Startling new science reveals the truth about chronic pain

Western medicine limits the treatment of chronic pain to pills and procedures, Dr. Haider Warraich says.

(CNN)"Medicine is nothing more than a misguided miseducation in mortal misery."

That's not something you'd expect to hear from a doctor, especially one with the bona fides of Haider Warraich, a Brigham and Women's Hospital physician and assistant professor at Harvard Medical School.
The "misguided miseducation" of Western medicine, he argues, stems from "turning persons into patients and healers into providers, and by separating the body from the mind, physical sensations from emotional states and pain from suffering."
    Warraich examines chronic pain in his new book, "The Song of Our Scars."
    The misery that Warraich investigates in his new book, "The Song of Our Scars: The Untold Story of Pain," is chronic pain, which affects an estimated 1 in 5 people worldwide, including Warraich. That's about 1.5 billion people.
      Longtime battles with debilitating back pain nearly thwarted his medical career. Today, he brings his experiences as both physician and patient to his examination of the nature and history of pain. Condemning modern medicine's failures, he calls for a more holistic, interdisciplinary approach.
        This conversation has been edited and condensed for clarity.
        CNN: What is the biggest misconception people have about pain?
          Dr. Haider Warraich: Almost everything we know about pain and how we treat it is wrong. Both patients and physicians have been taught that chronic pain is essentially acute pain prolonged. But while acute pain rises up the spinal cord to the brain, chronic pain can often descend down from the brain, often without any trigger from below.
          Dr. Haider Warraich
          The fallacy that treatments for acute pain will work for chronic pain has, in part, led to the opioid epidemic and prevented people from treatments that might have given more relief.
          Western medicine has tried to constrain pain to strictly physical sensations, based on the tools it has to address those. But pain is not purely physical.
          CNN: What is pain, if not physical sensation?
          Warraich: The science suggests what many patients know to be true: Pain is a combination of physical sensation, emotional trauma and memory. Brain imaging has revealed that the emotional brain is far more involved in the experience of chronic pain than acute pain. To the nervous system, chronic pain is most often akin to an emotion we feel in a part of our body.
          By considering pain as a purely physical phenomenon, we limit treatments to pills and procedures, preventing people from getting the mental health interventions that are probably as, if not more, effective. The ideal approach to pain management is interdisciplinary.
          CNN: What does that entail?
          Warraich: The chief function of pain is to direct all your energies and attention to it by inducing fear that your body is under threat. For example, when I had terrible back pain, I worried that exercise might leave me paralyzed or that my spine might snap in half. Alternative modalities help us reframe how we think about pain.
          Alternative treatments such as cognitive therapy or physical rehab can help patients with chronic pain.
          An interdisciplinary approach provides patients with access to different options, including cognitive therapy, acceptance and commitment therapy, exercise, physical rehab and even hypnosis. Particularly effective is pain reprocessing therapy. Developed specifically for people in chronic pain, it helps to defang pain's fear component.
          The evidence supporting the effectiveness of alternative treatments like these is often more compelling than for many of the common procedures and prescriptions that we typically provide our patients.
          CNN: With such strong science supporting alternative approaches, why have standard pain protocols remained so crude?
          Warraich: One limiting factor is that doctors and nurses are highly unlikely to have lived with serious illness. They're like chefs who have never tasted their own food. Based on our training as physicians, our thinking can wind up rigid.
          Because some providers don't take patients' pain seriously, patients worry that the moment that they bring up their emotional state, their pain will instantly be dismissed.
          Until physicians' approaches shift, patients are going to struggle with accepting how closely linked things like mental health, depression, anxiety or history of previous trauma are to how much our bodies hurt.
          Recognizing that pain is, in fact, worsened by psychological factors makes it no less real.
          CNN: You write that there is "no dedicated pain center in the brain" yet also explain that chronic pain can reorganize the ner