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The Nature of Pain: Roots, Recovery, and Redemption amid the Opioid Crisis
"One by one, the mourners came to me. I didn't want to talk. I didn't want to discuss what might have happened. I didn't want to be here. The lump in my throat was suffocating. I'm not meant to grieve like this... I wanted to go somewhere without all these eyes. Pain is easier to digest in solitude."
Mandi Fugate Sheffel was born in the heart of rural small-town America, in a place where "wild teaberry grows" and with creeks "as clear and cold as nature would allow." As a curious, sensitive child raised in a challenging environment, she formed a deep bond with her cousin Eric. As the pair grew up together, they sought a sense of belonging, and drugs and alcohol provided a temporary escape from the harsh realities of their lives. Everything shifted when Purdue Pharma launched aggressive marketing campaigns for OxyContin in central Appalachia.
In The Nature of Pain, Fugate Sheffel recounts coming of age during the opioid epidemic of the late nineties and early 2000s. She illuminates the importance of kinship and connection to place while exposing the bitter truths of a community transformed by opioids. With candid, lyrical prose, Fugate Sheffel reveals what life is really like for people in active addiction and recovery. Her lived experience as an eastern Kentuckian affected by the opioid crisis is an underrepresented story that must be heard. Fugate Sheffel's memoir is an aching tale of empathy for modern mountain folks—of love and grief, family and place, and the addictions that continue to pain them.
Mandi Fugate Sheffel was born in the heart of rural small-town America, in a place where "wild teaberry grows" and with creeks "as clear and cold as nature would allow." As a curious, sensitive child raised in a challenging environment, she formed a deep bond with her cousin Eric. As the pair grew up together, they sought a sense of belonging, and drugs and alcohol provided a temporary escape from the harsh realities of their lives. Everything shifted when Purdue Pharma launched aggressive marketing campaigns for OxyContin in central Appalachia.
In The Nature of Pain, Fugate Sheffel recounts coming of age during the opioid epidemic of the late nineties and early 2000s. She illuminates the importance of kinship and connection to place while exposing the bitter truths of a community transformed by opioids. With candid, lyrical prose, Fugate Sheffel reveals what life is really like for people in active addiction and recovery. Her lived experience as an eastern Kentuckian affected by the opioid crisis is an underrepresented story that must be heard. Fugate Sheffel's memoir is an aching tale of empathy for modern mountain folks—of love and grief, family and place, and the addictions that continue to pain them.
192 pages, Hardcover
Published October 7, 2025
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Displaying 1 - 15 of 15 reviews
August 22, 2025
⭐️⭐️⭐️⭐️⭐️ (5 stars)
Thank you to NetGalley and author Mandi Fugate Sheffel for the opportunity to read The Nature of Pain. This is my honest review of the ARC I received, and I truly appreciate it.
From the very first page, that letter to Eric, I felt an immediate emotional connection. It’s rare for a book to touch you so deeply, so quickly, but this one did. The grief, the sorrow, the weight of loss... it’s all here, and it’s portrayed with such honesty that it’s impossible not to feel it in your own chest.
The theme of death is always difficult, but The Nature of Pain explores it with tenderness and truth. When someone you love dies, the world doesn’t just change - it collapses. And even if time dulls the pain, it never truly disappears. You carry it with you, quietly, forever.
This book dives into generational trauma, depression, anxiety, addiction, and the quiet devastation of watching loved ones spiral. It’s a richly detailed portrait of one family navigating grief, dysfunction, and healing. Divorce, conflict, and the impact on children - all of it is heartbreakingly real.
The memoir-like structure, filled with warm memories and tragic moments, mirrors life itself: messy, beautiful, painful, and precious. The author’s reflections on alcohol and cigarette abuse hit close to home for me. I’ve seen it firsthand, and the way it imprints on a child’s life is something you never forget.
Environmental destruction is also touched upon, and it’s upsetting to see how carelessly we treat the world around us. The inclusion of photographs adds depth and nostalgia, grounding the story in reality and memory.
The story of two children growing up and one of them losing their life far too soon - it is devastating. The depiction of drug addiction and its consequences is raw and painful. It’s a reminder of how many lives are lost to substances, how many teenagers suffer silently, and how often love and support are missing when they’re needed most.
The spread of disease through needles, the loss of friendships to romantic relationships, the emotional isolation, all of it is portrayed with heartbreaking accuracy. The journey toward recovery, especially from addiction, was one of the most emotional parts of the book for me. I cried. It’s terrifying to think how many young lives are cut short by pain they don’t know how to process. Mental illness, aging parents, and the quiet tragedies of everyday life, this book doesn’t shy away from any of it.
One quote that stayed with me: “He was living a life he didn’t want to live, just as I was finding a new way to live.” That line hit me hard.
Ultimately, The Nature of Pain is a powerful reminder to care for the people we love - especially the ones who seem distant. They may need us more than we realize.
Note: I read the PDF version on my phone, which was a bit challenging since I usually prefer ePUB files on Apple Books or Kindle. But that didn’t affect my rating, the story was too powerful to be diminished by format.
Thank you to NetGalley and author Mandi Fugate Sheffel for the opportunity to read The Nature of Pain. This is my honest review of the ARC I received, and I truly appreciate it.
From the very first page, that letter to Eric, I felt an immediate emotional connection. It’s rare for a book to touch you so deeply, so quickly, but this one did. The grief, the sorrow, the weight of loss... it’s all here, and it’s portrayed with such honesty that it’s impossible not to feel it in your own chest.
The theme of death is always difficult, but The Nature of Pain explores it with tenderness and truth. When someone you love dies, the world doesn’t just change - it collapses. And even if time dulls the pain, it never truly disappears. You carry it with you, quietly, forever.
This book dives into generational trauma, depression, anxiety, addiction, and the quiet devastation of watching loved ones spiral. It’s a richly detailed portrait of one family navigating grief, dysfunction, and healing. Divorce, conflict, and the impact on children - all of it is heartbreakingly real.
The memoir-like structure, filled with warm memories and tragic moments, mirrors life itself: messy, beautiful, painful, and precious. The author’s reflections on alcohol and cigarette abuse hit close to home for me. I’ve seen it firsthand, and the way it imprints on a child’s life is something you never forget.
Environmental destruction is also touched upon, and it’s upsetting to see how carelessly we treat the world around us. The inclusion of photographs adds depth and nostalgia, grounding the story in reality and memory.
The story of two children growing up and one of them losing their life far too soon - it is devastating. The depiction of drug addiction and its consequences is raw and painful. It’s a reminder of how many lives are lost to substances, how many teenagers suffer silently, and how often love and support are missing when they’re needed most.
The spread of disease through needles, the loss of friendships to romantic relationships, the emotional isolation, all of it is portrayed with heartbreaking accuracy. The journey toward recovery, especially from addiction, was one of the most emotional parts of the book for me. I cried. It’s terrifying to think how many young lives are cut short by pain they don’t know how to process. Mental illness, aging parents, and the quiet tragedies of everyday life, this book doesn’t shy away from any of it.
One quote that stayed with me: “He was living a life he didn’t want to live, just as I was finding a new way to live.” That line hit me hard.
Ultimately, The Nature of Pain is a powerful reminder to care for the people we love - especially the ones who seem distant. They may need us more than we realize.
Note: I read the PDF version on my phone, which was a bit challenging since I usually prefer ePUB files on Apple Books or Kindle. But that didn’t affect my rating, the story was too powerful to be diminished by format.
September 25, 2025
Thank you so much to Netgalley for providing me with early access to this book.
The Nature of the Pain follows Mandi Fugate Sheffel in a small town and her close connection with her cousin, Eric. This book touches on themes of addiction, specifically the rise of OxyContin dependence in Central Appalachia during Purdue Pharma’s aggressive marketing of the drugs.
The introduction to this book was immediately very impactful. Sheffel has a way of writing events I have never experienced as being very nostalgic. I do have some small experience with small, rural towns, though nowhere near Central Appalachia. The beginning serves a very practical purpose to this story. There is a lot of familial and day-to-day context that is carefully explained and fleshed out. Sheffel really surrounds the readers and immerses them within her environment and her life before throwing conflict out at them that we could not truly understand.
The writing was one of my favorite parts of this. The descriptions and reflections are truly so very strong. All of these people we are receiving second-hand accounts about are living and breathing in this book. I went in somewhat blindly in terms of knowing exactly what to expect and I am glad to have made that choice. I was able to feel drawn to warning red flags and watch the slow descent without any sure knowledge, similar to the author’s position.
The chapters are very short and things start to get darker, especially in the midpoint of the story. By the end of the novel, I was very engaged and very sad. Everyone was portrayed so vividly and profoundly that I truly did feel like so invested in their relationships. Sheffel did a lot of self reflection before writing this, because I honestly did feel like her standpoint and retelling was so honest to her experience while also so productive. She was able to acknowledge her own wrongdoings and hold herself and Eric accountable while also being able to openly grieve him. I will say, Eric’s passing occurred in a very unexpected way compared to what is set up at the beginning and middle of the novel. I think this was a very brave and very important story to tell. Big Pharma’s push of OxyContin continues to negatively impact communities and infect individuals with addiction. I really was perplexed to read her journey and the world she experienced. I really think this is an important and worthwhile book to read.
The Nature of the Pain follows Mandi Fugate Sheffel in a small town and her close connection with her cousin, Eric. This book touches on themes of addiction, specifically the rise of OxyContin dependence in Central Appalachia during Purdue Pharma’s aggressive marketing of the drugs.
The introduction to this book was immediately very impactful. Sheffel has a way of writing events I have never experienced as being very nostalgic. I do have some small experience with small, rural towns, though nowhere near Central Appalachia. The beginning serves a very practical purpose to this story. There is a lot of familial and day-to-day context that is carefully explained and fleshed out. Sheffel really surrounds the readers and immerses them within her environment and her life before throwing conflict out at them that we could not truly understand.
The writing was one of my favorite parts of this. The descriptions and reflections are truly so very strong. All of these people we are receiving second-hand accounts about are living and breathing in this book. I went in somewhat blindly in terms of knowing exactly what to expect and I am glad to have made that choice. I was able to feel drawn to warning red flags and watch the slow descent without any sure knowledge, similar to the author’s position.
The chapters are very short and things start to get darker, especially in the midpoint of the story. By the end of the novel, I was very engaged and very sad. Everyone was portrayed so vividly and profoundly that I truly did feel like so invested in their relationships. Sheffel did a lot of self reflection before writing this, because I honestly did feel like her standpoint and retelling was so honest to her experience while also so productive. She was able to acknowledge her own wrongdoings and hold herself and Eric accountable while also being able to openly grieve him. I will say, Eric’s passing occurred in a very unexpected way compared to what is set up at the beginning and middle of the novel. I think this was a very brave and very important story to tell. Big Pharma’s push of OxyContin continues to negatively impact communities and infect individuals with addiction. I really was perplexed to read her journey and the world she experienced. I really think this is an important and worthwhile book to read.
October 5, 2025
So much of the story of the opioid crisis in Appalachia has been told by researchers and journalists. While they may empathize with the humanity of the people whose story they are telling, it can never authentically be their story to tell. Mandi Fugate Sheffel is not just telling the story of addiction or the predatory industries that fed lies to those they promised to help. She tells the story of herself and a life lived in a very particular place and time. Something that can't be explained or analyzed but has to be experienced.
Her book is a massively important piece of context that is often missing from the topic. It is not all doom and gloom, it is about the beauty of being a child during the 80s and 90s in Appalachia even in sometimes difficult circumstances. It is a book that compares and contrasts her life with that of her cousin and how their very similar upbringing yielded different endings and how the place that was often the source of pain was also her place of healing.
The writing is not overly flowery but is still descriptive enough to put you in the setting. She makes it feel like a place a time I have experienced even though it is completely different to my upbringing. I cannot recommend this book enough to someone trying to understand Appalachia, addiction, grief, recovery, and the bittersweet joy that can come when you get clean and find happiness but can't take the ones you love with you on your journey.
Her book is a massively important piece of context that is often missing from the topic. It is not all doom and gloom, it is about the beauty of being a child during the 80s and 90s in Appalachia even in sometimes difficult circumstances. It is a book that compares and contrasts her life with that of her cousin and how their very similar upbringing yielded different endings and how the place that was often the source of pain was also her place of healing.
The writing is not overly flowery but is still descriptive enough to put you in the setting. She makes it feel like a place a time I have experienced even though it is completely different to my upbringing. I cannot recommend this book enough to someone trying to understand Appalachia, addiction, grief, recovery, and the bittersweet joy that can come when you get clean and find happiness but can't take the ones you love with you on your journey.
September 29, 2025
This is a well written memoir and a strong voice to add to the literature about the opioid crisis (particularly as it affected Appalachia). The author particularly does a good job writing about her childhood, adolescence, and the part of Kentucky she calls home. This opening section vividly illustrates the culture of the area, as well as what life was like for her and for her cousin/best friend Eric in terms of parenting, free time, attitudes toward drugs/drinking, etc. This is a strong background for the rest of the book, which sees both Mandi and Eric fall into addiction. There is more to the latter sections, in terms of grief and recovery but I won't give away everything. This memoir is well worth reading for the full story.
Though I found the well done, I would have liked to hear more about the author's experiences with treatment and recovery, along with more about her relationship with Eric. The book opens with a heart-wrenching letter to Eric and although you do get a sense of who he was and what he meant to Mandi during the book, this opening sets up an expectation that this relationship will be even more important to the story.
Thank you to University Press of Kentucky and NetGalley for access to an electronic ARC of this book. All views are my own.
Though I found the well done, I would have liked to hear more about the author's experiences with treatment and recovery, along with more about her relationship with Eric. The book opens with a heart-wrenching letter to Eric and although you do get a sense of who he was and what he meant to Mandi during the book, this opening sets up an expectation that this relationship will be even more important to the story.
Thank you to University Press of Kentucky and NetGalley for access to an electronic ARC of this book. All views are my own.
October 12, 2025
An unconventional coming of age story about family bonds and trauma told through the lens of addiction. There’s a very specific stereotype that most people have for someone who struggles with addiction. There’s also a very specific and negative stereotype associated with the people of Appalachia. It has been my experience that neither of these is even remotely close to accurate. In this book, Mandi does a beautiful job diving into the nuances and beauty of growing up and living in Appalachia. It’s a place with so much heart and soul. The beauty, community, and resilience of the region far outweighs the poverty and negativity associated with it. Mandi’s story humanizes addiction. It showcases how the people of this region were taken advantage of and lied to in a way that is still wreaking havoc on a lot of really good people today. The lies and greed of Purdue pharma will continue to cause heartache for generations to come.
This is a story that needed to be told. For anyone who doesn’t understand the opioid epidemic or the Appalachian people, I think it’s so important for them to read stories like this. My hope is that Mandi sharing her story encourages readers to empathize and have compassion for those who struggle with addiction. Drugs happen to good people.
This is a story that needed to be told. For anyone who doesn’t understand the opioid epidemic or the Appalachian people, I think it’s so important for them to read stories like this. My hope is that Mandi sharing her story encourages readers to empathize and have compassion for those who struggle with addiction. Drugs happen to good people.
August 22, 2025
The Nature of Pain tells the story that many of us in Appalachia are far too familiar with. It is so clear that Mandi (the author) put a lot of time and energy into healing that allowed her to write this book. Her story is important to tell, as often this narrative is shared from an outsider's perspective. Her writing allows Appalachians everywhere to lay claim to their story and mold the regional narrative into one of hope and resilience.
She walked a tightrope between sharing what was important and not exploiting the family she loves. This decision does make the book feel a little short, and I easily could have read a book that was twice as long from her perspective. However, the tenderness and care she took in sharing her story shine through, even in the shorter format.
Thank you to University Press of Kentucky and NetGalley for an ARC. In exchange, I'm sharing my honest review.
She walked a tightrope between sharing what was important and not exploiting the family she loves. This decision does make the book feel a little short, and I easily could have read a book that was twice as long from her perspective. However, the tenderness and care she took in sharing her story shine through, even in the shorter format.
Thank you to University Press of Kentucky and NetGalley for an ARC. In exchange, I'm sharing my honest review.
August 19, 2025
The Nature of Pain is a memoir of growing up in Appalachia in a family surrounded by drug and alcohol abuse, where the author herself becomes addicted to opioids. She eventually loses her cousin tragically, and her relationship with him is a focus of the book. This book was gorgeously written; I could feel her love for Eric and her pain at losing him deeply. My one critique of this book was that it was very short - there were many parts of her life and her cousin that I felt could have been expanded upon in a way that would have connected the reader more when it came to the point of Eric's death. That all being said, it is clear this was written as a way to help her heal from losing Eric, and if this was what the author wanted to write, it does stand up well on its own.
Thank you to University Press of Kentucky and Netgalley for an ARC in exchange for an honest review.
Thank you to University Press of Kentucky and Netgalley for an ARC in exchange for an honest review.
July 2, 2025
I always have a hard time rating memoirs because they are so intimate it can feel wrong to put a star value on it.
I think the writing was pretty and flowed nicely without being flowery. I appreciated that the author did not feel the need to describe in details the worst parts of her life to make the reader understand the horrors of addiction.
It is a very interesting read if you are looking for a first hand account of what addiction can look like and what a life before, during, and afrer it can be. It did not feel cliché, it is the author's life as it happened and I am grateful she wanted to share it with the world.
Thank you NetGalley for providing me with an ARC of this book
I think the writing was pretty and flowed nicely without being flowery. I appreciated that the author did not feel the need to describe in details the worst parts of her life to make the reader understand the horrors of addiction.
It is a very interesting read if you are looking for a first hand account of what addiction can look like and what a life before, during, and afrer it can be. It did not feel cliché, it is the author's life as it happened and I am grateful she wanted to share it with the world.
Thank you NetGalley for providing me with an ARC of this book
June 26, 2025
This book was beautifully written: bleak, raw, brimming with emotion. I thoroughly enjoyed reading the author’s backstory, about her less than conventional childhood in the Appalachia and what could have possibly led to this outcome. I enjoyed this book because of the writing, which was intentional, poetic and quietly powerful. It possessed honesty and an insight into the American small town opioid crisis through the telling of her own personal and tragic story. Thanks to Netgalley for the opportunity to read this ARC.
October 4, 2025
thank you to netgalley and university press of kentucky for this arc! this book was absolutely beautiful. the author’s writing is incredibly poetic and i am grateful that she decided to share her story. this book is very short, but it packs a punch for sure. if you want a look into the opioid crisis from a firsthand account, or if you just want a memoir that will make you feel a LOT, i would definitely recommend this one.
August 21, 2025
dnf at a few pages in :)
September 26, 2025
Amazing story of strength and heartbreak!
October 7, 2025
A great read that captures what it was like in the heart of the opioid epidemic in Eastern Kentucky.
November 26, 2025
Thank you NetGalley for the ARC!
This book was very different from what I'm used to reading. It provided deep insight into addiction and pain overall. There were some parts that were hard to read, but the author's writing style was so captivating that I just couldn't put it down.
This book was very different from what I'm used to reading. It provided deep insight into addiction and pain overall. There were some parts that were hard to read, but the author's writing style was so captivating that I just couldn't put it down.
September 19, 2025
Thanks to Netgalley and University Press of Kentucky for the arc in exchange for my honest review
Side note for Netgalley, if a book isn’t available for Kindle, I would like to know before requesting, the netgalley reader is a nightmare. I do not regret requesting this book though, because this was beautiful
We hear a lot about addicts from Appalachia, but we don’t often hear from them and that’s a damn shame. This is a book about grief mostly, about the people the author lost, especially her cousin Eric. I knew this was coming because she starts the book with the news that he’s dead, but his death was just so sad.
I don’t know much about being an addict, like many people I like to say that we’re all addicted to something but let’s be real coffee and books are very unlikely to kill me, so this was an interesting journey through the author’s eyes. Again I read a lot about the way Purdue pharma was operating, especially in those area of the US, but it’s very different to actually have first hand testimony of it.
Incredibly touching and well written, it made me happy to know that the author is still doing well with her recovery
Side note for Netgalley, if a book isn’t available for Kindle, I would like to know before requesting, the netgalley reader is a nightmare. I do not regret requesting this book though, because this was beautiful
We hear a lot about addicts from Appalachia, but we don’t often hear from them and that’s a damn shame. This is a book about grief mostly, about the people the author lost, especially her cousin Eric. I knew this was coming because she starts the book with the news that he’s dead, but his death was just so sad.
I don’t know much about being an addict, like many people I like to say that we’re all addicted to something but let’s be real coffee and books are very unlikely to kill me, so this was an interesting journey through the author’s eyes. Again I read a lot about the way Purdue pharma was operating, especially in those area of the US, but it’s very different to actually have first hand testimony of it.
Incredibly touching and well written, it made me happy to know that the author is still doing well with her recovery
Displaying 1 - 15 of 15 reviews