Why We Hurt: The Natural History of Pain

Why We Hurt: The Natural History of Pain

by Frank T. Vertosick Jr.

As much as we detest pain, it remains curiously indispensable. Medical science still struggles to conquer pain, yet those who feel no pain at all live in great peril. Dr. Frank Vertosick, a practicing neurosurgeon, explores this paradox, using pain as a lens to give insight into how our bodies function.

C. S. Lewis called pain God's megaphone: it gets our


As much as we detest pain, it remains curiously indispensable. Medical science still struggles to conquer pain, yet those who feel no pain at all live in great peril. Dr. Frank Vertosick, a practicing neurosurgeon, explores this paradox, using pain as a lens to give insight into how our bodies function.

C. S. Lewis called pain God's megaphone: it gets our attention and warns us of danger. Using stories of patients in pain, Dr. Vertosick explains how pain evolved and why it functions the way it does. Beginning with his own battle against severe migraines, he goes on to explain other common pain syndromes-back pain, angina, cancer pain, arthritis, childbirth, and carpal tunnel syndrome. A fine writer and empathic physician, Dr. Vertosick combines the scientific beauty of the bestselling How We Die with the superb storytelling of Oliver Sacks. He gives us a mixture of medicine, history, anthropology, drama, inspiration, and practical advice. For people in pain, as Dr. Vertosick explains so well, knowledge is often the first, and best, analgesic.

About the Author:

Frank T. Vertosick, Jr., M.D., is a neuro-surgeon and author of When the Air Hits Your Brain, a memoir of his surgical training. A former president of the Pennsylvania Neurosurgical Society and a Fellow of the American College of Surgeons, he lives in Pittsburgh, Pennsylvania.

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According to Frank Vertosick, pain is in your brain. "Pain isn't synonymous with life," he insists, "it's synonymous with intelligence." Human beings have few physical defenses, so we must learn to avoid danger. And pain -- which we hate -- both alerts us to danger and teaches us to dodge it. Really, we should appreciate pain, says Vertosick; by paying attention to its signals, we may learn to avoid suffering entirely.

Vertosick, a neurosurgeon who explains intricate systems simply, has won praise for his memoir of doctor training, When the Air Hits Your Brain. In his new book, Why We Hurt, Vertosick brings his empathy and skill to the broader subject of human pain. He considers an array of torturous conditions and then considers why being human hurts so much. And through his deliberate, insightful study, Vertosick reaches a conclusion: Pain is a necessary phase in our evolution. "Pain is not a punishment from God but a natural process," he argues. "This book is about the biological nature of pain and our attempts to expunge it from our lives.... By understanding the beast, we will be better equipped to grapple with it." Intelligence brings us pain, but it also brings us closer to pain's cure.

Vertosick's study begins with a consideration of our most common ache: migraines. These explosive headaches happen when arteries of the brain and scalp clench, then stretch unbearably. Migraines are so terrible, he explains, that sufferers can barely shift their heads without misery; any activity torments. Vertosick carefully sorts through these symptoms and then wonders if migraines might be acting as an evolutionary guide. Perhaps, he suggests, they teach us stillness: "Migraines are supposed to incapacitate us, at least temporarily.... Migraines are like a stern but benevolent parent telling us we've been through enough and should attempt to do no more for a while." In other words, headaches urge us to slow down.

For Vertosick, all pain figures into nature's plan. For example, the distress of labor prods women to give birth quickly. "Labor is a dangerous time.... Escalating pain forces the mother to pay attention and drive the event to completion as quickly as possible." Pain speeds labor and protects babies from the difficulties that arise during the birthing process. In this way, pain teaches us how to protect ourselves and our children from the most lethal of dangers.

Pain teaches us how to survive so well, in fact, that it can cause problems. For example, trigeminal neuralgia (TN), a disease in which worn facial nerves tear at the cheeks and nose, arises because we can outlive our nerves. "Maladies such as cancer, heart disease, arthritis, and TN are modern curses, targeting the burgeoning populations of elderly who have been shielded by technology from natural selection," Vertosick notes.

But if pain sometimes causes problems, it can also teach us to solve them. For example, Vertosick observes that our increased life spans have made us prone to slipped discs: "Since we've only been using our newly upright spines for a few hundred thousand years," he shrugs, "there has been no time for natural selection to work out all the kinks." But he also points out that pain can still teach us to ease suffering: "Evolution didn't abandon us entirely. Our erect posture damages our spines but also frees our hands, giving us one way to compensate for our rupturing discs: we can now become surgeons and remove them." Pain has taught us to live long, Vertosick suggests, and now it is teaching us to live comfortably. In our evolution, the painful burden of intelligence has become our best hope for relief.

After all, the history of pain is also the history of medical triumph. Headaches have driven humans to develop stress management treatments; phantom pain has spurred on specialized spine operations. The wretched face pain of the elderly has advanced our understanding of microvascular decompression, a treatment in which a nerve is cauterized to kill pain pathways. Wherever there is pain, doctors have found ways to soothe it. The pain of childbirth is treated with Lamaze breathing techniques; autoimmune disorders are treated with steroids. Carpal tunnel syndrome, that modern bugaboo, has driven surgeons to develop both vitamin therapy and sophisticated surgical releases. Heart disease, as Vertosick points out, brought us aspirin.

For Vertosick, pain teaches us about our origins and our future. When we consider the evolutionary reasons for pain, we can also consider our evolution as healers. "If we study all the triumphs of the human psyche over great diseases and injury," Vertosick promises, "we will see that the body is indeed the lesser partner in the mind-body dualism. We must try to shed the chains of pain, cloak our souls against the cold, and continue to climb our mountains." With Vertosick's insightful guidance, we do.

—Jesse Gale

Fascinating . . . Falls squarely in the territory of Oliver Sacks.
Chicago Tribune
[Vertosick] tells personal anecdotes about his own migraines and crafts stories of emergency room horrors with a deft sense of suspense and timing.
Jerome Groopman
...a feat of literary alchemy. [Vertosick] transmutes the lugubrious subject of pain into a provocative and edifying treatise that tightly engages the reader.
New York Times Book Review
Carole Horne
Vertosick brings commendable, accessible understanding to the knotty question of pain...
Washington Post
Publishers Weekly - Publisher's Weekly
This accessible and compassionate exploration of physical pain should be of great interest since, at one time or another, almost everyone has experienced severe or recurrent pain. As a neurosurgeon, Vertosick (When the Air Hits Your Brain) has treated patients with migraines, back problems, neuralgia, rheumatoid arthritis, angina and cancer. Drawing on case histories from his practice and on scientific research, he surveys the experience and the processes of pain, as well as the idea of it. He gives a brief, clearly stated history of painful conditions, explains how and why pain strikes and describes the various ways medical intervention can ease or eradicate pain. He also reflects on his wife's labor pains; details the history of anesthesia (a medical invention that he rates as "high among the greatest achievements of our age"); and tells a series of stories about how he and his patients have dealt with their pain. He recounts, for example, how he worked with Anne, a patient whose ruptured disc prevented her from walking on one of her legs. First he tried physical therapy, steroids and narcotic medications to alleviate her pain. Then, when all these treatments failed, he performed the back surgery that enabled her to recover. Combining personal narrative with scientific explanation, Vertosick, who describes himself as "a bit of a wimp" who dislikes seeing patients in pain, displays an enormous dedication to relieving suffering. (June) Copyright 2000 Cahners Business Information.|
Kirkus Reviews
Neurosurgeon Vertosick (When the Air Hits Your Brain, 1996) presents a clear and in-depth study of the nerve-racking nature of human pain. Vertosick does not progress chronologically through medical or evolutionary history, as the words "natural history" might suggest. Instead, he organizes his study in a much more engaging way, with thorough examinations of various types of pain that afflict patients of every class and age. The variety of these tribulations is astonishing: Vertosick devotes entire chapters to migraine, "phantom," and back pains, carpal tunnel syndrome, childbirth, and cancer pains. At its core, Vertosick's study is a series of case studies, each one presenting his explanation of the patient's ailment and portraying the steps he and other doctors took to alleviate the pain. These topics are sometimes quite personal to Vertosick, who once found himself in the "Shadowlands" of pain (suffering migraines for over a decade before learning to treat them himself). Vertosick's suffering may explain why he is such a sympathetic writer, giving due attention to emotion and science with each case study he presents. Whether recounting his wife's mid-labor abandonment of "natural" childbirth or investigating a milkman's mysterious arm pains, Vertosick tells each story with an eye for critical analysis and a heart that understands and shares in the patient's plight. He also takes note of religion, philosophy, and literature throughout, providing a holistic look at a topic that science alone cannot explain away. Vertosick's work can be useful to those who suffer from chronic pain, as well as to those who want tobetterunderstand the complexity of the body and the nature of human frailty.

Product Details

DIANE Publishing Company
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What People are saying about this

Harold Kushner
Writing with eloquence, clarity and wit, Dr. Vertosick has given us a masterful book on a subject of concern to us all.
— (Rabbi Harold Kushner, author of When Bad Things Happen to Good People)

Meet the Author

Frank T. Vertosick, Jr., M.D., is a neurosurgeon and author of When the Air Hits Your Brain , a highly acclaimed memoir of his surgical training. A former president of the Pennsylvania Neurosurgical Society and a Fellow of the American College of Surgeons, he lives in Pittsburgh, Pennsylvania.

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