Notes on the Pain Chronicles

These are my personal notes from The Pain Chronicles: Cures, Myths, Mysteries, Prayers, Diaries, Brain Scans, Healing, and the Science of Suffering, by Melanie Thernstrom....

"There are interesting differences in male and female opioid receptors. (The differences are also present in male and female rats.) There are three types of opioid receptors, most notably mu and kappa; most opioid drugs such as morphine target mu receptors. Few drugs that target kappa receptors have been developed, because early trials found them ineffective. The research, however, was conducted largely on men, and it turns out that women are more responsive to kappa-receptor drugs. One study of a rarely prescribed kappa-receptor analgesic (Nalbuphine) on postoperative pain in men and women ... found that the drug had the opposite effects on the two sexes, ameliorating female pain and exacerbating male pain." - page 175

Writing about a patient named George who scoffed at the idea of taking the anti-depressant Cymbalta, the author describes how he changed his mind when she told him that "antidepressants mitigate pain in rats as well as humans." She writes, "It had not been enough for him to be told that antidepressants effectively mitigate pain in humans, because he believed they worked in the wrong way. But to work for a rat -- that was really working." - page 223

"I used heat therapy with an ingenious product called ThermaCare [by Proctor and Gamble] -- pads that adhere to your neck or back that interact with the air in some way that makes them stay hot for hours." - page 253

Botox is used to paralyze neck muscles in order to relieve spasms that contribute to migraines. - page 256

Omneuron develops real-time functional neuroimaging. One application with fMRI is to help patients learn to lower activity in their rACC, "the part of the limbic system that gives pain its emotional valence. The pain of pain, as it were, is the way it's suffused with particular unpleasantness -- the sadness, anxiety, distress, and dislike that researchers refer to as dysphoria -- a reaction so fierce that you are instantly compelled to try to make the stimulus cease, not in five minutes, not in five seconds, now." - page 313, 316.


Further reading:
The War on Pain, a book by Dr. Scott Fishman

It's Hard Work Behaving as a Credible Patient, paper by Dr. Anne Werner & Dr. Kirsti Malterud, details "the ways in which women with chronic pain symptoms try to discern and comply with the hidden rules of the medical encounter in order to get the help they need. The women described struggling to present their pain in a way that others will feel is "just right": to make their symptoms "socially visible, real and physical" and to achieve "a subtle balance not to appear too strong or too weak, too healthy or too sick." - page 148 - 149