Opinion Today: A new way to understand — and treat — pain

The “biopsychosocial phenomenon” of pain has more to do with our brains than previously thought. [View in browser](~/AAAAAQA~/RgRl2em4P4QoAWh0dHBzOi8vbWVzc2FnaW5nLWN1c3RvbS1uZXdzbGV0dGVycy5ueXRpbWVzLmNvbS90ZW1wbGF0ZS9vYWt2Mj9jYW1wYWlnbl9pZD0zOSZlbWM9ZWRpdF90eV8yMDIzMDIyMyZpbnN0YW5jZV9pZD04NjA3NiZubD1vcGluaW9uLXRvZGF5JnByb2R1Y3RDb2RlPVRZJnJlZ2lfaWQ9Nzc2NzQ5NTImc2VnbWVudF9pZD0xMjYwNjcmdGU9MSZ1cmk9bnl0JTNBJTJGJTJGbmV3c2xldHRlciUyRjI3ODFhOTg1LTg2ZTQtNTg4NC1hY2VlLThhOTliYzNhM2U0OCZ1c2VyX2lkPWFhNDkxZWY3ZjFkOTY0ZTQ5NzlmYjc4NGU3NGUwMWQ3VwNueXRCCmP2uGT3Y2M_7BhSG3RyaXN0cmFtYmFsZHdpbjkwQGdtYWlsLmNvbVgEAAAAAA~~)|[nytimes.com](~/AAAAAQA~/RgRl2em4P0SwaHR0cHM6Ly93d3cubnl0aW1lcy5jb20vP2NhbXBhaWduX2lkPTM5JmVtYz1lZGl0X3R5XzIwMjMwMjIzJmluc3RhbmNlX2lkPTg2MDc2Jm5sPW9waW5pb24tdG9kYXkmcmVnaV9pZD03NzY3NDk1MiZzZWdtZW50X2lkPTEyNjA2NyZ0ZT0xJnVzZXJfaWQ9YWE0OTFlZjdmMWQ5NjRlNDk3OWZiNzg0ZTc0ZTAxZDdXA255dEIKY_a4ZPdjYz_sGFIbdHJpc3RyYW1iYWxkd2luOTBAZ21haWwuY29tWAQAAAAA)[Continue reading the main story](#a11y-skip-ad-marquee) [Marquee Ad](~/AAAAAQA~/RgRl2em4P0SYaHR0cHM6Ly9saXZlaW50ZW50Lm5ld3lvcmt0aW1lc2luZm8uY29tL2NsaWNrP3M9MTYyMTM5JmxpPVRZJm09YWE0OTFlZjdmMWQ5NjRlNDk3OWZiNzg0ZTc0ZTAxZDcmcD1UWV8yMDIzMDIyMyZ0ZT0xJm5sPW9waW5pb24tdG9kYXkmZW1jPWVkaXRfdHlfMjAyMzAyMjNXA255dEIKY_a4ZPdjYz_sGFIbdHJpc3RyYW1iYWxkd2luOTBAZ21haWwuY29tWAQAAAAA) [Read more from Opinion](~/AAAAAQA~/RgRl2em4P0S_aHR0cHM6Ly93d3cubnl0aW1lcy5jb20vc2VjdGlvbi9vcGluaW9uP2NhbXBhaWduX2lkPTM5JmVtYz1lZGl0X3R5XzIwMjMwMjIzJmluc3RhbmNlX2lkPTg2MDc2Jm5sPW9waW5pb24tdG9kYXkmcmVnaV9pZD03NzY3NDk1MiZzZWdtZW50X2lkPTEyNjA2NyZ0ZT0xJnVzZXJfaWQ9YWE0OTFlZjdmMWQ5NjRlNDk3OWZiNzg0ZTc0ZTAxZDdXA255dEIKY_a4ZPdjYz_sGFIbdHJpc3RyYW1iYWxkd2luOTBAZ21haWwuY29tWAQAAAAA) February 23, 2023 By Annie Galvin Producer, Opinion Audio Physical pain is a universal human experience. We all experience temporary pain at some point, perhaps following an accident, an illness or an annoying tweak from moving that couch up the stairs. But roughly 50 million Americans — 20 percent of adults — suffer from chronic pain, the kind that can derail a person’s life. Given how common both acute and chronic pain are, it’s remarkable how unsuccessful we tend to be at treating it. Over the past several decades, however, a disparity has emerged between pain treatment and pain science. Researchers have learned that clinicians have made a major miscalculation in their approach to treating pain. The dominant model has been “biomechanical,” assuming that pain lives almost exclusively in our tissues and joints. According to this model, pain should be treated solely with medication, physical therapies and surgeries. And many doctors don’t learn how to treat pain effectively: [A 2018 paper](~/AAAAAQA~/RgRl2em4P0TNaHR0cHM6Ly93d3cubmNiaS5ubG0ubmloLmdvdi9wbWMvYXJ0aWNsZXMvUE1DNjI1MTgzNS8_Y2FtcGFpZ25faWQ9MzkmZW1jPWVkaXRfdHlfMjAyMzAyMjMmaW5zdGFuY2VfaWQ9ODYwNzYmbmw9b3Bpbmlvbi10b2RheSZyZWdpX2lkPTc3Njc0OTUyJnNlZ21lbnRfaWQ9MTI2MDY3JnRlPTEmdXNlcl9pZD1hYTQ5MWVmN2YxZDk2NGU0OTc5ZmI3ODRlNzRlMDFkN1cDbnl0Qgpj9rhk92NjP-wYUht0cmlzdHJhbWJhbGR3aW45MEBnbWFpbC5jb21YBAAAAAA~) found that 96 percent of medical schools in the United States and Canada don’t offer pain education, and the 4 percent of medical schools that do adhere to this outdated model. While physical remedies can certainly help, an exclusive focus on surgery and pills can lead to astronomical medical bills, not to mention addiction to opioids and other medications. That approach also misses two huge pieces of the pain puzzle. As the pain psychologist Rachel Zoffness explains on [The Ezra Klein Show this week](~/AAAAAQA~/RgRl2em4P0TwaHR0cHM6Ly93d3cubnl0aW1lcy5jb20vMjAyMy8wMi8yMS9vcGluaW9uLzE3ZWtzLWV6cmEta2xlaW4tcG9kY2FzdC1yYWNoZWwtem9mZm5lc3MuaHRtbD9jYW1wYWlnbl9pZD0zOSZlbWM9ZWRpdF90eV8yMDIzMDIyMyZpbnN0YW5jZV9pZD04NjA3NiZubD1vcGluaW9uLXRvZGF5JnJlZ2lfaWQ9Nzc2NzQ5NTImc2VnbWVudF9pZD0xMjYwNjcmdGU9MSZ1c2VyX2lkPWFhNDkxZWY3ZjFkOTY0ZTQ5NzlmYjc4NGU3NGUwMWQ3VwNueXRCCmP2uGT3Y2M_7BhSG3RyaXN0cmFtYmFsZHdpbjkwQGdtYWlsLmNvbVgEAAAAAA~~), pain is a “biopsychosocial” phenomenon, influenced, yes, by injury and illness, but also by our mood, our stress levels, our social contexts, our attention, our exercise and other factors. Experts haven’t fully unpacked the mystery of how our physicality interconnects with our emotions and the social worlds we inhabit, but they have established enough of a link to start changing the way we think about pain. This may sound complicated, but it’s actually great news for patients suffering from pain. “If the brain can change, pain can change,” Zoffness tells Ezra Klein. If we can educate clinicians to better understand pain and help patients take advantage of techniques like cognitive behavioral therapy and scaled-up exercise, we may see drastic reductions in pain and relief from suffering. [Listen to the episode here](~/AAAAAQA~/RgRl2em4P0TwaHR0cHM6Ly93d3cubnl0aW1lcy5jb20vMjAyMy8wMi8yMS9vcGluaW9uLzE3ZWtzLWV6cmEta2xlaW4tcG9kY2FzdC1yYWNoZWwtem9mZm5lc3MuaHRtbD9jYW1wYWlnbl9pZD0zOSZlbWM9ZWRpdF90eV8yMDIzMDIyMyZpbnN0YW5jZV9pZD04NjA3NiZubD1vcGluaW9uLXRvZGF5JnJlZ2lfaWQ9Nzc2NzQ5NTImc2VnbWVudF9pZD0xMjYwNjcmdGU9MSZ1c2VyX2lkPWFhNDkxZWY3ZjFkOTY0ZTQ5NzlmYjc4NGU3NGUwMWQ3VwNueXRCCmP2uGT3Y2M_7BhSG3RyaXN0cmFtYmFsZHdpbjkwQGdtYWlsLmNvbVgEAAAAAA~~) and [join the conversation in the comments](~/AAAAAQA~/RgRl2em4P4QCAWh0dHBzOi8vd3d3Lm55dGltZXMuY29tLzIwMjMvMDIvMjEvb3Bpbmlvbi8xN2Vrcy1lenJhLWtsZWluLXBvZGNhc3QtcmFjaGVsLXpvZmZuZXNzLmh0bWw_Y2FtcGFpZ25faWQ9MzkmZW1jPWVkaXRfdHlfMjAyMzAyMjMmaW5zdGFuY2VfaWQ9ODYwNzYmbmw9b3Bpbmlvbi10b2RheSZyZWdpX2lkPTc3Njc0OTUyJnNlZ21lbnRfaWQ9MTI2MDY3JnRlPTEmdXNlcl9pZD1hYTQ5MWVmN2YxZDk2NGU0OTc5ZmI3ODRlNzRlMDFkNyNjb21tZW50c0NvbnRhaW5lclcDbnl0Qgpj9rhk92NjP-wYUht0cmlzdHJhbWJhbGR3aW45MEBnbWFpbC5jb21YBAAAAAA~). [[Article Image] DyAnn Chao](~/AAAAAQA~/RgRl2em4P0TwaHR0cHM6Ly93d3cubnl0aW1lcy5jb20vMjAyMy8wMi8yMS9vcGluaW9uLzE3ZWtzLWV6cmEta2xlaW4tcG9kY2FzdC1yYWNoZWwtem9mZm5lc3MuaHRtbD9jYW1wYWlnbl9pZD0zOSZlbWM9ZWRpdF90eV8yMDIzMDIyMyZpbnN0YW5jZV9pZD04NjA3NiZubD1vcGluaW9uLXRvZGF5JnJlZ2lfaWQ9Nzc2NzQ5NTImc2VnbWVudF9pZD0xMjYwNjcmdGU9MSZ1c2VyX2lkPWFhNDkxZWY3ZjFkOTY0ZTQ5NzlmYjc4NGU3NGUwMWQ3VwNueXRCCmP2uGT3Y2M_7BhSG3RyaXN0cmFtYmFsZHdpbjkwQGdtYWlsLmNvbVgEAAAAAA~~) [This Book Changed My Relationship to Pain The pain psychologist Rachel Zoffness explains how pain is a “biopsychosocial phenomenon” — and how we can better treat it as such. By ‘The Ezra Klein Show’](~/AAAAAQA~/RgRl2em4P0TwaHR0cHM6Ly93d3cubnl0aW1lcy5jb20vMjAyMy8wMi8yMS9vcGluaW9uLzE3ZWtzLWV6cmEta2xlaW4tcG9kY2FzdC1yYWNoZWwtem9mZm5lc3MuaHRtbD9jYW1wYWlnbl9pZD0zOSZlbWM9ZWRpdF90eV8yMDIzMDIyMyZpbnN0YW5jZV9pZD04NjA3NiZubD1vcGluaW9uLXRvZGF5JnJlZ2lfaWQ9Nzc2NzQ5NTImc2VnbWVudF9pZD0xMjYwNjcmdGU9MSZ1c2VyX2lkPWFhNDkxZWY3ZjFkOTY0ZTQ5NzlmYjc4NGU3NGUwMWQ3VwNueXRCCmP2uGT3Y2M_7BhSG3RyaXN0cmFtYmFsZHdpbjkwQGdtYWlsLmNvbVgEAAAAAA~~) [Continue reading the main story](#a11y-skip-universal-0) ADVERTISEMENT [Ad](~/AAAAAQA~/RgRl2em4P0SXaHR0cHM6Ly9saXZlaW50ZW50Lm5ld3lvcmt0aW1lc2luZm8uY29tL2NsaWNrP3M9NTk3ODUmbGk9VFkmbT1hYTQ5MWVmN2YxZDk2NGU0OTc5ZmI3ODRlNzRlMDFkNyZwPVRZXzIwMjMwMjIzJnRlPTEmbmw9b3Bpbmlvbi10b2RheSZlbWM9ZWRpdF90eV8yMDIzMDIyM1cDbnl0Qgpj9rhk92NjP-wYUht0cmlzdHJhbWJhbGR3aW45MEBnbWFpbC5jb21YBAAAAAA~) Here’s what we’re focusing on today: Editors’ Picks [KATHERINE MILLER Joe Biden’s Greatest Strength Is Also His Greatest Vulnerability Joe Biden’s age has loomed over his presidency. 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America has failed to do all the things that might have secured lasting normalcy. By David Wallace-Wells](~/AAAAAQA~/RgRl2em4P0TeaHR0cHM6Ly93d3cubnl0aW1lcy5jb20vMjAyMy8wMi8yMi9vcGluaW9uL2JpcmQtZmx1LXBhbmRlbWljLWg1bjEuaHRtbD9jYW1wYWlnbl9pZD0zOSZlbWM9ZWRpdF90eV8yMDIzMDIyMyZpbnN0YW5jZV9pZD04NjA3NiZubD1vcGluaW9uLXRvZGF5JnJlZ2lfaWQ9Nzc2NzQ5NTImc2VnbWVudF9pZD0xMjYwNjcmdGU9MSZ1c2VyX2lkPWFhNDkxZWY3ZjFkOTY0ZTQ5NzlmYjc4NGU3NGUwMWQ3VwNueXRCCmP2uGT3Y2M_7BhSG3RyaXN0cmFtYmFsZHdpbjkwQGdtYWlsLmNvbVgEAAAAAA~~) [Article Image](~/AAAAAQA~/RgRl2em4P0TeaHR0cHM6Ly93d3cubnl0aW1lcy5jb20vMjAyMy8wMi8yMi9vcGluaW9uL2JpcmQtZmx1LXBhbmRlbWljLWg1bjEuaHRtbD9jYW1wYWlnbl9pZD0zOSZlbWM9ZWRpdF90eV8yMDIzMDIyMyZpbnN0YW5jZV9pZD04NjA3NiZubD1vcGluaW9uLXRvZGF5JnJlZ2lfaWQ9Nzc2NzQ5NTImc2VnbWVudF9pZD0xMjYwNjcmdGU9MSZ1c2VyX2lkPWFhNDkxZWY3ZjFkOTY0ZTQ5NzlmYjc4NGU3NGUwMWQ3VwNueXRCCmP2uGT3Y2M_7BhSG3RyaXN0cmFtYmFsZHdpbjkwQGdtYWlsLmNvbVgEAAAAAA~~) [SPENCER BOKAT-LINDELL A Farewell to Readers The debate continues. 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Also: Children and loss; John Fetterman; population growth.](~/AAAAAQA~/RgRl2em4P0TkaHR0cHM6Ly93d3cubnl0aW1lcy5jb20vMjAyMy8wMi8yMi9vcGluaW9uL2xldHRlcnMvbWFza3MtbWFuZGF0ZXMtY292aWQuaHRtbD9jYW1wYWlnbl9pZD0zOSZlbWM9ZWRpdF90eV8yMDIzMDIyMyZpbnN0YW5jZV9pZD04NjA3NiZubD1vcGluaW9uLXRvZGF5JnJlZ2lfaWQ9Nzc2NzQ5NTImc2VnbWVudF9pZD0xMjYwNjcmdGU9MSZ1c2VyX2lkPWFhNDkxZWY3ZjFkOTY0ZTQ5NzlmYjc4NGU3NGUwMWQ3VwNueXRCCmP2uGT3Y2M_7BhSG3RyaXN0cmFtYmFsZHdpbjkwQGdtYWlsLmNvbVgEAAAAAA~~) [Article Image](~/AAAAAQA~/RgRl2em4P0TkaHR0cHM6Ly93d3cubnl0aW1lcy5jb20vMjAyMy8wMi8yMi9vcGluaW9uL2xldHRlcnMvbWFza3MtbWFuZGF0ZXMtY292aWQuaHRtbD9jYW1wYWlnbl9pZD0zOSZlbWM9ZWRpdF90eV8yMDIzMDIyMyZpbnN0YW5jZV9pZD04NjA3NiZubD1vcGluaW9uLXRvZGF5JnJlZ2lfaWQ9Nzc2NzQ5NTImc2VnbWVudF9pZD0xMjYwNjcmdGU9MSZ1c2VyX2lkPWFhNDkxZWY3ZjFkOTY0ZTQ5NzlmYjc4NGU3NGUwMWQ3VwNueXRCCmP2uGT3Y2M_7BhSG3RyaXN0cmFtYmFsZHdpbjkwQGdtYWlsLmNvbVgEAAAAAA~~) Exclusive for Subscribers [[Article Image] Illustration by The New York Times; images by CSA Images/Getty Images](~/AAAAAQA~/RgRl2em4P0TraHR0cHM6Ly93d3cubnl0aW1lcy5jb20vMjAyMy8wMi8yMi9vcGluaW9uL2FpLWNoYXRncHQtbWljcm9zb2Z0LXNpbGljb24tdmFsbGV5Lmh0bWw_Y2FtcGFpZ25faWQ9MzkmZW1jPWVkaXRfdHlfMjAyMzAyMjMmaW5zdGFuY2VfaWQ9ODYwNzYmbmw9b3Bpbmlvbi10b2RheSZyZWdpX2lkPTc3Njc0OTUyJnNlZ21lbnRfaWQ9MTI2MDY3JnRlPTEmdXNlcl9pZD1hYTQ5MWVmN2YxZDk2NGU0OTc5ZmI3ODRlNzRlMDFkN1cDbnl0Qgpj9rhk92NjP-wYUht0cmlzdHJhbWJhbGR3aW45MEBnbWFpbC5jb21YBAAAAAA~) [PETER COY We’re Unprepared for the A.I. Gold Rush Should we apply the brakes on this rapidly developing technology — or let it develop and deal with problems as they arise? By Peter Coy](~/AAAAAQA~/RgRl2em4P0TraHR0cHM6Ly93d3cubnl0aW1lcy5jb20vMjAyMy8wMi8yMi9vcGluaW9uL2FpLWNoYXRncHQtbWljcm9zb2Z0LXNpbGljb24tdmFsbGV5Lmh0bWw_Y2FtcGFpZ25faWQ9MzkmZW1jPWVkaXRfdHlfMjAyMzAyMjMmaW5zdGFuY2VfaWQ9ODYwNzYmbmw9b3Bpbmlvbi10b2RheSZyZWdpX2lkPTc3Njc0OTUyJnNlZ21lbnRfaWQ9MTI2MDY3JnRlPTEmdXNlcl9pZD1hYTQ5MWVmN2YxZDk2NGU0OTc5ZmI3ODRlNzRlMDFkN1cDbnl0Qgpj9rhk92NjP-wYUht0cmlzdHJhbWJhbGR3aW45MEBnbWFpbC5jb21YBAAAAAA~) Subscribe Today New York Times Opinion curates a wide range of views, inviting rich discussion and debate that help readers analyze the world. This work is made possible with the support of subscribers. 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