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At some point in our lives, we’ve all wondered if pain is truly necessary, and whether modern medicine wouldn’t one day simply find a way to turn it off permanently. Maybe you thought about it, after getting that first bee sting in the backyard or after suffering that second-degree burn while “helping” Mom in the kitchen. That searing, thought-scattering sensation shocks us into the present, hurting at the site of the injury and somehow all over at once, leaving us to wonder, “Why must we feel pain?”

Pain, in short, is unpleasant. In many ways, it is the polar opposite of everything we enjoy in life, the yin to pleasure’s yang. It is also complex and fascinating, an essential element of our experience, as it is indispensable to our overall well-being, as the treasured capacity to feel pleasure. Pain is fundamental to life.

Pain is in another more mundane sense, a colossal problem. Over 116 million Americans suffer from chronic pain, and that pain costs us over $635 billion annually in the U.S. alone.

I have spent over a decade practicing the science—and art—of managing pain as a physician specializing in its treatment. By sharing my experiences, I hope to shed some light on a difficult and frightening subject. In transforming your perspective on pain—revealing its protective function and life-nurturing purpose—I hope to help you develop resilience, whether you are coping with chronic pain, caring for someone who is, or simply seeking a deeper understanding of a profoundly important subject.

As patients and physicians working together, how aggressively should we treat pain? What is “good” pain versus “bad” pain? When pain is truly unavoidable, how do we make the best of the situation? How do we become better equipped to use our pain as the powerful adaptive tool that it can be?

Although this book is about pain, on a deeper level it is about resilience, healing, and growth. Pain helps reveal the root causes of what ails us. It is a highly developed alarm system the body uses to help us prevent further injury and properly attend to our underlying conditions.

Despite being part of a remarkably sophisticated process, physical pain can be very mysterious when used as a diagnostic tool. Doctors can accurately measure a person’s red blood cell count, vitamin D level, or blood glucose level, but to this day we do not have a simple blood test or scan to reliably reveal the source of pain. As healers, doctors face a deductive process combining patient self-reports with clinical findings and the impact of known interventions. Following these diagnostic steps, we do our best to treat the underlying cause. If it is not a “fixable” problem, we aim to relieve the patient’s suffering as best we can without causing more harm. It’s always a delicate balance.

Doctors also encounter physical pain’s close relative, psychological pain, which we often label suffering. Of course, the mind is intrinsically linked to how we experience all pain. How do we put psychological pain into perspective? This is highly individual. In my experience, psychological pain is even more difficult to understand. Clearly there is a relationship between physical and psychological pain, and yet as a society we place far more emphasis on the former than on the latter, a misconception I also hope to address in this book.

In my own practice as a pain management specialist, I have often wondered about the deeper meaning of pain. This book is the result of that ongoing reflection. In these pages, I recount conversations I’ve had and situations I’ve encountered over the years in my work. I attempt to offer a sense of the different ways people experience their pain, think about it, and frame it as part of the larger whole of their existence. While many questions still linger for me, I am certain of one thing: Our beliefs about our pain are crucial to the nature and intensity of our suffering.

A disclaimer: while writing this book, I’ve worked hard to reflect on my experiences, as objectively as possible. I have incorporated the latest research, notes from observers, and, above all, feedback from patients. But pain is as subjective as anything in the human experience. So keep in mind that everything you read here is interpreted through my own beliefs, preferences, and prejudices as a pain specialist and as a person. Your mileage, as they say, will vary.

The process of writing this book has been therapeutic for me. It has allowed me to dwell on and deeply consider aspects of pain that often go overlooked in the day-to-day operation of a busy pain management practice. It has given me the opportunity to step outside my primary field of expertise, delving into the literature of psychology, business, military history, mythology, and more in the search for collective wisdom and new perspectives on the subject at hand.

In my work as a pain physician, I follow the path set by my patients’ physical and psychological symptoms to guide me to the root cause of their pain. Often, conversations with my patients lead me toward a better understanding of the complexities of pain. Their questions have inspired me to go on this quest for answers that might help them better understand their experience.

I make no claims of completeness. I’ve only scratched the surface in these pages and I am certain you will leave this book with more questions about pain than answers. However, I have done my best to patiently assemble some of the pieces of the puzzle together. Perhaps reading this book will help you begin to form a picture of the completed puzzle in your mind. You may also gain some insight into painful experiences in your own life.

One final note: in the following chapters, I share stories from real patients. I hope these will resonate with you, not just in terms of the pain they experienced but also in the joy, recovery, and wisdom they display. I have changed patient names and identifying details but the essential elements of every case study are true.