The book helps readers understand the intricacies of pain and points out ways to reduce it.
Tell me where it hurts
Rachel Zoffness
Grand Central Editions, $30.00
It is a rare book that both expands a problem into one of dizzying complexity and proposes to solve it. In Tell me where it hurtspain psychologist and scientist Rachel Zoffness achieves both.
Pain, she argues, has been deeply misunderstood. Of course, pain signals can come from damaged body parts. But that’s not the whole story. Through compelling patient stories and clear scientific descriptions, Zoffness leads readers to understand that pain is created by a complex cocktail of elements, including emotions, trauma, beliefs, and social connections. These ingredients can combine to form brownie batter, just as eggs, flour, butter, and cocoa powder can combine to form brownie batter. The recipe for pain is one of Zoffness’s central metaphors that helps convey various scientific explanations. It’s a simple approach, but it works.
Consider the ingredient of expectations. To illustrate the power of beliefs over pain, Zoffness tells us the story of two nails. A young construction worker accidentally jumped off a board and onto the first nail, a 7-in. The sharp end of the nail protruded from his boot, leaving him in anguish. He was rushed to the emergency room and given strong medication to relieve his significant pain. When the boot finally came off, the sight was shocking: the nail had missed the man’s foot. “But despite the lack of injury, his pain was real,” Zoffness writes.
The second nail came from a nail gun used by another man. The weapon misfired. As the man’s head fell back, he saw a nail sticking out of the nail gun in the wall in front of him. Luck, or so he thought. Six days later, a toothache took him to the dentist, where X-rays revealed a 4-inch nail lodged in his face just a few feet from his right eye. “In this case, there was significant damage, but very little pain,” Zoffness wrote.
Together, these stories remind us of an often overlooked truth: pain is not an accurate indicator of bodily harm. Damaged body parts can certainly be painful, but the other ingredients are important too. Pain is a biopsychosocial creation, writes Zoffness. “Our short-sighted focus on bio alone means we’ve missed two-thirds of the pain problem.”
This expanded view of pain seems sinister – even incredibly complex. But Zoffness offers a balm. We can control some of the ingredients we use in our recipe. We can choose ingredients that are minimally painful, and this book describes many options. One section offers a menu of behavioral changes, broken down into specific, detailed plans for sufferers and their healthcare providers. For example: “Never tell patients that their pain is incurable,” she writes. Even though an illness may be incurable, a person’s pain may lessen.
As scientific prose, this book threads a fine needle. The writing is quick and not loaded with technical details. Nonetheless, Zoffness provides details in footnotes and citations for the curious reader. The neuroscience journalist in me rejoiced at the following footnote explaining the overly simple phrase, pain pathway: “There is no single, universal “pain pathway” in the human body. Another fabulous note tells us that the phrase “pain receptor” is a misnomer. “There is no pain until the sensory data reaches the brain and is interpreted as such.” These nuanced and careful explanations clearly show that we are in good hands.
The reality is that the U.S. healthcare system is not designed to handle the complexities of pain, Zoffness points out. This is particularly true for chronic painwhich affects millions of people in the United States alone, and is often defined as lasting three months or more (a somewhat arbitrary marker, Zoffness says). Clinicians are experts at writing prescriptions or recommending procedures. It may be more difficult to relieve a person’s chronic pain by strengthening social connections, improving sleep hygiene, or finding a therapist who can help them process trauma.
Despite these great challenges, Tell me where it hurts gives hope. The overall message is that there are many paths forward. These possibilities arise when we consider pain holistically. After all, as Zoffness says, “a problem involving a whole person requires a holistic solution.”
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