Publishers Weekly
03/07/2022
Warraich (State of the Heart), a physician who suffers from chronic pain, explores the biology, psychology, culture, history, and treatment of pain in this fascinating meditation. Warraich distills pain into three components: nociception, “the sensory nervous system’s response to stimuli”; pain, the meaning given to the sensation; and suffering, the way one interprets that meaning. He posits that in medical contexts, these aspects are often conflated, and points out the how pill-based treatment that has resulted in “eerily similar cycles of opioid outbreaks” throughout history stems from an over-focus on the initial nociceptive response. Warraich draws on thinkers such as Descartes (who believed “only humans were capable” of feeling pain), Freud (who believed pain was closely tied to emotions), and Tolstoy (whose stories offer an example of “medicine’s new antiseptic approach to the management of pain”), and covers such emerging interventions as ketamine, cannabis, and acceptance and commitment therapy. Warraich makes a convincing case for a deeper understanding of pain and a “truly ‘person-oriented’ ” healthcare system: “Synthesizing our knowledge about the fundamentals of pain could move us closer to a future in which even if we hurt, we don’t suffer.” This solid survey makes a memorable case that those in pain need not suffer in silence. (Apr.)
From the Publisher
What Warraich says in The Song of Our Scars about early-twenty-first-century medicine’s explosion in opioid use holds true of the hegemony of the pain score: it has ‘erased whatever little we knew about the nature of suffering,’ and by stripping out the nuances of pain studies, it also ‘exaggerate[s] the biases that lead to vulnerable people’s agony going unattended.’”—Laura Kolbe, New York Review of Books
“A fascinating tour of the biology and neuroscience of pain…[Warraich] blasts the US medical system for lacking empathy and time to devote to patients, as well as for being too siloed, insufficiently committed to social justice and too swayed by pharmaceutical marketing.”—Anna Nowogrodzki, Nature
“Warraich writes vividly and well… he carefully and incisively analyzes the persistence of racial and gender differences in medical imagery and treatment of pain… Warraich’s tour de force is a fine introduction.” —Marcia L. Meldrum, Science
“Warraich’s push to change the way we talk about pain and prescribe treatment is compelling… The Song of Our Scars balances history against narrative examples from Warraich’s experiences a patient and physician to provide an engaging and thought-provoking approach to a difficult topic. Ultimately, it’s a very satisfying read and hard to put down, and when one does, the book stays with you in the questions it poses and the subtle shift it makes in the reader’s understanding of pain and its treatment.”——Shelby Smoak, New York Journal of Books
“Warraich’s fascinating, informative, and very personal narrative remains an invaluable, thought-provoking call to arms to rethink our relationship with this nebulous human experience.” —Emily Cataneo, Undark
“Warraich’s very well written book looks at all aspects of acute and chronic pain: its history, its biology, medical treatment and mistreatment, and disparities in pain management and care that stem from racism and other biases… A must read.”—Library Journal
“[A] fascinating meditation... Warraich makes a convincing case for a deeper understanding of pain and a 'truly person oriented’ healthcare system.”—Publishers Weekly
“In a wide-ranging overview, the author draws on scientific and medical studies, his work at the Pain Management Center of Brigham and Women’s Hospital, and his clinical practice to examine the history, physiology, biology, and treatment of pain… A clear and timely examination of the complexities of pain.”—Kirkus
"In this insightful and humane book about pain, suffering and survival, Warraich once again braids history and personal history to confront questions both ancient and contemporary. It is a marvelous read.”—Dr. Siddhartha Mukherjee, author of The Emperor of All Maladies
"As physician-author Haider Warrich aptly points out, ‘Almost everything we know about pain and how we treat it is wrong.’ His masterful new book is a unique, panoramic and deep view of pain, taking us through his personal experience, its history and evolution, the science, and the massive corporate corruption that undermined the opioid epidemic. An incredible book."—Dr. Eric Topol, author of Deep Medicine
“Pain is both a universal experience and one that is deeply connected to class, gender, race, and power—truths that the opioid epidemic and declining life expectancy have made tragically apparent. In The Song of Our Scars, Warraich explores how the medical community’s approach to pain went off the rails and makes a passionate case for more holistic, person-centered treatment. Beautifully written and deeply humane, this is essential reading for anyone seeking to understand the roots of the opioid crisis.”—Beth Macy, author of Dopesick
“A wonderful exploration of the chronic pain conundrum—past and present—in all of its varied dimensions: biomedical, psychological, social, and economic. Warraich is truly a gifted storyteller.”—Dr. Damon Tweedy, author of Black Man in a White Coat
“The Song of Our Scares is a brilliant deep dive into the emotional, physical, and metaphysical world of pain. The very personal and ultimately hopeful book, takes us on a remarkable journey, across the millennia and deep into the brain and consciousness. It also offers an unsparing look at how the cure (for chronic pain) became the disease. Dr. Haider Warraich has written The Emperor of All Maladies for pain.”—Dr. Jonathan Reiner, author of Heart
“Pain is the most universal yet misunderstood aspect of what it means to be human. Dr. Warraich leverages his own intimate relationship with suffering and highly developed skills as a physician healer to pen a masterful book that will change your lens on mankind forever. The Song of Our Scars attacks the principal element of the human condition to be deciphered if we hope to mitigate the torment of societal scourges such as racism, poverty, chronic illness, and loneliness. The net result of Dr. Warraich’s research and writing will, I believe, shorten the distance from our brains to our hearts and create a path toward healing and lasting empathy for one another.”—Dr. Wes Ely, author of Every Deep-Drawn Breath
“To paraphrase Virginia Woolf, considering how common pain is, it’s strange that it hasn’t “taken its place with love and battle and jealousy among the prime themes of literature”. The Song of Our Scars goes a long way to remedying this. Essential reading for anyone hoping to understand what it means to be alive.”—Daniel Wallace, author of Big Fish
Library Journal
★ 03/01/2022
Physician Warraich's (State of the Heart) very well written book looks at all aspects of acute and chronic pain: its history, its biology, medical treatment and mistreatment, and disparities in pain management and care that stem from racism and other biases. Warraich, who himself has chronic pain, draws from his own experiences in addition to scientific research. His book begins with historical views of pain (how some in earlier eras connected pain to sin; how societies treated and viewed people who were in pain). Warraich also details how paternalistic white medical establishments have often ignored the pain of women and people of color (for instance, the pain of childbirth). He goes on to discuss the biology of pain, including new studies in neurobiology that aim to learn how the environment and the context of pain can change patients' perception of it; later chapters cover recent studies in alternative ways to treat pain, including hypnosis and exercise. There are also several chapters on the opioid crisis in the United States and the social, commercial, and medical factors that contributed to overprescription of opioids. VERDICT A must-read for anyone with chronic pain and those in the health professions.—Margaret Henderson
Kirkus Reviews
2022-01-21
An investigation of a little-understood sensation.
After suffering a back injury at his gym in 2008, physician Warraich became one of an estimated 1.5 billion people affected by chronic pain. In a wide-ranging overview, the author draws on scientific and medical studies, his work at the Pain Management Center of Brigham and Women’s Hospital, and his clinical practice to examine the history, physiology, biology, and treatment of pain. Acute and chronic pain, he asserts, are “entirely distinct phenomena, and there is no justification for treating them the same way.” Acute pain, incited by a physical trauma, ascends up the spinal cord to the brain, whereas chronic pain “descends down from the brain, often with no need for an incitation from below.” Recurrent and invisible, chronic pain frustrates physicians. “If doctors didn’t learn about it in medical school or cannot make it go away,” writes Warraich, “it must not be real.” Patients, forced to doubt themselves, become frustrated as well, and “their lack of conformity to the rules of medicine can turn the healthcare system into an agent of persecution rather than therapy.” In the U.S., medical response to chronic pain has resulted in an opioid epidemic “carefully orchestrated [and] intentionally designed” by the Sackler family, which developed OxyContin through their company Purdue Pharma. A physician who had worked in advertising, Arthur Sackler brought his expertise to pharmaceuticals, redefining the patient as a consumer. From their use in alleviating the pain of dying patients, opioids, Sackler saw, could be sold to customers who would be alive longer and who could be convinced that they could live without pain. Coming from medical training in Pakistan, Warraich was shocked at American patients’ demands for opioids and doctors’ complicity in prescribing a medicine proven ineffective against chronic pain. He has been shocked, too, at the underlying racism, sexism, and ageism that affects how the medical community treats patients in pain.
A clear and timely examination of the complexities of pain.
