on gender explores the history of pain management during childbirth, including the misogynist and white-supremacist origins of the natural-childbirth movement, and a rousing endorsement of the epidural. He reports the finding that physicians are five times less likely to prescribe opioids to Black children with acute appendicitis than to white children with the condition.

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Warraich explores biases including the ugly colonial history of opioids, and the racist notion that Black people have thicker skin than white people (a survey shows that this idea persisted very recently K. When researchers blocked it in mice, the animals stopped displaying behaviours associated with chronic pain. Other research examined PKMzeta, a protein that helps to solidify memories in humans. But neuroscientist Vania Apkarian suggests that chronic pain could be a memory gone haywire, inducing pain without stimulus. Memory usually helps us to survive by avoiding painful stimuli in future. вЂњWe basically treat chronic pain the way we used to treat tuberculosis before we discovered what caused it,вЂќ neuroscientist Clifford Woolf tells Warraich.Д¬hronic pain might be a memory of pain.

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One in five people worldwide has chronic pain, yet doctors donвЂ™t know how to treat it effectively, and patients are used to being dismissed and disappointed.

Chronic and acute pain вЂњlight up two separate, non-overlapping circuits in the brainвЂќ, he writes. It is a top-down process in which the brain can tell the body to feel pain without any input from the senses or environment.

Or acute pain is.Д¬hronic pain is a different beast, Warraich contends. So pain is created by the brain and the environment working together. Suffering results when mental or emotional distress is added - when the pain makes you feel worried, out of control or bad about yourself. Pain happens when nociception is processed in the brain and labelled as negative or unpleasant. Nociception is sensory information - for example, the feeling of the sharp end of a pin pressing into your finger. The common usage, he explains, encompasses nociception, pain and suffering. One of WarraichвЂ™s central criticisms is that the medical system has flattened pain, erasing its context and emotional dimensions and collapsing its diversity into numbers on a ten-point scale. His case is made more urgent by chronic painвЂ™s links with long COVID: around 30% of people with the condition in an Italian study reported chronic muscle or bone pain ( F. He blasts the US medical system for lacking empathy and time to devote to patients, as well as for being too siloed, insufficiently committed to social justice and too swayed by pharmaceutical marketing. He delves into the US opioid-use epidemic, and asks how treatment is affected by systemic racial and gender biases. Warraich, now a doctor at Brigham and WomenвЂ™s Hospital in Boston, Massachusetts, offers a fascinating tour of the biology and neuroscience of pain. When pain persists after the underlying cause has healed, or for more than 12 weeks, itвЂ™s chronic pain. Acute pain is caused by a specific injury, illness or other trauma.

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In The Song of our Scars, Warraich draws on personal and professional experiences to explore acute pain, chronic pain and the US medical systemвЂ™s dismal failures to address them effectively. But it gave him something unusual in common with his patients: an insiderвЂ™s view of a life lived in chronic pain. His back injury ended his plans to become a surgeon and almost dashed his hopes of being a physician. One day, while bench pressing, he dropped a 90-kilogram weight on himself. The Song of our Scars: The Untold Story of Pain Haider Warraich Basic (2022)ДЄs a medical student in Pakistan, Haider Warraich loved to go to the gym.

Credit: Ilana Panich-Linsman/New York Times/Redux/eyevine Chiropractor Toya Burton treats Alabama man Robert Prince.