Excerpt from All In My Head by Paula Kamen, plus links to reviews, author biography & more

And not to toot my own horn, but this display was also quite adept at illustrating basic neurological concepts in the treatment of pain. Fundamental was the gate theory, first formulated in 1965, which demonstrates how counterirritant pain blockers (Ben Gay, electrical stimulators, acupuncture needles) work, by blocking pain signals from the spinal cord. On the right lower panel of my poster board display, this process was illustrated by two parallel spaghetti noodles, representing the C nerve, the source of the pain, and then the friendlier A delta nerve. At the point where they reached the spinal cord, the A delta branched downward to overlap the C and impede its signals with a little "gate." In another diagram, I illustrated another relatively new scientific concept of that time: endorphins, "pain-fighting chemicals which are made in the pituitary gland in the brain." I explained that we try to activate these natural opiates in a variety of ways, such as placebos (fake pills that the patient thinks are the real thing) or acupuncture.

The result: I got a B on it.



Indeed, in the end, with so many possible interpretations, the really awful part of having a really bad headache that won't go away is the confusion of it all. What does it all mean?

How we conceptualize and treat real physical pain is indeed rooted in our culture, and our culture today gives us more mixed and extreme messages than ever before. On the one hand, everything I know from growing up in an educated, doctor-worshiping Jewish home in the Midwest pulls me to the first answer, that basically "shit happens" in life, and that Western doctors are the answer. But then, the whirlwind of popular alternative medicine philosophies of the past several years-not to mention, my own natural internal quest for meaning-alert me to a second universe of other possibilities.

But I do know for sure that I'm not alone in asking such difficult questions about the experience of chronic pain in the United States, in one form or another. In our culture, experiencing chronic pain or any long-term illness can be a complicated, isolating, self-blaming, guilt-ridden process. Millions of chronic pain sufferers in the United States like me have silently suffered their own individual and profoundly strange battles. In the process, we've questioned and overturned basic concepts of ourselves, of the medical system, of the world, and of illness and its metaphors. We need to share our journeys through this strange terrain for the benefit of those just beginning their struggles. More than a decade ago, when I embarked on my search for a cure for an American headache, I was painfully ignorant about the real, often hidden limits of many common treatments, from both Western and alternative medicine. I wish I had been armed with such essential, hard-won, critical information.

Needless to say, this book, my second major lifetime report on chronic pain in the United States, has been much more complicated to research than the one I did in 1979. When I wasn't a patient with actual pain, understanding how to control it seemed so much easier, so much more straightforward. In my sixth-grade report and display, I was just giving the obvious facts, which had been mapped out for me in the clinical literature and were translatable to a two-dimensional cardboard display.

In this book, in addition to developing and expanding on some of that information, I try to fill in some gaps, examining many popular and culturally rooted myths denying the physical realities of chronic pain. Most basically, I describe the experience and ask questions from the perspective of the patient. And as in my other writing as a journalist, I hope to give the "bigger picture," so that my story doesn't start and end just with me personally. As well as eventually telling about other patients I have met, I also report some findings about chronic pain, culled from texts, interviews, and medical meetings.

From the preface to All In My Head, pages ix - xvi. Copyright Paula Kamen 2005. All rights reserved. No part of this book maybe reproduced without written permission from the publisher, Da Capo Press.