Although the causes of chronic pain are often unclear, its consequences are obvi- ous. In addition to its physical toll (which includes sleep deprivation and exhaustion), chronic pain damages social relationships; increases depression, anxiety, and the risk of suicide; and costs the nation $600 billion yearly in medical costs and re- duced productivity. As Thernstrom writes:
[As] the pain worsens, the body sensitizes, and other parts begin to hurt, too. She has trouble sleeping; she stumbles through her days. Her sense of her body as a source of pleasure changes to a sense of it as a source of pain. She feels haunted, persecuted by an unseen tormentor. Depression sets in. It feels wrong . . . maddening . . . delusional. She tries to describe her torment, but others respond with skepticism or contempt. She consults doctors, to no avail. Her original affliction—whatever it may have been— has been superseded by the new “disease of pain,”.
Treating those who live with chronic pain is notoriously difficult. In addition, doctors disagree on treatment, and few American doctors are trained in pain man- agement. Physical therapy, strength training, medi- tation, and psychological treatments that help people think differently about their pain can often help but are underutilized. Marijuana may well be useful, but little money is available for research on it, and it remains illegal in many states (and under federal law). Drugs derived from opiates such as OxyContin are often used and sometimes overused. Ironically, they are also often underused both because doctors share popular American beliefs about opiates and addiction and because they fear arrest under strict U.S. drug trafficking laws