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The Song of Our Scars: The Untold Story of Pain
A doctor’s personal and unsparing account of how modern medicine’s failure to understand pain has made care less effective
In The Song of Our Scars , physician Haider Warraich offers a bold reexamination of the nature of pain, not as a simple physical sensation, but as a cultural experience.
Warraich, himself a sufferer of chronic pain, considers the ways our notions of pain have been shaped not just by science but by politics and power, by whose suffering mattered and whose didn’t. He weaves a provocative history from the Renaissance, when pain transformed into a medical issue, through the racial legacy of pain tolerance, to the opiate epidemics of both the nineteenth and twenty-first centuries, to the cutting edge of present-day pain science. The conclusion is only by reckoning with both pain’s complicated history and its biology can today’s doctors adequately treat their patients’ suffering.
Trenchant and deeply felt, The Song of Our Scars is an indictment of a broken system and a plea for a more holistic understanding of the human body.
In The Song of Our Scars , physician Haider Warraich offers a bold reexamination of the nature of pain, not as a simple physical sensation, but as a cultural experience.
Warraich, himself a sufferer of chronic pain, considers the ways our notions of pain have been shaped not just by science but by politics and power, by whose suffering mattered and whose didn’t. He weaves a provocative history from the Renaissance, when pain transformed into a medical issue, through the racial legacy of pain tolerance, to the opiate epidemics of both the nineteenth and twenty-first centuries, to the cutting edge of present-day pain science. The conclusion is only by reckoning with both pain’s complicated history and its biology can today’s doctors adequately treat their patients’ suffering.
Trenchant and deeply felt, The Song of Our Scars is an indictment of a broken system and a plea for a more holistic understanding of the human body.
320 pages, Hardcover
Published April 19, 2022
84 people are currently reading
781 people want to read
About the author
Haider Warraich
6 books64 followersAs a physician, writer, and clinical researcher, Haider Warraich wears many hats that have come together in his new book, State of the Heart - Exploring the History, Science and Future of Cardiac Disease, launched July 2019 by St Martin's Press/Macmillan.
He writes most frequently for the New York Times but also contributes to the Guardian, the Atlantic, the LA Times and the Boston Globe amongst others. He writes about all things that fall within the purview of healthcare, from health policy to the daily interactions between patients and their physicians.
Haider Warraich completed internal medicine and cardiology training at Harvard Medical School and Duke University and will be the Associate Director of Heart Failure at the Boston Veterans Affairs Hospital, Associate Physician at Brigham and Women’s Hospital and Instructor at Harvard Medical School in the Fall of 2019.
Dr Warraich is also an avid clinical researcher and has published in the New England Journal of Medicine and Journal of the American Medical Association amongst many others.
He writes most frequently for the New York Times but also contributes to the Guardian, the Atlantic, the LA Times and the Boston Globe amongst others. He writes about all things that fall within the purview of healthcare, from health policy to the daily interactions between patients and their physicians.
Haider Warraich completed internal medicine and cardiology training at Harvard Medical School and Duke University and will be the Associate Director of Heart Failure at the Boston Veterans Affairs Hospital, Associate Physician at Brigham and Women’s Hospital and Instructor at Harvard Medical School in the Fall of 2019.
Dr Warraich is also an avid clinical researcher and has published in the New England Journal of Medicine and Journal of the American Medical Association amongst many others.
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Displaying 1 - 30 of 41 reviews
May 20, 2022
The book was somewhat disappointing for me. Like many others, I have chronic pain (osteoarthritis, off and on lower back pain) and my wife does, too (Peripheral neuropathy). I was hoping to read about breakthroughs, promising treatments or at least experiments, in short, a beacon of hope. It is not that. The book is largely an outpouring of the author's own experience as a chronic pain sufferer and as a pain doctor. It focuses largely on the psychological aspects, e.g. the difference between nociception (the biological process of detection of pain) and suffering, which is the broader mental effect the nociception has on the sufferer. There are many stories of individuals who experience chronic or severe pain (which are different things) but that becomes little more than a series of anecdotes. Some of it was interesting, but I believe the main purpose of the book is the catharsis the author felt in offloading his lifelong anguish.
May 1, 2022
Absolute horse sh*t. I’m not apologizing for my language because there is no other way to describe what I just finished listening to. Only giving it one star because I can’t give it negative stars. I was really excited to see a chronic illness book written by a doctor who suffers from chronic illness as an individual with multiple chronic illnesses. This doctor healed from a broken back with surgery, no drugs, and physical therapy, because he ass afraid of getting addicted to opioids. Then it went to be a whole history of what opioids are, the opioid epidemic, and why opioids are bad for pain. Also, why pain meds are bad for pain. And why depression and anxiety meds don’t work, people should just use calming thoughts and try hypnosis. I expected more and higher hopes. I thought I would get a book that would have a compassionate doctor, not one that tells me to stop all my meds because “pain is, in fact, in our heads.”
Full extensive review to come.
Full extensive review to come.
April 12, 2022
This is an excellent book for anyone who suffers or has suffered from chronic pain, but also for anyone who shares my interest in medical non-fiction. Doctors writing from first hand experience with a problem, often after being a patient themselves, bring a unique understanding that incorporates both the science and the human perspective. This is a fast read, beautifully written, that I recommend.
July 23, 2022
This book attempts a challenging task: threading the needle between explaining the physical elements of chronic pain while acknowledging the complexity of the mental processes around chronic pain. There were times that I thought the author was making a dangerous argument, such as there is a purpose to chronic pain or that there was nothing doctors could really do about pain, but what the author was really doing was explaining how medical training in Euro-America, but especially in the United States, conceptualizes pain. Stick with the book in these sections because the payoff is worth it.
In the end, the author reveals that a crucial element to understanding and treating pain is empathy. Not a false sense of "I know how it feels", but rather an understanding that patients live in complex worlds where they are subjected to discrimination, like racism and gender discrimination, that prime the body to react differently. It pulls back the curtain on the opioid epidemic from the perspective of what the drugs don't solve and challenges doctors to actually care about their patients and get involved in social issues.
All in all, a great companion read to something like In the Realm of Hungry Ghosts.
In the end, the author reveals that a crucial element to understanding and treating pain is empathy. Not a false sense of "I know how it feels", but rather an understanding that patients live in complex worlds where they are subjected to discrimination, like racism and gender discrimination, that prime the body to react differently. It pulls back the curtain on the opioid epidemic from the perspective of what the drugs don't solve and challenges doctors to actually care about their patients and get involved in social issues.
All in all, a great companion read to something like In the Realm of Hungry Ghosts.
September 4, 2024
Fantastic book about the science of chronic pain and how to treat it. Kind of a 4.5-star book given that it has a few bizarre untruths (no, flails and other instruments of self-flagellation are not core components of Abrahamic faiths' religious laws.) But don't let that distract you from the book's central argument: our experience of pain is not simply a matter of signals traveling from peripheral nerves to brain, but a highly mediated process affected by everything from culture to your doctor's demeanor. Doctors need to read this so that they can take better care of their patients; people with chronic pain need to read this so that they can better understand their pain and take back their lives.
June 10, 2023
Dr. Warraich do-loops a few themes in his 320 pages: he has back pain that he manages with physical therapy. Doctors are much like auto mechanics. Opioid use is rampant...and this one struck a chord in me:
Dr. Warraich expresses concern over simplifying pain to a number. Just like a measurement equivalent to our blood pressure or temperature: “assessing pain on a numeric scale doubles the risk of opioid overdoses in hospitals,” he writes. As innocuous as the now ubiquitous 1–10 scale may seem at triage in our local doctor’s office, it skips myriad other issues that influence the patient’s feel of their own pain. I then think it indicates that, with blurting out a number, say, eight and above, a response, some prescribed drug, will be required.
Pain is indeed a personal call.
Good example of a two-star book--it is OK.
Dr. Warraich expresses concern over simplifying pain to a number. Just like a measurement equivalent to our blood pressure or temperature: “assessing pain on a numeric scale doubles the risk of opioid overdoses in hospitals,” he writes. As innocuous as the now ubiquitous 1–10 scale may seem at triage in our local doctor’s office, it skips myriad other issues that influence the patient’s feel of their own pain. I then think it indicates that, with blurting out a number, say, eight and above, a response, some prescribed drug, will be required.
Pain is indeed a personal call.
Good example of a two-star book--it is OK.
July 12, 2022
Overall a pretty good run down of the historic failures to treat the root causes of chronic pain and why we have such a crappy medical system in America, but still, the ending is why I only have it 3 stars. I’m a mental health therapist so I get it that psychological interventions absolutely do make an impact and are a vital part of treatment for many people with physical health concerns, especially chronic conditions. But something doesn’t stick right with me by ending with presenting “placebo effects, empathy, and ACT therapeutic techniques” as the concluding solution to chronic pain. He even acknowledges that many people are worried that it’s dismissive and patients are invalidated and it could be dangerous if providers will stop looking for an accurate diagnosis. I’m someone who had a spinal fusion at 15, a hip replacement at 36, and I’m *allergic* to opioids. They make me incredibly sick. I’ve been left to suffer pain like most people can’t imagine in acute situations or deal with incredibly terrible side effects because there are literally no other options for pain management other than what I’m *allergic* to. We *need* safe and effective ways to manage acute as well as chronic pain. It is not acceptable to put the entire burden of pain management on individual’s personal abilities and skills. The author tries to make a case for the need for cultural considerations and the harmful impact on health of marginalization, which are good, however, that’s not enough to hide that there are some undercurrent ableist vibes going on here. If he’d stuck to a historical account and left out his ableist biases at the end, I’d have nothing but good things to say about this book. The way pain and emotional distress are treated in our healthcare system is abysmal and horrific, which is why presenting effective alternatives is so important.
November 5, 2022
I actually read the hard back version cover to cover and I would not recommend this book for people with chronic illness or to their caregivers, although there are some good portions on biological research on pain as well as on historical developments in treatments and theories of pain. Unfortunately there were too many historical inaccuracies, misquotations, cherry-picked data, and misinformation for me to take this book seriously. Fact checking yielded so many errors that this book was actually painful to read. It did encourage me to read more about the opium war and classical literature and history - just to get the actual story and not what was presented in this work.
The book also suffers substantially from the author's anti-opioid crusade. Although it is true that oxycontin was marketed in a decidedly unethical manner, to claim that doctors in the United States still "hand out opioids like candy on Halloween," is a gross distortion of actual present day prescribing practices. https://www.painnewsnetwork.org/stori...
The book also suffers substantially from the author's anti-opioid crusade. Although it is true that oxycontin was marketed in a decidedly unethical manner, to claim that doctors in the United States still "hand out opioids like candy on Halloween," is a gross distortion of actual present day prescribing practices. https://www.painnewsnetwork.org/stori...
October 31, 2022
Having suffered from chronic pain for nearly 8 years I was hoping for some information that would help me. The author explains in detail how we move from the fight or flight response to an acute injury to feeling pain all the time. He does a good job of explaining that while the pain is "in your head" it's not because you're crazy. There is a rewiring of the brains sensitivity to pain that takes place over time that typically cannot be overcome using pills etc. A fascinating fact from his research is that opioid prescriptions directed a patient to take them continuously so that pain could not break through (typically how morphine is used for hospice patients) but turns out the way opioids work has no effect on chronic pain mechanisms. This is partly to blame for the opioid problem we now experience in the US.
Sadly there are no real solutions in this book but that is because each individuals life experiences lead to the experience of chronic pain.
Sadly there are no real solutions in this book but that is because each individuals life experiences lead to the experience of chronic pain.
August 1, 2022
This book was a bit "it's all in your head" but still was an interesting discussion of chronic pain. And to be honest there are things one can do with their "head" that help manage chronic pain, but I can see why some chronic pain patients find this offensive after being told for years and years "it's all in your head"
March 8, 2025
Một quyển sách thú vị nói về nỗi đau của con người ở cả mặt tinh thần lẫn thể xác. tác giả tập trung giải thích về nỗi đau thể xác cả mạn tính lẫn cấp tính, và việc đau đớn ảnh hưởng đến chất lượng cuộc sống lẫn tính khí của một con người như thế nào. Cuốn sách được viết rất gần gũi, vô cùng dễ tiếp thu và có rất nhiều sự kiện lịch sử trong ngành dược mà hiện tại vẫn còn đang tiếp diễn.
Ví dụ như đại dịch opioid hiện tại vẫn đang là một nỗi nhức nhối ít nhất là trong nước mỹ. bởi vì con người có nhu cầu cao trong việc ngăn chặn cơn đau, việc sử dụng thuốc giảm đau, thuốc phiện, thuốc an thần đã trở thành một vấn nạn liên quan cả về mặt khoa học lẫn đạo đức. Sách kể nhiều sự kiện đã xảy ra trước kia trong ngành y dược của nước mỹ và về việc các công ty dược lợi dụng người tiêu dùng ra sao. Người tiêu dùng ở đây bao gồm cả bệnh nhân thật sự sử dụng thuốc và bác sĩ kê đơn thuốc.
Một lý do mình cảm giác quyển này rất thời sự bởi vì tất cả những vấn đề này đều được lặp đi lặp lại trong các series phim mỹ về ngành y, đi��n hình là new amsterdam.
Cá nhân mình đặc biệt thích chương 5,6 khi tác giả nói về các sự kiện opiod và việc công ty dược thao túng truyền thông cỡ nào để bán được thuốc, và truyền thông đã ảnh hưởng như thế nào đến cách các bác sĩ kê đơn thuốc.
Đối với cơn đau mãn tính, opioid có khả năng làm tăng sự mẫn cảm với cơn đau sau khi sử dụng và giảm thời gian chịu đựng cơn đau của mỗi người. Một số người đau mãn tính khi dùng opioid còn có khả năng chịu đau kém hơn những người chỉ dùng ibuprofen hoặc acemitanophen. Nhìn chung, opioid làm giảm ngưỡng đau của người bị đau mãn tính. Tuy vậy, opioid vẫn phù hợp và giúp ích với các cơn đau cấp tính và dành cho các bệnh nặng như ung thư.
Endorphin chính là opioid cơ thể tự tạo ra, gọi là opioid nội sinh. Việc sử dụng opioid cho các cơn đau mãn tính có thể làm mất cân bằng thần kinh do lượng opioid trong bất kỳ viên thuốc nào cũng là lớn hơn gấp nhiều lần lượng opioid nội sinh. Điều này về lâu dài làm giảm khả năng tạo oipiod của cơ thể, dẫn đến việc chịu đau kém hơn, điển hình ở các cá nhân bị bệnh trầm cảm, vốn là những người có khả năng tạo ra ít opioid nội sinh hơn. Và cũng vì thế mà bệnh nhân trầm cảm thường đáp ứng tốt với opioid.
Những chương còn lại cũng ổn. Sách đề cập nhiều đoạn về việc "người da đen chịu đau giỏi hơn" cũng thấy phần nào nhưngz vấn đề về phân biệt sắc tộc, những định kiến đã và vẫn luôn ảnh hưởng đến ngành y, dù muốn hay không .
Nhìn chung thì mình cũng thích quyển này.
Ví dụ như đại dịch opioid hiện tại vẫn đang là một nỗi nhức nhối ít nhất là trong nước mỹ. bởi vì con người có nhu cầu cao trong việc ngăn chặn cơn đau, việc sử dụng thuốc giảm đau, thuốc phiện, thuốc an thần đã trở thành một vấn nạn liên quan cả về mặt khoa học lẫn đạo đức. Sách kể nhiều sự kiện đã xảy ra trước kia trong ngành y dược của nước mỹ và về việc các công ty dược lợi dụng người tiêu dùng ra sao. Người tiêu dùng ở đây bao gồm cả bệnh nhân thật sự sử dụng thuốc và bác sĩ kê đơn thuốc.
Một lý do mình cảm giác quyển này rất thời sự bởi vì tất cả những vấn đề này đều được lặp đi lặp lại trong các series phim mỹ về ngành y, đi��n hình là new amsterdam.
Cá nhân mình đặc biệt thích chương 5,6 khi tác giả nói về các sự kiện opiod và việc công ty dược thao túng truyền thông cỡ nào để bán được thuốc, và truyền thông đã ảnh hưởng như thế nào đến cách các bác sĩ kê đơn thuốc.
Đối với cơn đau mãn tính, opioid có khả năng làm tăng sự mẫn cảm với cơn đau sau khi sử dụng và giảm thời gian chịu đựng cơn đau của mỗi người. Một số người đau mãn tính khi dùng opioid còn có khả năng chịu đau kém hơn những người chỉ dùng ibuprofen hoặc acemitanophen. Nhìn chung, opioid làm giảm ngưỡng đau của người bị đau mãn tính. Tuy vậy, opioid vẫn phù hợp và giúp ích với các cơn đau cấp tính và dành cho các bệnh nặng như ung thư.
Endorphin chính là opioid cơ thể tự tạo ra, gọi là opioid nội sinh. Việc sử dụng opioid cho các cơn đau mãn tính có thể làm mất cân bằng thần kinh do lượng opioid trong bất kỳ viên thuốc nào cũng là lớn hơn gấp nhiều lần lượng opioid nội sinh. Điều này về lâu dài làm giảm khả năng tạo oipiod của cơ thể, dẫn đến việc chịu đau kém hơn, điển hình ở các cá nhân bị bệnh trầm cảm, vốn là những người có khả năng tạo ra ít opioid nội sinh hơn. Và cũng vì thế mà bệnh nhân trầm cảm thường đáp ứng tốt với opioid.
Những chương còn lại cũng ổn. Sách đề cập nhiều đoạn về việc "người da đen chịu đau giỏi hơn" cũng thấy phần nào nhưngz vấn đề về phân biệt sắc tộc, những định kiến đã và vẫn luôn ảnh hưởng đến ngành y, dù muốn hay không .
Nhìn chung thì mình cũng thích quyển này.
June 24, 2025
Part memoir, part history book, part solution oriented Haider Warraich explores the nature of pain and how we have misunderstood and mistreated it within the Western Biomedical industrial complex.
here's my notes:
Suffering is a uniquely human experience more in the mind than body as theorized by Descartes where as pain was seen as in the body.
Acute pain comes from body up to the mind where as chronic pain is seen as coming from the mind and finding a home to resonate in the body or phantom body part.
Mind- body dichotomy is false tho.
Fish & invertebrates are shown to feel pain not just nociception (awareness of body and threats to it) which may indicate consciousness because it is connected to learning.
Pain is deeply personal but also serves a social purpose in how it is shared or repressed. Pain is also felt very differently based on its context.
Pain turns into suffering when there is no answer for why, it is chronic, or connected to something dire.
Chronic pain became increasingly epidemic as life spans lengthened. Now ~1/5 people live with it world wide.
Despite how common it is it is still not fully understood or prioritized in its study. This often leads to doctors dismissing it especially along racialized and gendered lines.
Chronic pain likely more entwined with memory process (painful moments remembered much more clearly, trauma flash backs) than acute pain which lights up different parts of the brain.
Opium crisis: sprung out of the chronic pain crisis in the US in the 1990s but humans relationship with poppys & opiates is perhaps as old as civilization and frequently follows a similar trajectory from miracle medicine to addiction to death.
Opiates likely make chronic pain worse over time not better and are only helpful for immediate severe acute pain but have been systemically over and misprescribed for profit motives by the medical industrial complex and specifically pushed for by Purdue.
Civil War was the source of the first opiate addiction crisis in the US, and had rippled thru culture in waves since then switching from smoking to injection and morphine to heroin based on what is considered least tainted by poor peoples and people of colors usage of these drugs.
Current opiate crisis with fentanyl coming from China is almost an ironic inverse of the first Opium War in which Brittain created an opium addiction crisis in Chinese population to have an in for spice and tea trade creating an abundance of cheap opium with slave labor to sell first cheaply then more expensively once folks got hooked while banning the sale of it back home.
Industrialization changed how people related to their bodies and therefore their pain seeing them as machines and pain as a sign they needed to oil their gears (self-care discourse of late) rather than stopping to listen to what the pain is trying to communicate and shifting the life styles and systems that make these unsustainable demands on our bodies. It also shifted how people related to their pain as more than just a bodily experience but perhaps a spiritual and emotional one which would be witnessed and held in community the medicalization of pain also led to isolation of those who have to bear it.
Patent medicines gave way to pharmaceutical oligopoly in WW2 as penicillin needed to be mass produced, rewarded companies with large market control and made medicine gate kept by doctors who could prescribe it taking away the ability to self-medicate as prior generations had. Pharmaceutical companies however have profit motives and so do the doctors they work with which has led to the current problems we have with our medical system.
Large scale use of oxyconton came from hospice movement which was seeking to remedy end of life pain in part because Sicily Saunders (head of the movement) was Catholic and opposed to death with dignity and asked for a longer lasting opiate and came up with the idea of giving it before pain set in to avoid pain ever being felt- hospice wasn't profitable enough alone so this use of opiates got peddled to pain management at large in the US even tho its lax use initially was motivated by not worrying about addiction because death was around the corner an entirely different context.
When concerns started getting voiced about oxyconton and other prescription opiates being widely given to non- hospice patients Purdue & other companies paid out doctors & created "patient advocacy" groups that led a movement to guarantee patient access to relief and paid for falsified research and theorizing about opiods safety, lack of addiction & side affects going even so fast as to coin "pseudo addiction" which looks like addiction but is supposedly not and requires treatment by giving the patient even more if the meds they are appearing to be addicted to.
Purdue also had a revolving door with the FDA that had kept their medicines unhindered in usage despite research warning against our current policy or lack there of.
Wide spread use of Valium was a cultural shift in which doctors were expected to profile tired or stressed women and offer it to them (Mothers little helper by the Stones) and changed the way Americans thought about what was normal and what they could ask for from a doctor (prescriptions for social isolation, exhaustion, sadness etc instead of just bodily matters tho these are often entangled). This was pushed in large part by magazines paid for by big pharma with ads that detailed this profiling and which became a source for doctors continued education- something they couldn't usually access after having graduated.
Chronic pain and couples: leads to divorce often, especially men leaving women once they're disabled, women are much more likely to stick it out for a disabled partner- almost all caretaking for chronic pain is done by women. The more empathetic/ deeply entwined the couple is the harder the chronic pain is to manage and the more likely the other partner is to develop it in some way or another (esp because caretaking + working + homemaking is often a lot on 1 body). Its not sustainable within a nuclear family (Leah Lakshmi Piepshna has lots to say about this).
Chronic pain and emotions: catastrophizing makes perception of pain worse and more likely to endure but hope can also be unhelpful sending people to specialist after specialist looking for an answer that doesn't necessarily exist or isn't accessible within the current medical hegemony and to taking more and more pills trying to escape it- rather than working towards acceptance of a new chapter of life at a new speed and listening to what our bodies and their pain is demanding of us rather than trying to hit re-set and jump back to business as usual.
Our internal andogenous opiod system balances our sense of wellness in our nervous system (& most vertebrates). This system includes MOP receptors & beta endorphins which can open & close the doors to pain between nosoception in or bodies and the creation of pain in our minds. Endorphins are also tied to our reward system triggered by sex, connection, delicious food and our stress management (yin & yang)- responding to crises is important for survival but chronic stress creates illness within us so the dopamine reward system kicks in afterward to try & rebalance andogenous opiods to counteract stress hormones - also decreases pain sensitivity to escape an immediate crisis, while increasing our sensitivity to pain more in the aftermath to compensate so we can take stock of and nurse our potential wounds. This is trickier when our stressors are chronic not immediate & short term like escaping a predator but instead living in a volatile home or working a stressful job, our andogenous opiod systems are put into over use and makes us more sensitive to developing chronic pain. Taking synthetic opiates rather than helping with this vicious cycle just adds fuel to the fire by decreasing our bodies natural ability to regulate and decreasing our connection to our organic reward system and increasing the follow up sensitivity when they wear off requiring more and more drugs with less and less return and getting in the way of our reward system sapping the ability to feel the warmth of connecting with loved ones, delicious food, and even sex when in withdrawal and more sensitive to pain and negative emotions.
This is especially tricky for people with depression & ptsd which are disorders that show up in disregulation of the andogenous opiod system already.
Adverse childhood experiences are one of the primary predictors of chronic pain 👀
"The body only knows how to speak one language that of aches and pains. "
Who's pain is considered to be real and matter is incredibly reflective of societal power dynamics.
Black kids suffering from appendicitis (easily diagnosable and with a clear need for acute pain mediation) are 5× less likely to recieve pain meds than white kids.
Corporal punishment- pain and the maintenance of the status quo.
"Medical" rationale given for torture in medieval Europe and ancient Greece and Rome. Pain also used to be seen as more spiritual, connecting you to something beyond yourself, ancestors, God, etc. a message to be recieved- as this worldview feel out of fashion and pain became seen as a bodily symptom torture began to fall out of fashion and our cultures tolerance for a pain that has no meaning began to plummet as well.
Medicalization of racism backed the Atlantic slave trade and its undercurrents still show up in how drs treat Black people today. Cartwright the founder of psychiatry and a signer of the declaration of independence came up with diagnoses for enslaved African Americans who wanted to escape and didn't believe they had the same pain tolerance as "more civilized people" which had trickled down into today 1/4 med students still don't believe Black people experience pain the same as white people.
War on drugs focused primarily on Black people to counteract the Black power movement which has also led to doctors (and the general public) to associate Black people with drug addiction more than white ones ever though the rates are the same, this shows up as fewer prescriptions for opiates for Black folks in the US which is bad for managing acute pain but has led to them largely escaping the most recent opiate crisis though just like how injecting heroin was sheek compared to smoking opium which became associated with Chinese immigrants, now injecting heroin has trickled down to being seen as uncouth and taboo and cheaper, someday taking oxys will also likely trickle out into the larger population as the current war on drugs plows ahead.
The Bible and Eve's punishment of pain in childbirth has similarly trickled into the medical field and is response to women's pain. The main interventions to child birth pain from ether to the free birth mvmt always came with eugenic white death scares, it turns out white supremacy will trump misogyny.
The vast majority of testing is done on men or male tissue or make animals which is probs interfering with how women, intersex, and trans folks recieve care.
Integrating a broken system isn't enough the whole medical system and the way it approaches people needs to be overhauled to take in the complexity of whole people.
Now that the risks of opiods are being realized there's jumps towards other miracle drugs namely ketamine clinics & cannabis being pursued.
Warraich puts forth hypnotism and psychotherapy as tools to listen to what the chronic pain is trying to teach us. Its giving the premise of Crazy Like Us but for chronic pain not just classic mental health diagnoses which is very interesting to me.
Empathy and placebo go a long way, sometimes performing just as much as actual treatments in studies.
Known placebo or medical ritual with a side of kindness may be even more powerful than hidden placebo for psychic/ chronic pain (feels in conversation with Drawing Down the Moon).
Feeling cared for is maybe the secret ingredient which is troubling because chronic pain sufferers are last likely to be taken seriously compared to other visible issues. This is especially a problem as many doctors are men and white and not likely to be good at empathizing in general but esp not with women and people of color.
Multidisciplinary care is starting to gain traction again pushing back on increasingly separate specialists, due to pressure from insurance companies and big pharmas push towards opiates.
For profit health care puts pressure on doctors to push for more expensive reimbursed procedures and pills that may or may not be effective- a real conflict of interest.
The VA is an example of social medicine in the US and seems to be leading the way in multidisciplinary pain mediation.
Acceptance and commitment therapy is about accepting quality of life (not catastrophizing or holding onto unrealistic hope) while committing to work through the pain to live the life they want and is within their values, emphasis on agency is key.
here's my notes:
Suffering is a uniquely human experience more in the mind than body as theorized by Descartes where as pain was seen as in the body.
Acute pain comes from body up to the mind where as chronic pain is seen as coming from the mind and finding a home to resonate in the body or phantom body part.
Mind- body dichotomy is false tho.
Fish & invertebrates are shown to feel pain not just nociception (awareness of body and threats to it) which may indicate consciousness because it is connected to learning.
Pain is deeply personal but also serves a social purpose in how it is shared or repressed. Pain is also felt very differently based on its context.
Pain turns into suffering when there is no answer for why, it is chronic, or connected to something dire.
Chronic pain became increasingly epidemic as life spans lengthened. Now ~1/5 people live with it world wide.
Despite how common it is it is still not fully understood or prioritized in its study. This often leads to doctors dismissing it especially along racialized and gendered lines.
Chronic pain likely more entwined with memory process (painful moments remembered much more clearly, trauma flash backs) than acute pain which lights up different parts of the brain.
Opium crisis: sprung out of the chronic pain crisis in the US in the 1990s but humans relationship with poppys & opiates is perhaps as old as civilization and frequently follows a similar trajectory from miracle medicine to addiction to death.
Opiates likely make chronic pain worse over time not better and are only helpful for immediate severe acute pain but have been systemically over and misprescribed for profit motives by the medical industrial complex and specifically pushed for by Purdue.
Civil War was the source of the first opiate addiction crisis in the US, and had rippled thru culture in waves since then switching from smoking to injection and morphine to heroin based on what is considered least tainted by poor peoples and people of colors usage of these drugs.
Current opiate crisis with fentanyl coming from China is almost an ironic inverse of the first Opium War in which Brittain created an opium addiction crisis in Chinese population to have an in for spice and tea trade creating an abundance of cheap opium with slave labor to sell first cheaply then more expensively once folks got hooked while banning the sale of it back home.
Industrialization changed how people related to their bodies and therefore their pain seeing them as machines and pain as a sign they needed to oil their gears (self-care discourse of late) rather than stopping to listen to what the pain is trying to communicate and shifting the life styles and systems that make these unsustainable demands on our bodies. It also shifted how people related to their pain as more than just a bodily experience but perhaps a spiritual and emotional one which would be witnessed and held in community the medicalization of pain also led to isolation of those who have to bear it.
Patent medicines gave way to pharmaceutical oligopoly in WW2 as penicillin needed to be mass produced, rewarded companies with large market control and made medicine gate kept by doctors who could prescribe it taking away the ability to self-medicate as prior generations had. Pharmaceutical companies however have profit motives and so do the doctors they work with which has led to the current problems we have with our medical system.
Large scale use of oxyconton came from hospice movement which was seeking to remedy end of life pain in part because Sicily Saunders (head of the movement) was Catholic and opposed to death with dignity and asked for a longer lasting opiate and came up with the idea of giving it before pain set in to avoid pain ever being felt- hospice wasn't profitable enough alone so this use of opiates got peddled to pain management at large in the US even tho its lax use initially was motivated by not worrying about addiction because death was around the corner an entirely different context.
When concerns started getting voiced about oxyconton and other prescription opiates being widely given to non- hospice patients Purdue & other companies paid out doctors & created "patient advocacy" groups that led a movement to guarantee patient access to relief and paid for falsified research and theorizing about opiods safety, lack of addiction & side affects going even so fast as to coin "pseudo addiction" which looks like addiction but is supposedly not and requires treatment by giving the patient even more if the meds they are appearing to be addicted to.
Purdue also had a revolving door with the FDA that had kept their medicines unhindered in usage despite research warning against our current policy or lack there of.
Wide spread use of Valium was a cultural shift in which doctors were expected to profile tired or stressed women and offer it to them (Mothers little helper by the Stones) and changed the way Americans thought about what was normal and what they could ask for from a doctor (prescriptions for social isolation, exhaustion, sadness etc instead of just bodily matters tho these are often entangled). This was pushed in large part by magazines paid for by big pharma with ads that detailed this profiling and which became a source for doctors continued education- something they couldn't usually access after having graduated.
Chronic pain and couples: leads to divorce often, especially men leaving women once they're disabled, women are much more likely to stick it out for a disabled partner- almost all caretaking for chronic pain is done by women. The more empathetic/ deeply entwined the couple is the harder the chronic pain is to manage and the more likely the other partner is to develop it in some way or another (esp because caretaking + working + homemaking is often a lot on 1 body). Its not sustainable within a nuclear family (Leah Lakshmi Piepshna has lots to say about this).
Chronic pain and emotions: catastrophizing makes perception of pain worse and more likely to endure but hope can also be unhelpful sending people to specialist after specialist looking for an answer that doesn't necessarily exist or isn't accessible within the current medical hegemony and to taking more and more pills trying to escape it- rather than working towards acceptance of a new chapter of life at a new speed and listening to what our bodies and their pain is demanding of us rather than trying to hit re-set and jump back to business as usual.
Our internal andogenous opiod system balances our sense of wellness in our nervous system (& most vertebrates). This system includes MOP receptors & beta endorphins which can open & close the doors to pain between nosoception in or bodies and the creation of pain in our minds. Endorphins are also tied to our reward system triggered by sex, connection, delicious food and our stress management (yin & yang)- responding to crises is important for survival but chronic stress creates illness within us so the dopamine reward system kicks in afterward to try & rebalance andogenous opiods to counteract stress hormones - also decreases pain sensitivity to escape an immediate crisis, while increasing our sensitivity to pain more in the aftermath to compensate so we can take stock of and nurse our potential wounds. This is trickier when our stressors are chronic not immediate & short term like escaping a predator but instead living in a volatile home or working a stressful job, our andogenous opiod systems are put into over use and makes us more sensitive to developing chronic pain. Taking synthetic opiates rather than helping with this vicious cycle just adds fuel to the fire by decreasing our bodies natural ability to regulate and decreasing our connection to our organic reward system and increasing the follow up sensitivity when they wear off requiring more and more drugs with less and less return and getting in the way of our reward system sapping the ability to feel the warmth of connecting with loved ones, delicious food, and even sex when in withdrawal and more sensitive to pain and negative emotions.
This is especially tricky for people with depression & ptsd which are disorders that show up in disregulation of the andogenous opiod system already.
Adverse childhood experiences are one of the primary predictors of chronic pain 👀
"The body only knows how to speak one language that of aches and pains. "
Who's pain is considered to be real and matter is incredibly reflective of societal power dynamics.
Black kids suffering from appendicitis (easily diagnosable and with a clear need for acute pain mediation) are 5× less likely to recieve pain meds than white kids.
Corporal punishment- pain and the maintenance of the status quo.
"Medical" rationale given for torture in medieval Europe and ancient Greece and Rome. Pain also used to be seen as more spiritual, connecting you to something beyond yourself, ancestors, God, etc. a message to be recieved- as this worldview feel out of fashion and pain became seen as a bodily symptom torture began to fall out of fashion and our cultures tolerance for a pain that has no meaning began to plummet as well.
Medicalization of racism backed the Atlantic slave trade and its undercurrents still show up in how drs treat Black people today. Cartwright the founder of psychiatry and a signer of the declaration of independence came up with diagnoses for enslaved African Americans who wanted to escape and didn't believe they had the same pain tolerance as "more civilized people" which had trickled down into today 1/4 med students still don't believe Black people experience pain the same as white people.
War on drugs focused primarily on Black people to counteract the Black power movement which has also led to doctors (and the general public) to associate Black people with drug addiction more than white ones ever though the rates are the same, this shows up as fewer prescriptions for opiates for Black folks in the US which is bad for managing acute pain but has led to them largely escaping the most recent opiate crisis though just like how injecting heroin was sheek compared to smoking opium which became associated with Chinese immigrants, now injecting heroin has trickled down to being seen as uncouth and taboo and cheaper, someday taking oxys will also likely trickle out into the larger population as the current war on drugs plows ahead.
The Bible and Eve's punishment of pain in childbirth has similarly trickled into the medical field and is response to women's pain. The main interventions to child birth pain from ether to the free birth mvmt always came with eugenic white death scares, it turns out white supremacy will trump misogyny.
The vast majority of testing is done on men or male tissue or make animals which is probs interfering with how women, intersex, and trans folks recieve care.
Integrating a broken system isn't enough the whole medical system and the way it approaches people needs to be overhauled to take in the complexity of whole people.
Now that the risks of opiods are being realized there's jumps towards other miracle drugs namely ketamine clinics & cannabis being pursued.
Warraich puts forth hypnotism and psychotherapy as tools to listen to what the chronic pain is trying to teach us. Its giving the premise of Crazy Like Us but for chronic pain not just classic mental health diagnoses which is very interesting to me.
Empathy and placebo go a long way, sometimes performing just as much as actual treatments in studies.
Known placebo or medical ritual with a side of kindness may be even more powerful than hidden placebo for psychic/ chronic pain (feels in conversation with Drawing Down the Moon).
Feeling cared for is maybe the secret ingredient which is troubling because chronic pain sufferers are last likely to be taken seriously compared to other visible issues. This is especially a problem as many doctors are men and white and not likely to be good at empathizing in general but esp not with women and people of color.
Multidisciplinary care is starting to gain traction again pushing back on increasingly separate specialists, due to pressure from insurance companies and big pharmas push towards opiates.
For profit health care puts pressure on doctors to push for more expensive reimbursed procedures and pills that may or may not be effective- a real conflict of interest.
The VA is an example of social medicine in the US and seems to be leading the way in multidisciplinary pain mediation.
Acceptance and commitment therapy is about accepting quality of life (not catastrophizing or holding onto unrealistic hope) while committing to work through the pain to live the life they want and is within their values, emphasis on agency is key.
June 1, 2022
Warraich is an assistant professor at Harvard Medical School and a practising physician and in this book he tackles the difficult topic of pain. While the book is primarily concerned with the somatic nature of pain and how it relates to modern medicine, Warraich also uses his own experience dealing with chronic pain to show how debilitating pain affects the lives of those who suffer from it. At the same time he places the medical history of pain in a larger historical context. The book is a fascinating look at how Western culture understands the nature of pain.
"In reality, pain is one of three distinct but overlapping phenomena. On one end of the spectrum is something called nociception,...the process through which potentially injurious stimulation is detected and transmitted by our nervous system...[this] is a purely physical sensation, shared by all living things, even cells and plants. On the other end is what many come to call suffering, an entirely psychological consequence of the experience of visceral injury or emotional trauma...Between nociception and suffering is pain, both sensation and emotion, both physiological and psychological..." 16
"The central problem of pain in recent times is that it has been conflated with nociception; people have come to believe that pain is synonymous with the sensory signals coming to your brain from distant parts of the body that are hurting. But in fact pain is a conscious, integrated experience that the human mind generates...." 22
"Suffering is a voyage that one often sets out on after the onset of pain. Yet an injury is not a prerequisite for suffering. Losing a loved one, being fired from a cherished job...are all events that cause us to suffer...What pain is to the body, suffering is to the heart and soul. Pain derives from physical discomfort and suffering from mental anguish." 35
"The big difference between pain and all these conditions is that pain is not a disorder but a normal bodily function." 47
"Disease is a primal part of every human being's story; a rite of passage we all have to undergo as we slowly move between birth and death. And the way we often make sense of our diseases is through storytelling. Patients tell a tale, and it is the job of the nurses, physicians, social works....that we call the healthcare system to listen." 76
"The researchers identified five themes that define the struggles of patients with chronic pain. The first two-the fights to affirm oneself and to reconstruct oneself in time-were a direct function of this disruptive disease...the next three struggles the researchers identified-constructing an explanation for suffering, negotiating with the healthcare system, and proving legitimacy-are all toxic side effects of modern medicine, the clinicians it has trained and the healthcare system it has propped up." 80
"We may work for basic sustenance, for food and shelter and health insurance, but we also work for meaning. Work provides us a way to be recognized, by our coworkers but also by society at large." 94
"Negative emotions can easily turn memories into deep wounds that might never fully heal. Merely remembering a traumatic burn can bring with it the smell of burning flesh and the blistering of the skin." 121
"The Industrial Revolution fundamentally shifted how we relate to our own body, which was now seen as a mechanical appliance, with pain being a beeping alarm that sounded when the gears started to grind." 143
"The US government desperately needed to boost the production of the first truly blockbuster drug-penicillin-and awarded contracts to fifteen American firms to produce it in large quantities. This massive funding boost transformed the industry into an oligopoly in which fifteen firms now reaped 90 percent of all profits. The pharmaceutical industry, which hadn't existed as such only two decades before, became the most profitable industry in the United States after World War II, retaining that position for the rest of the century." 162-163
"The true success of pharmaceutical marketing was transforming the patient into a consumer, making pill popping and overprescription a way of life." 164
"The United States and New Zealand are today the only countries that allow drugmakers to directly advertise to consumers." 166
"Pain and its treatment have always been about the assertion of power. Power has long been wielded through the infliction of pain, but even more so in its acknowledgement." 193
"In reality, pain is one of three distinct but overlapping phenomena. On one end of the spectrum is something called nociception,...the process through which potentially injurious stimulation is detected and transmitted by our nervous system...[this] is a purely physical sensation, shared by all living things, even cells and plants. On the other end is what many come to call suffering, an entirely psychological consequence of the experience of visceral injury or emotional trauma...Between nociception and suffering is pain, both sensation and emotion, both physiological and psychological..." 16
"The central problem of pain in recent times is that it has been conflated with nociception; people have come to believe that pain is synonymous with the sensory signals coming to your brain from distant parts of the body that are hurting. But in fact pain is a conscious, integrated experience that the human mind generates...." 22
"Suffering is a voyage that one often sets out on after the onset of pain. Yet an injury is not a prerequisite for suffering. Losing a loved one, being fired from a cherished job...are all events that cause us to suffer...What pain is to the body, suffering is to the heart and soul. Pain derives from physical discomfort and suffering from mental anguish." 35
"The big difference between pain and all these conditions is that pain is not a disorder but a normal bodily function." 47
"Disease is a primal part of every human being's story; a rite of passage we all have to undergo as we slowly move between birth and death. And the way we often make sense of our diseases is through storytelling. Patients tell a tale, and it is the job of the nurses, physicians, social works....that we call the healthcare system to listen." 76
"The researchers identified five themes that define the struggles of patients with chronic pain. The first two-the fights to affirm oneself and to reconstruct oneself in time-were a direct function of this disruptive disease...the next three struggles the researchers identified-constructing an explanation for suffering, negotiating with the healthcare system, and proving legitimacy-are all toxic side effects of modern medicine, the clinicians it has trained and the healthcare system it has propped up." 80
"We may work for basic sustenance, for food and shelter and health insurance, but we also work for meaning. Work provides us a way to be recognized, by our coworkers but also by society at large." 94
"Negative emotions can easily turn memories into deep wounds that might never fully heal. Merely remembering a traumatic burn can bring with it the smell of burning flesh and the blistering of the skin." 121
"The Industrial Revolution fundamentally shifted how we relate to our own body, which was now seen as a mechanical appliance, with pain being a beeping alarm that sounded when the gears started to grind." 143
"The US government desperately needed to boost the production of the first truly blockbuster drug-penicillin-and awarded contracts to fifteen American firms to produce it in large quantities. This massive funding boost transformed the industry into an oligopoly in which fifteen firms now reaped 90 percent of all profits. The pharmaceutical industry, which hadn't existed as such only two decades before, became the most profitable industry in the United States after World War II, retaining that position for the rest of the century." 162-163
"The true success of pharmaceutical marketing was transforming the patient into a consumer, making pill popping and overprescription a way of life." 164
"The United States and New Zealand are today the only countries that allow drugmakers to directly advertise to consumers." 166
"Pain and its treatment have always been about the assertion of power. Power has long been wielded through the infliction of pain, but even more so in its acknowledgement." 193
August 4, 2025
"The Song Of Our Scars” by Dr Haider Warraich is a fascinating exploration of pain, delving into its physical, emotional, and psychological dimensions. The author weaves together insights from neuroscience, psychology, and philosophy to create a rich and nuanced understanding of pain.
One of the most striking aspects of the book is its discussion of the complex relationship between pain and consciousness. The author draws on the work of Carl Jung, Julian Jaynes, and Sigmund Freud, among others, to illuminate the ways in which pain can be both a transformative and debilitating experience.
I also learned that MRIs don’t detect neuroactivity; instead, they detect changes in blood flow to different parts of the brain. I’ve read about oxytocin and the placebo effect. The placebo response is one of the best-studied neuropsychological phenomena. However, delving deeper into its origins in the brain and its role in modulating our immune system is simply fascinating to imagine.
“ Pain exists and is so well preserved throughout species, because pain is meaningful. It hurts because it is trying to teach us an important lesson. “
The book also sheds light on the science behind pain, including the role of the amygdala and posterior insula in processing pain and fear. I found it particularly interesting to learn about the ways in which memories of painful experiences can trigger the same chemicals and hormones, and how this knowledge can be used to develop new approaches to pain management.
“The only thing that makes my memories stick is pain “
The author's discussion of the history of opium and its uses throughout history was also captivating. From its role in Greek mythology to its impact on colonial wars and epidemics, opium's story is both complex and compelling. I didn’t knew the impact and importance it had, and how it could be a lethal weapon at the same time.
What I found most valuable, however, was the author's exploration of chronic pain and its emotional and psychological dimensions. Sadly there aren’t any redemptions or closure in this book but in fact it teaches about the core of chronic pain. Warraich puts forth hypnotism and psychotherapy as tools to listen to what the chronic pain is trying to teach us is so thought, provoking.
“ The body only knows how to speak one language that of - aches and pains.”
Overall, this book is a insightful exploration of pain and its many complexities. While it's written in an accessible style, the book's themes and ideas are likely to resonate most with readers who have a background or interest in psychology, neuroscience, or philosophy.
One of the most striking aspects of the book is its discussion of the complex relationship between pain and consciousness. The author draws on the work of Carl Jung, Julian Jaynes, and Sigmund Freud, among others, to illuminate the ways in which pain can be both a transformative and debilitating experience.
I also learned that MRIs don’t detect neuroactivity; instead, they detect changes in blood flow to different parts of the brain. I’ve read about oxytocin and the placebo effect. The placebo response is one of the best-studied neuropsychological phenomena. However, delving deeper into its origins in the brain and its role in modulating our immune system is simply fascinating to imagine.
“ Pain exists and is so well preserved throughout species, because pain is meaningful. It hurts because it is trying to teach us an important lesson. “
The book also sheds light on the science behind pain, including the role of the amygdala and posterior insula in processing pain and fear. I found it particularly interesting to learn about the ways in which memories of painful experiences can trigger the same chemicals and hormones, and how this knowledge can be used to develop new approaches to pain management.
“The only thing that makes my memories stick is pain “
The author's discussion of the history of opium and its uses throughout history was also captivating. From its role in Greek mythology to its impact on colonial wars and epidemics, opium's story is both complex and compelling. I didn’t knew the impact and importance it had, and how it could be a lethal weapon at the same time.
What I found most valuable, however, was the author's exploration of chronic pain and its emotional and psychological dimensions. Sadly there aren’t any redemptions or closure in this book but in fact it teaches about the core of chronic pain. Warraich puts forth hypnotism and psychotherapy as tools to listen to what the chronic pain is trying to teach us is so thought, provoking.
“ The body only knows how to speak one language that of - aches and pains.”
Overall, this book is a insightful exploration of pain and its many complexities. While it's written in an accessible style, the book's themes and ideas are likely to resonate most with readers who have a background or interest in psychology, neuroscience, or philosophy.
September 3, 2024
How far have we come in understanding pain ?? Has the medical field failed those suffering from chronic pain ??
Diving deep into such questions , this book is a doctor’s raw and unsparing account of his journey with chronic pain. Throughout this journey he also analyzes the historical and current connections between the medical field and pain.
From the inception of pain to its perception , the author discusses the mechanisms associated with acute and chronic pain. The complexity of pain is depicted by the fact that there is no dedicated pain center in the brain. There is a complex neuromatrix of pain. The transmission of pain through the body as well as its sensation is a convoluted process , one which needs more studies.
The author has also described the associated apathy and indifference associated with pain since historical times. This attitude towards pain exists till date and exhibits the lack of understanding of the field. The use of the term “Idiopathic” is another evidence of the failure of the medical field to understand chronic pain.
The appalling details of the opioid epidemic narrated by the author is eye opening. The indiscriminate use of opioids and the associated medical complications bring to light the opportunistic and exploitative nature of the corporate pharma sector.
Using several case studies, the author not only explores the life restricting nature of pain but its effect on a person’s social and mental health. The effect of pain is multi-dimensional and usually discarded by terms like “it's all in your head” . From discussing phantom pain to the various studies associated with the study of pain , the author has touched upon several aspects of the field.
Various quotes in the book are noteworthy. Few of my favorites are :
“A healthy body feels absent and invisible.”
“Pain has transformed from a symptom into a disease”
“There is no force that pushes us towards introspection quite like pain. The person in pain is hypervigilant focusing on every twist their body takes and every surface their body touches. ”
“Hope can be poisonous. Giving up hope that things will be otherwise can allow people to come into a phase of acceptance and give the individual psychological and physical relief. ”
This account of the author opens the unexplored territory in the study of pain. Living with chronic pain has changed the lives of many in different ways but there is still a long way to go to understand the field and mitigate its effects.
Diving deep into such questions , this book is a doctor’s raw and unsparing account of his journey with chronic pain. Throughout this journey he also analyzes the historical and current connections between the medical field and pain.
From the inception of pain to its perception , the author discusses the mechanisms associated with acute and chronic pain. The complexity of pain is depicted by the fact that there is no dedicated pain center in the brain. There is a complex neuromatrix of pain. The transmission of pain through the body as well as its sensation is a convoluted process , one which needs more studies.
The author has also described the associated apathy and indifference associated with pain since historical times. This attitude towards pain exists till date and exhibits the lack of understanding of the field. The use of the term “Idiopathic” is another evidence of the failure of the medical field to understand chronic pain.
The appalling details of the opioid epidemic narrated by the author is eye opening. The indiscriminate use of opioids and the associated medical complications bring to light the opportunistic and exploitative nature of the corporate pharma sector.
Using several case studies, the author not only explores the life restricting nature of pain but its effect on a person’s social and mental health. The effect of pain is multi-dimensional and usually discarded by terms like “it's all in your head” . From discussing phantom pain to the various studies associated with the study of pain , the author has touched upon several aspects of the field.
Various quotes in the book are noteworthy. Few of my favorites are :
“A healthy body feels absent and invisible.”
“Pain has transformed from a symptom into a disease”
“There is no force that pushes us towards introspection quite like pain. The person in pain is hypervigilant focusing on every twist their body takes and every surface their body touches. ”
“Hope can be poisonous. Giving up hope that things will be otherwise can allow people to come into a phase of acceptance and give the individual psychological and physical relief. ”
This account of the author opens the unexplored territory in the study of pain. Living with chronic pain has changed the lives of many in different ways but there is still a long way to go to understand the field and mitigate its effects.
January 17, 2026
This book provides important insights by distinguishing acute and chronic pain as entirely distinct phenomena that shouldn't be treated the same way. The book addresses social justice issues, highlighting how Black patients' pain is often discounted or disbelieved by the medical system, and examines racism, sexism, and ageism in pain treatment. Warraich documents how the opioid epidemic was carefully orchestrated and intentionally designed by the Sackler family. Despite the heavy subject matter, the book carries a hopeful message, making a case that even if we hurt, we don't have to suffer through better understanding. It has received glowing endorsements from major medical authors.
The narrative jumps between topics like Greek mythology, opium history, and the Civil War in ways that feel scattered and disjointed. The book includes descriptions of painful animal experiments that found disturbing.
Warraich proposes that chronic pain might not be a physical sensation or emotional state but a memory. He breaks pain into three components: nociception as the sensory response, pain as the meaning given to sensation, and suffering as the interpretation of that meaning. Interestingly, the most promising treatments don't involve any chemical medication or procedural manipulation but instead focus on empathy, listening, and learning to live with pain. The book reveals that pain only became a medical issue during the Renaissance and wasn't always viewed this way. Despite the heavy topic, the book is ultimately an attempt to find faith again in medicine and advocates for holistic, empathetic care.
Overall, this is a mixed bag. It's academically rigorous but sometimes dry, important but potentially difficult to read for someone lwho prefers a positive mental attitude and finds pain discussions difficult, I'd honestly suggest skipping this one or being very selective. Perhaps read only the final chapters on solutions and future treatments rather than the historical trauma and opioid crisis sections.
The narrative jumps between topics like Greek mythology, opium history, and the Civil War in ways that feel scattered and disjointed. The book includes descriptions of painful animal experiments that found disturbing.
Warraich proposes that chronic pain might not be a physical sensation or emotional state but a memory. He breaks pain into three components: nociception as the sensory response, pain as the meaning given to sensation, and suffering as the interpretation of that meaning. Interestingly, the most promising treatments don't involve any chemical medication or procedural manipulation but instead focus on empathy, listening, and learning to live with pain. The book reveals that pain only became a medical issue during the Renaissance and wasn't always viewed this way. Despite the heavy topic, the book is ultimately an attempt to find faith again in medicine and advocates for holistic, empathetic care.
Overall, this is a mixed bag. It's academically rigorous but sometimes dry, important but potentially difficult to read for someone lwho prefers a positive mental attitude and finds pain discussions difficult, I'd honestly suggest skipping this one or being very selective. Perhaps read only the final chapters on solutions and future treatments rather than the historical trauma and opioid crisis sections.
January 14, 2024
Chủ đề nghiên cứu vết thương cũng khá lý thú, vì như tác giả nói, đây là đối tượng không được xác định. Bởi mỗi người đều có 1 thang đau riêng, mỗi người đều diễn tả nó theo cách khác nhau... nên sẽ không có 1 nền tảng chung nào đặt ra cho đối tượng này.
Tác giả đã khảo sát nó về nhiều khía cạnh, đầu tiên nhất là sinh học. Chắc do k phải người chuyên ngành nên đối với mình đoạn này khá chán. Một hàng dằng dặc những cơ quan, tế bào, hormone... nói chung là lạ lẫm, và cũng khó đọng lại trong mình những điểm mấu chốt. Phần này hay nhất chính là khi tác giả khai thác cơn đau chi ma và cơn đau mãn tính, để thấy muôn sự phức tạp của cơn đau. Hồi nhỏ mình cũng đau mãn tính nhưng khi nói ba mẹ không tin đâu, bảo nít ranh 11, 12 tuổi mà đau gì, nên đọc mấy dòng này rất đồng cảm í.
Phần sau lại cực kỳ hay, gắn nỗi đau với các thể chế chính trị - văn hóa- xã hội bất ngờ. Mình biết đối tượng nào cũng có thể khai thác lịch sử quanh nó, nhưng cơn đau thì mình khó tưởng tượng được làm nó ra sao. Nhưng tác giả cho thấy nó gắn với quá trình thực dân da trắng đàn áp người bản địa thế nào, trong bất bình đẳng giới ra sao, cũng như cảnh báo về thực trạng nghiện thuốc giảm đau ở nhiều nơi trên thế giới...
Nếu bạn không quan tâm 1 cách bài bản mà muốn khám phá những điều mới lạ, thì hãy bắt đầu đọc ở nửa cuối cuốn sách thôi, đảm bảo là rất lý thú. Nhưng do phần đầu viết chán quá nên mình xin bớt sao lại ^^ Sorry tác giả.
Bạn có thể đọc chi tiết hơn mình viết ở đây: https://www.nguoidothi.net.vn/khuc-tr...
Tác giả đã khảo sát nó về nhiều khía cạnh, đầu tiên nhất là sinh học. Chắc do k phải người chuyên ngành nên đối với mình đoạn này khá chán. Một hàng dằng dặc những cơ quan, tế bào, hormone... nói chung là lạ lẫm, và cũng khó đọng lại trong mình những điểm mấu chốt. Phần này hay nhất chính là khi tác giả khai thác cơn đau chi ma và cơn đau mãn tính, để thấy muôn sự phức tạp của cơn đau. Hồi nhỏ mình cũng đau mãn tính nhưng khi nói ba mẹ không tin đâu, bảo nít ranh 11, 12 tuổi mà đau gì, nên đọc mấy dòng này rất đồng cảm í.
Phần sau lại cực kỳ hay, gắn nỗi đau với các thể chế chính trị - văn hóa- xã hội bất ngờ. Mình biết đối tượng nào cũng có thể khai thác lịch sử quanh nó, nhưng cơn đau thì mình khó tưởng tượng được làm nó ra sao. Nhưng tác giả cho thấy nó gắn với quá trình thực dân da trắng đàn áp người bản địa thế nào, trong bất bình đẳng giới ra sao, cũng như cảnh báo về thực trạng nghiện thuốc giảm đau ở nhiều nơi trên thế giới...
Nếu bạn không quan tâm 1 cách bài bản mà muốn khám phá những điều mới lạ, thì hãy bắt đầu đọc ở nửa cuối cuốn sách thôi, đảm bảo là rất lý thú. Nhưng do phần đầu viết chán quá nên mình xin bớt sao lại ^^ Sorry tác giả.
Bạn có thể đọc chi tiết hơn mình viết ở đây: https://www.nguoidothi.net.vn/khuc-tr...
June 20, 2023
Warraich is no Oliver Sacks. He’s not even an Atul Gawande. This book reads like an undergraduate term paper. It’s not well organized. It merely recapitulates one study after another without providing a framework. Many of the studies are about awful experiments on animals and pain. The title, The Song of Our Scars, is misleading. There is nothing lyrical or poetic about the writing in this book.
Pitifully, the author tries to wedge his own back pain into the book. But it’s clear the author doesn’t really have any personal understanding of pain. He may have experienced it, but he has no deep understanding of it. Plus his own experience of pain is mitigated by the fact that when he goes through the medical system, he goes through as a doctor. What could that tell us about how doctors treat the average patient regarding pain?
He uses the story of a young white woman’s pain and concludes with the claim that the pain of people of color is not taken seriously. Why not use an actual example of that?
Warraich makes a claim in the intro: “It is said that pain is inevitable but suffering is optional. Yet I cannot imagine that anyone who has experienced persistent pain personally or cared for someone in unflagging agony would ever believe such hogwash.” He is completely wrong about that. There are many contemplative practices that demonstrate otherwise.
This is the best Harvard can offer? Too bad. Nothing useful here.
Pitifully, the author tries to wedge his own back pain into the book. But it’s clear the author doesn’t really have any personal understanding of pain. He may have experienced it, but he has no deep understanding of it. Plus his own experience of pain is mitigated by the fact that when he goes through the medical system, he goes through as a doctor. What could that tell us about how doctors treat the average patient regarding pain?
He uses the story of a young white woman’s pain and concludes with the claim that the pain of people of color is not taken seriously. Why not use an actual example of that?
Warraich makes a claim in the intro: “It is said that pain is inevitable but suffering is optional. Yet I cannot imagine that anyone who has experienced persistent pain personally or cared for someone in unflagging agony would ever believe such hogwash.” He is completely wrong about that. There are many contemplative practices that demonstrate otherwise.
This is the best Harvard can offer? Too bad. Nothing useful here.
June 2, 2024
I loved the first half of this. The beautiful prose really illustrates the state of chronic pain- how it makes someone feel and how little we know about it, but the second half about origins and solutions left me with a bad taste in my mouth. While I agree with encouragement to live well with pain and limit our reliance on opioids, I felt like some of the conclusions that were being drawn were a little extreme. There is so much that could be said about inequity in women's pain and he chooses childbirth? And then he goes on and on about how women are more sensitive to pain and suffer more which is only half the story. While I think he was trying to tie pain to stress and structural level bias... it just felt like backwards thinking. I appreciate the appeal to empathy and empowerment, but the solution to chronic pain is much more complicated. While I feel like the author is on the same side, the message felt like it could do more harm than good in the way it was ultimately delivered. Maybe it was unintentional, but this really just made people living with chronic illness seem fragile/stuck when I'd argue they are anything but.
June 19, 2024
We have all experienced pain, yet its true nature remains elusive, a shadow lurking at the edges of our understanding.
Maybe we never really tried to comprehend pain. Whenever we experience pain, All we think about it is the way out of it.
In ‘the song of our scars’ The author, presents a profoundly insightful and empathetic exploration of one of most universal yet misunderstood experiences: pain.
>His analysis portrays pain beyond physical sensation.
>It talks about chronic pain which is widely visible among people these days.
>Warraich Recalls his encounter with an injury and how it led him to write this book and there he presented different shades of pain.
> This historical perspective is not just informative but also serves as a backdrop to question modern medical practices and societal attitudes towards pain.
> His analysis of the opioid crisis is particularly poignant, exposing how societal and medical failures have compounded the suffering of millions.
Overall It was an informative and insightful read fostering on enhancing perspective towards pain.
Maybe we never really tried to comprehend pain. Whenever we experience pain, All we think about it is the way out of it.
In ‘the song of our scars’ The author, presents a profoundly insightful and empathetic exploration of one of most universal yet misunderstood experiences: pain.
>His analysis portrays pain beyond physical sensation.
>It talks about chronic pain which is widely visible among people these days.
>Warraich Recalls his encounter with an injury and how it led him to write this book and there he presented different shades of pain.
> This historical perspective is not just informative but also serves as a backdrop to question modern medical practices and societal attitudes towards pain.
> His analysis of the opioid crisis is particularly poignant, exposing how societal and medical failures have compounded the suffering of millions.
Overall It was an informative and insightful read fostering on enhancing perspective towards pain.
July 21, 2024
After reading the author’s book State of The Heart, I immediately knew I wanted to pick up anything and everything else he’s ever written— his ability to weave medical history, science, clinical cases and personal anecdotes into his work makes it incredibly difficult to put his books down, and The Song of Our Scars was no exception! I truly enjoyed reading this book from start to finish. It walks us through comparing/contrasting nociception & pain, acute & chronic pain, is incredibly well-researched and qualifies many sides to the issue of chronic pain and its treatment, also offering a broad spectrum of histories/context that impacts pain management today (racism, sexism, obstetrics, big pharma, religion, and more). His work synthesizes so many topics and so much history I’ve learned as a medical student into captivating stories, and also encourages me to never stop thinking of ways we can better incorporate empathy and humanity into medicine. Huge fan of his work as you can tell lol, it is so inspiring to read!
September 3, 2023
I have no skin in the game when it comes to pain care so I went in to reading this book based on a recommendation because the science topic was intriguing. The author is a doctor who also now has chronic pain and he tries to approach pain from history, science, popular culture, and more which works because it doesn't get too academic though there are times and shows the progression of pain in our understanding, research, and from people themselves while then moving toward the Sackler family and Purdue Pharma, and what the future may look like for pain treatment.
I feel like I know a little more now.
"Beta-endorphin is more than our very own painkiller. It is also the key facilitator of the feeling one gets when eating a delicious meal or making love or when holding one's child really close. Endorphins are the chunk of cheese at the end of the maze, the summit at the end of the trek, the trophy at the end of the tournament."
I feel like I know a little more now.
"Beta-endorphin is more than our very own painkiller. It is also the key facilitator of the feeling one gets when eating a delicious meal or making love or when holding one's child really close. Endorphins are the chunk of cheese at the end of the maze, the summit at the end of the trek, the trophy at the end of the tournament."
March 5, 2023
Another book club read. Written by a doctor who lives with chronic pain and his investigations into the how and why of it all. A good history on how the medical profession (with the help of Sackler and his ilk) rewrote how pain and suffering were viewed and treated.
Outcome alert: if you live with chronic pain and are hoping for a cure, there isn’t one.
The doctors were right: it’s all in our head - in the insula to be exact. And the doctors were wrong, it is real. Although it cannot be tempered or controlled with pain meds (opioids); those are for acute pain. This book also highlights how Sackler knew exactly what he was doing, knew about the addictive nature, etc.
Outcome alert: if you live with chronic pain and are hoping for a cure, there isn’t one.
The doctors were right: it’s all in our head - in the insula to be exact. And the doctors were wrong, it is real. Although it cannot be tempered or controlled with pain meds (opioids); those are for acute pain. This book also highlights how Sackler knew exactly what he was doing, knew about the addictive nature, etc.
May 18, 2024
Well balanced and didn't feel like a self help book, the last few pages were a nice summary that showed all the key points but I liked the Personality mixed with history, as well as brave and honest criticism that US Healthcare is often the instigator. Hard to understand so soon after finishing but not giving up on idea that it's in your head but embracing it with fact that placebos, ACT care acceptance and commitment therapy are as important as ground breaking chemical fixes. Feel much more encouraged and empathetic after reading, humbled as well but connected to fact that to suffer is to exist and eradicating pain is not the goal.
January 5, 2023
I really enjoyed this book. It's not perfect, but its the most compassionate and understanding book on chronic pain I've ever read. He emphasizes caring treatment and the role it can play in relieving fear and distress associated with chronic conditions, and I wholeheartedly agree. In the long process of trying to get someone to take me seriously and really listen, the doctors who helped me the most were the ones who saw me as a human.
May 18, 2022
This book looks into the causes and the treatments of chronic pain afflicting so many people in the United States. It shows how medicines and surgeries often do not help but continue to be used and how the brain and body work together in all things including pain. And finally the author offers better ways to help those with chronic pain.
April 1, 2023
This book it's a denounce of the bad vision of how the medics treat the pain, how the pharmaceutical industry prostitutes the medical specialties to threat pain. But also talk about the importance to put attention to the emotional factors before give drugs how primary treatment. A good book to understand the basic process of how surge the pain on our bodies
Currently reading
May 18, 2025The book was recommended by my partner who is a rheumatologist. I read the reviews before picking up the book and, as imagined, the topic of chronic pain is riddled with human suffering. The premise of the book that "everything we know about pain is wrong" set a very high expectation for any reader, much less a physician.
April 24, 2022
Being new to the experience of living with chronic pain, I hoped to find something that might give me hope in terms of new medical advances. Not sure I did, still, I found this book informative and well written.
May 16, 2022
insightful
The book provides a good overview of pain, its historical background, its basic physiology, and its interpretation through a personal eye. As a physician of 40 years, I learned a lot.
Jeff Kleiman
The book provides a good overview of pain, its historical background, its basic physiology, and its interpretation through a personal eye. As a physician of 40 years, I learned a lot.
Jeff Kleiman
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