254 15 APRIL 2022 • VOL 376 ISSUE 6590 science.org SCIENCEPHOTO: ASIAVISION/ISTOCK.COMBy Marcia L. MeldrumI
n The Song of Our Scars: The Untold
Story of Pain, Haider Warraich con-
fronts the enigma of chronic pain both
as a physician and a patient. Building
on his own experience with chronic
pain—the result of an injury sustained
during a weight-lifting accident while War-
raich was in medical school—and extensive
research and interviews with patients and
scientists, he explores the neurophysiology
of pain and explains why the nervous sys-
tem mechanisms under lying acute pain fail
to explain the persistence and intensity of
chronic pain. The book also traces the his-
tory of pain and pain treatment and indicts
the US health care system and the modern
pharmaceutical industry for the roles both
have played in the ongoing opioid epidemic
and the persistence of racial and gender in-
equities in pain treatment.
Warraich writes vividly and well, using
diverse sources that range from Tolstoy (he
uses The Death of Ivan Ilyich to illustrate
the experience of suffering) to unpublishedcourt documents exposing the machinations
of the Sackler family. His opening discussion
of the physiology of pain is clear and acces-
sible, and he carefully and incisively analyzes
the persistence of racial and gender differ-
ences in medical imagery and treatment of
pain. Histories of discrimination may inten-
sify pain experience, he explains, yet white
physicians often “don’t trust” pain levels re-
ported by patients of color.
The book’s discussion of the long-term
memory–forming protein PKMzeta and its
potential role in chronic pain sensitization
is thought-provoking, drawn from recent
research, and a topic that may be new to
many readers. When PKMzeta is blocked in
mice, chronic pain behaviors fail to develop,
suggesting a failure to establish long-term
memories of pain-related events and emo-
tions. Further integration of these research
findings with other recent work by neuro-
scientists would have improved this section.
Warraich’s tour de force is a fine introduc-
tion for someone unfamiliar with this topic,
but the narrative presented is not necessarily
an “untold story,” as the book’s subtitle prom-
ises. Readers familiar with recent works such
as Joanna Bourke’s The Story of Pain ( 1 ) or
Sam Quinones’s Dreamland ( 2 ) will find very
little new information here.In addition, Warraich’s valiant endeavor
to integrate the various intersections of
pain with science, history, medicine, and so-
ciology is impressive, but he too often sac-
rifices depth for breadth. His discussion of
the early years of US opioid regulation, for
example, seems to be entirely drawn from
a single article in Smithsonian magazine
( 3 ), and he devotes three paragraphs to the
early anti-opium crusader Hamilton Wright
but fails to mention the crucial Harrison
Act and its impact.
Meanwhile, in chapter 6, Warraich leads
into the practice of direct-to-consumer drug
advertising, which was first allowed in the
US by the Food and Drug Administration
in the 1980s, from a discussion of the mis-
leading and hyperbolic direct-to-physician
marketing of Valium of the 1960s and 1970s
without fully explaining the development
and ramifications of this practice. At other
points, he digresses briefly into topics that
are not uninteresting—discussing itch, for
example, in chapter 9—but interrupt the
flow of the narrative.
The book’s final chapter is the most origi-
nal and compelling. Here, Warraich shares
details of his own recovery from chronic
pain through physical therapy and makes a
case for alternative treatments, such as hyp-
notherapy and acceptance and commitment
therapy (ACT). He argues for the power
of touch and embraces the placebo effect,
advocating in particular for the “almost
magical quality” an empathetic physician or
therapist can bring to the healing process.
He also strongly indicts corporate medicine
for compromising the ability of physicians
to provide empathy, instead emphasizing
less-time-intensive therapies, whether those
be prescriptions or procedures.
It is hard to fault Warraich’s passion
for this topic or his thoroughness. But a
deeper examination of the crucial aspects
of the story of pain , along with some ju-
dicious editing of the supporting material,
would have made The Song of Our Scars a
stronger book. jREFERENCES AND NOTES- J. Bourke, The Story of Pain: From Prayer To Painkillers
(Oxford Univ. Press, 2014). - S. Quinones, Dreamland: The True Tale of America’s
Opiate Epidemic (Bloomsbury, 2015). - E. Trickey, “Inside the story of America’s 19th-century
opiate addiction,” Smithsonian, 4 January 2018.
10.1126/science.abo5020HEALTH AND MEDICINEThe complexity of chronic pain
A physician confronts an elusive physical phenomenon
The Song of Our Scars:
The Untold Story of Pain
Haider Warraich
Basic Books, 2022.
320 pp.Like science and medicine, politics and power have long informed our understanding of pain.INSIGHTS | BOOKSThe reviewer is at the UCLA Center for Social Medicine and
Humanities, Semel Institute for Neuroscience and Human
Behavior, University of California, Los Angeles, CA 90095,
USA. Email: [email protected]