Why Does It Still Hurt?: how the power of knowledge can overcome chronic pain

by Paul Biegler

Chronic pain is the single biggest cause of human suffering. Yet pain that persists for three months or more is often unrelated to any physical injury. So why does it still hurt?

Research over the last few decades shows that many of us — sufferers of chronic pain and health practitioners alike — are victims of a devilish trick of the nervous system. Where we believe that pain has its root in a damaged body, it is the brain that prolongs the hurting long after the body has healed. This leads to hundreds of billions of dollars being spent each year on treatments that sometimes do nothing and sometimes make matters worse.

Paul Biegler, a science journalist and former doctor who has been on his own pain journey, investigates the true source of chronic pain — our brain’s so-called neuroplasticity — and emerging therapies, including cognitive therapy and graded exercise exposure, that take advantage of that same neuroplasticity to rewire the brain and end the suffering. As he knows only too well, this doesn’t mean the pain is all in a person’s head. The pain is real, but its meaning is often misunderstood.

Through conversations with scientists, doctors, and people who have overcome chronic pain, Biegler shines a light on the rigorous new studies — and emotional personal stories — that are changing the way we understand and treat pain. Most importantly, he shows how to take control over persistent pain and truly heal.

Genres: Nonfiction, Health, Psychology, Science, Audiobook, Self Help, Disability

304 pages, Paperback

Published January 10, 2023

Reviews

[Alison · Rating 3 out of 5]

I borrowed this after hearing an interview with Paul Biegler. The topic is interesting and the studies described bring a complexity and innovation to chronic pain that are fascinating. This writer’s style however is so frustrating, padding out the book with descriptions of scenes and people, stopping one narrative to set the scene/life of another interlocutor. Tries too hard to transform ‘science’ into ‘story’ at the expense of actually getting the info. And so many ‘stories’ are left up in the air. I wouldn’t read his writing again but I would follow up some of the research he cites. (Refs are uneven in quality - I wouldn’t go to The Conversation podcast to learn about bioplasticity of the brain).

[Jess Brien · Rating 5 out of 5]

Thank you to Scribe for the advanced copy of this book, and I'm looking forward to sharing mine and Paul's interview on the That's So Chronic podcast next month.

I really enjoyed this book about chronic pain from Paul Biegler. He makes a statement that he is writing this book as a journalist as opposed to a doctor, and that is what sets this book apart. Rather than telling you what to do, Paul offers the readers insight into research, therapies, patient perspectives, as well as his own journey, and encourages you to collect what information might help you. It was easy to read, but I did have to stop occasionally to gasp (especially during the Passengers on the Bus chapter!) thanks to my mind being blown!

I recommend this book to anyone who would like to deepen their knowledge on chronic/persistent pain whether you are a medical professional or patient.

[Taryn ⋆ ˚｡⋆౨ৎ˚]

yeah no

[Christabel · Rating 1 out of 5]

DNFed at chapter 7 title page because I literally could not sit through the rest of this god-forsaken crap.

I tried REALLY hard to give this book a chance and labored through almost all of it hoping that it would actually give some good advice on HOW the power of knowledge can overcome chronic pain. Really, all this book has was DETAILED descriptions about ANYTHING BUT KNOWLEDGE ON OVERCOMING CHRONIC PAIN
Like for real, this guy must have a hard on for architecture, weather, and people, because all he would describe in EXCRUCIATING detail is buildings, areas/suburbs, what people were wearing, their voice, their life history, literally anything EXCEPT chronic pain.

I can appreciate that he describe studies and other medical jargon on how practitioners have pioneered new ways of dealing with chronic pain, but the back of this book literally states

“Most importantly, he shows how to take control over persistent pain and truly heal”

It definitely did not show me that.

If you are a chronic pain patient looking for a book with way to helps you cope or deal with your pain or find ways to heal from it/treat it - this is NOT the book for you. Please don’t even bother. It is a waste of time and hours of my life that I will never get back.

Genuinely wishing I had stopped reading this book sooner. Absolute garbage.

[Christina · Rating 4 out of 5]

For someone with chronic pain, I knew shockingly little about it. The insights and studies canvassed in this book were really interesting and gave me hope that I might not have this pain forever and the motivation to search for new treatment options.

[Courtney Coulson · Rating 5 out of 5]

This solved my problems faster and more effectively than a whole host of doctors and medications ever did.

[Hannah]

TW: graphic descriptions of injuries, surgeries, medical settings

An interesting one that has really changed my perspective on pain. The author looks at lots of different studies that have tried to challenge our presumptions on pain (eg. why is surgery the go-to fix-all for pain when it's not always successful? It doesn't have to be) and speaks to patients about their experiences. Learned quite a bit about the brain too which I wasn't expecting (yes, neuroplasticity will be my new favourite buzzword for the next month).

Honestly this book would be 5 stars for how it informed, enlightened and challenged me HOWEVER the author did this really annoying thing of describing everyone he met (doctors, psychologists, physios, patients etc) and where they lived in overdrawn and excruciating detail. It was so unnecessary and added nothing to the book except more pages. Once I learned to skim these parts I got through it much quicker. He spoke to and references so many people that even with the descriptions - maybe in spite of them actually - I can't recall a single one specifically. I remember the stories they told, which is the important thing, and shows (to me at least) that these descriptions weren't needed at all.

Still, worth a read if you suffer from chronic pain and want to learn a bit more about the lengths our body goes to in order to protect us 😫🫶

[Emily Fletcher · Rating 3 out of 5]

3.5 Why Does it Still Hurt is an optimistic view on the current medical discourse and scientific discovery around chronic pain, one of the fastest growing concerns in modern medicine. I have endometriosis, so read this for personal reasons, and although the types of chronic pain the book focuses on are quite different to my own I still got a lot out of this. In particular, I admire the way Biegler walks the line of acknowledging the psychology behind pain without levying that phrase every chronic pain sufferer dreads - 'its all in your head.'
There's a particular format of scientific books like this (set scene with flowery description, detail a medical study, discuss what this means in the context of the book), which I find quite endearing but does get repetitive after a while. I'd definitely recommend this to anyone else living with chronic pain, as an objectively interesting and personally relevant read.

[Alison · Rating 3 out of 5]

I understand why this book was written and think that a lot of it is valid - however, it should be used as more of a proactive approach to chronic pain than reactive. As someone that lived with chronic pain for 5 years and tried a lot of different pain relief techniques mentioned in this book, I found that it swung too far in one direction and set a tone similar to, “the pain is in your head.” I would have felt incredibly angry if I was told to read it when I was in the midst of dealing with chronic pain. That being said, it’s an interesting read and has some good tidbits of information, but I would recommend with extreme reservations.

[Mercedes · Rating 4 out of 5]

Well written informative look at pain and what has worked re managing it - these are not your typical solutions. Very interesting.

[Angela · Rating 3 out of 5]

While the book stands on solid ground, I felt the author got bogged down in rehashing the particulars of research studies. I appreciate a solid, scientific approach but it lacked a human element. There were case studies from pain sufferers Biegler met and interviewed, but the stories got lost in the dry details. I found The Way Out by Alan Gordon, and The Myth of Normal by Gabor Mate, much more engaging.

[Chloe · Rating 3 out of 5]

Some really great information buried beneath a lot of pointless ramblings, stories, and descriptions. I really disliked the writing style. Just tell me why it still hurts! I’m in pain, I don’t care what colour eyes and hair your interviewee has, what they are wearing, their life story… just please give me the information I need to heal. That is all I ask.

[Stella Mozarella · Rating 3 out of 5]

Very informative but quite dense at times and took ages to get through! Still worth the read though.

[Jessie Jones · Rating 4 out of 5]

3.75

[JasminReads · Rating 3 out of 5]

A really solid starting place for people who haven't engaged with pain education or modern pain science.

I found it a little tedious at times, I understand the stories being told was to give it a human face and show the science in action, but I really didn't care for all the details about different individuals - I'm here for knowledge and the stories felt like detours. He talked a lot about people receiving "pain education" but it would have been nice to go more in depth into what thorough pain education looks like including the different ways of understanding, visualising, and coping with pain that were mentioned abstractly but not in explicit ways. I feel like I am walking away from this book needing to look into the kinds of pain education and treatment are out there so I can get more details and put things into action, it's not the books fault it's not helpful on my pain journey but in combination with the vibes it really didn't do it for me. That's not to say the book is bad, I am sure for some the "pain stories" would be a helpful and valuable part of it - it just detracted from the value for me.

A gripe I have is the description of rats subjected to testing. Lab rats were described as lazy and they had this incredible idea to give them wheels and what do you know, the rats started running. Rats in labs are not lazy - they’re confined to tubs where they can only stand up to full height in one spot (this is what makes it “not abuse”) and there is no opportunity for them to climb, run, forage, nest, dig, or do a whole host of other natural behaviours.

The biggest take-aways of the book is ALL pain exists in your head, but chronic pain exists far more in the emotional parts of the brain that short term pain does. This doesn't mean your pain and suffering isn't real, it just means that your treatment options have changed. Regular movement (particularly movement that you enjoy and that doesn't trigger increased pain) of almost any kind is beneficial to individuals with chronic pain. Pain education alongside psychotherapy with a trusted practitioner can improve an individuals long term experience of pain.

[Jennifer (JC-S) · Rating 3 out of 5]

‘ … pain is more like an inference, a conclusion about danger based on all available evidence. And inferences are only as good as the evidence on which they are based.’

In this book, Paul Biegler, an academic, a journalist and a former doctor of emergency medicine provides the reader with a framework for understanding pain. This is important, especially for the more than 3.4 million Australians who are currently living with chronic pain.

‘Chronic pain is the single biggest cause of human suffering. Yet pain that persists for three months or more is often unrelated to any physical injury. So why does it still hurt?’

By providing a mixture of personal stories and a look at some of the research undertaken into chronic pain, Paul Biegler provides some insights into our understanding of pain. Yes, it is part physical and part psychological. Why does the brain sometimes prolong pain after the injury which initially caused it has healed? What is the meaning of the pain experienced in such cases?

I found the discussion about the brain’s neuroplasticity fascinating, especially the possibility of rewiring the same neuroplasticity so that instead of prolonging pain it ends it. Reading some of the personal stories included demonstrated how this works, for at least some sufferers of chronic pain.

I finished this book with some optimism for a future in which both pain and its effective management are better understood. I would recommend this book to anyone with an interest in (or experience of) chronic pain.

Jennifer Cameron-Smith

[Lynda · Rating 5 out of 5]

There is a lot to get out of this book, and I'd recommend you jot notes (and the associated page) of the most relevant things for you, so that you can return to the insights again and again. Biegler presents a very good case for the following:
Persistent pain causes ultra-sensitivity - even a breeze of air can be excruciating on the injury site. Neuroplasticity - the brain's ability to re-wire, re-learn. Maladaptive plasticity - pain stays put - the 'pain mistake' - this needs to be understood for that individual.

Therapies which address maladaptive neuroplasticity are overwhelmed by conventional and pharma solutions, often that don't work. Maladaptive neuroplasticity needs to work on the correct brain areas.

Messages and self-talk should be neutral - 'every step matters', 'it's never too late' - because overly positive and overly negative messages can be counter productive. Pain gets worse with stress and dark emotions.

Most importantly - Pain relief and a viable action plan for managing pain depends on the doctor's or professional's: attention, empathy, generosity of spirit, confidence in themselves and their patient, and connection with their patient.

There is so much to this book, even if you can only read it slowly over time, it's well worth it.

[Susanna Saunders · Rating 5 out of 5]

I'd seriously recommend reading this book if you are not familiar with the various studies into chronic pain and it's management - both personally and scientifically. As someone who has endured 7 years of chronic back pain due to a prolapsed disc (L5), I found the book challenged my world views and gave me a new perspective of pain and how I should view it, live my daily life and my expectations about the future.

The failure of the medical profession to address long term pain and it's lack of rolling out pain reprocessing therapy is a tragedy that sadly is endemic. I sincerely hope this book helps to promote the widespread adoption of such thinking in due course! Only then will we be able to re-educate a population of people who fail to understand pain in all it's complexity! Especially as back pain has become so ubiquitous with modern day living...

I heartily recommend you reading this book if struggle with chronic pain and especially if you are a health care professional who helps people with chronic pain.

[Georgina Van · Rating 4 out of 5]

Really enjoyed the personal anecdotes. These helped me to understand the concepts on a more meaningful level. Very intriguing learning about hypnosis, VR technology, and placebos for pain management. It provided me with some useful tips. However the science behind the ideas in the book are great and useful for someone with basic health literacy, it doesn't provide practical ways to change the way you experience pain in every day life but more describes the neuroscience and capability of the brain to rewire if given the correct circumstances, ie access to hyponotherapists CBT experts, and generally affordable healthcare and comprehensive information. I'm sure there are other books for what I seek regarding the psychology of pain management and how to deal with daily pain, but I spose still very useful knowing the fundamentals and to move from there. Side note. I skim read a lot of the detailed descriptions of buildings in this book.

[Ian]

Yup, I did struggle a bit but in the end it's a very good book for those wanting to explore ongoing pain. Presumably their own. The writer uses a Malcolm Gladwell style (learn from the master) but that didn't work quite so well.

The chosen data seemed great, referenced and conclusions and lack of conclusions seem logical.

I started this book two answer two questions. Is their things I can do with my mind to Decrease existing pain, and are their things (a mindset/belief etc) I can gradually learn to deal with future pain? The book has I believe moved me along both questions positively. I'd like to take that further now. Not sure how, maybe back to the cushion for further contemplation arround delusional thinking.

[Sarah · Rating 4 out of 5]

Listened to the Audio book, read by Grant Piro.

Oh I really enjoyed this. I loved the anecdotal stories that were used to back up the science.
The science was so interesting.
The book was really accessible - I don't think you would have to be too sciencey to understand or enjoy it.

The only downside, is my brain can't hold all the information imparted, so I don't retain all the studies/evidence. This makes it hard to share with people convincingly!

The main take away for me - pain is mainly subjective. There is no "cure" for chronic pain. Surgery is mostly unnecessary for chronic pain.

People hate being told this, but the science is all there - distraction and attitude control pain.

I would highly recommend this and would read another by the author.

[Donna · Rating 5 out of 5]

Anyone that's ever experienced an injury or long term pain, or lives with the possibility of that happening (um, that's everyone right?) should read (or listen to) this book. A fascinating, mind blowing collection of stories and the science behind how we experience and hopefully overcome chronic pain. There is so much more to it than most would realise. I've noticed this trend, particularly with the good physiotherapists I've consulted in the past. Knowing, and teaching, that there is more to pain than tissue injury or broken bones. I can't do it justice in a quick explanation here, but I highly recommend this book to everyone!
#Via audio.

[Elisabeth · Rating 4 out of 5]

Very inspirational book exploring studies and evidence out there currently about chronic pain, from painkillers, the reasons for pain, and of course - how it is difficult to ascertain what is really the cause for pain, as it is all synthesised in the brain. Definitely made me think about my patient-group and how often I encounter chronic pain - how much of it is manageable without analgesia. I would hope I will be able to turn to this book again should I start experiencing chronic pain myself.

[Victoria · Rating 1 out of 5]

DNF. What in the genre mess is this book? I do not care what colour hair someone has, where the McDonald’s is located, or every other completely irrelevant detail the author excessively elaborated on. It’s supposed to be non-fiction talking about pain, yet somehow it’s told like an incredibly overly descriptive scenery fiction book. There’s probably some great info in this book, but the writing style is frustrating and time wasting. Hard pass.

[Douglas Saunderson · Rating 5 out of 5]

A very in-depth review of the literature and investigations into chronic pain, written by an experienced medical doctor and researcher.
Style is easy to read and friendly. This is a difficult subject which no practitioners have yet found all the answers to, but literary works like this helps.
Well done Paul, the book has helped me to a little more understanding of this complex problem.

[Reader · Rating 5 out of 5]

Paul Biegler has written an absolutely brilliant treatise on pain. It chronicles the power of the mind through its influence on one’s experience of pain. That it’s effects can be both adaptive and maladaptive is the key to understanding how relief from chronic pain involves not only intellectual knowledge but also deep emotional sympathy, acceptance and then eventual release.

[Namita N · Rating 4 out of 5]

As someone who deals with chronic pain everyday, this book was eyeopening. It explores non pharmacological approaches to pain relief and dives deep into the psychology behind pain. I’ve learned so much about how the mind and body connect. This book is very informative!

[Charlotte Jukes · Rating 1 out of 5]

This did absolutely nothing for me. You could remove 95% of the content, and it would have the same impact. Parts were mildly interesting, but as someone who has suffered with chronic pain for fourteen years, I'd put this firmly in the CBT, yoga and kale camp.

[Adele · Rating 4 out of 5]

Easy read with some extra research studies I hadn’t come across

[A J · Rating 4 out of 5]

A very interesting approach to chronic pain that I believe has alot of value. Some bits were super boring, skimmed through those - too much history at times.