Editor’s Note: As a specialist in pain medicine, David Nagel, MD, discusses his thoughts on the current state of pain management in the U.S. Like many aspects of chronic pain, patients often find that their fibromyalgia pain is dismissed by many healthcare professionals. Through his writing, Nagel explores his own biases in the hopes of improving fibromyalgia treatment options and advocating for those in need of care.
I was honored when I was asked me to write something for ProHealth. Over the course of time, I would like to share my thoughts about chronic pain and public policy in a variety of settings. First, though, I’d like you to get to know me. Specifically, why I wrote a book about pain (Needless Suffering: How Society Fails Those with Chronic Pain), and who I am.
The reason why I wrote a book about pain is simple: I was angry, and I wanted to make a difference in the lives of fibromyalgia patients and others struggling with chronic pain.
I could no longer tolerate seeing those suffering from pain being ostracized, stigmatized, and blamed for their infirmities by social institutions, which were supposed to be caring for and supporting them, in the process, aggravating their suffering. When I began the process of writing Needless Suffering, I had practiced pain management for 18 years. I cared for thousands of patients on a 24/7/365 basis, rarely receiving the support I needed from my colleagues. In addition to my clinical work, I worked to create public policies to help those in pain, frequently finding road blocks which limited access to compassionate care.
Chronic Pain and The Final Straw
The final straw for me came in two simultaneous incidents in 2003. I was brought before our state’s medical board in what turned out to be a one-year investigation of my pain practice. While I knew I had done nothing wrong, which was later proved to be the case, the stress created an unnecessary burden to an already challenging life. The second came when my partners “asked” me to give up my pain practice to focus on the more lucrative practice of “interventional pain management.” They were no longer willing to support what I viewed as my calling.
In the midst of all of this tumult, I became angry with myself. I referred to myself as a coward, a hypocrite who would not stand up for his beliefs when the pressure became too great. I accused myself of the same ignorance I accused others of when, in my journey, I realized that I was blind to the effects of pain in my own world. My mother valiantly suffered with incapacitating pain her whole life, and I never saw it when it mattered most.
I felt backed into a corner with nowhere to turn and nobody to help. When I am hurt, angry, or frustrated, I write. And so I did. I sat at my laptop and wrote four short stories, all dealing with individual aspects of pain in America. As I saw the relationship of those in pain to the medical system as akin to that of the poor to society as a whole, the first story had to do with my first experience with homelessness. That story was entitled Poor Man. The rest of the stories were related to this one. The original title of the collection was Poor Man, Pained Man.
As I often do, I shared the work with a friend, a woman who suffers from fibromyalgia symptoms and other painful conditions. She is also a writer. She called me a day later and told me that I must publish this. “You are writing for us!” she told me quite emphatically.
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I was simultaneously honored and overwhelmed by her request. I had written dozens of short stories but never for the purpose of publication. They were merely therapeutic for me. We both realized these stories could not stand alone. They were too abstract to make meaningful social change. It took me several years to figure out how I wished to share my message in a more productive, concrete form, without losing the stories. I finally came to see what I was writing was a play, a tragedy, and that part of any play is the final critique of the characters. What was missing was the critique. I chose to take a broad sociological look at the phenomenon of pain in America. With the golden rule as a standard of measurement, “do unto others as you would have them do to you,” I looked at twelve social entities in our culture, each which proclaims proudly how they are there to serve. I looked at what they say they are going to do, what they really do, and the gap in between, and how, through creative public policy, we, as a collective whole, can close that gap and minimize the suffering of those in need and avoid creating “needless suffering.”
The book begins and ends with the most difficult task of all. I asked the question, “Am I a coward?” The question is posed in the first chapter and answered in the last one. With the biblical story of the Good Samaritan from the Gospel of Luke as a reference, I came to my own conclusions, which I leave to the reader to judge.
The original title of the book was You Do Have to Suffer, Just not as Much as We Make You. The editors wanted something shorter, but I was able to still use the original as a chapter title. I was thrilled when the publisher and the editors took great pains to preserve as many stories as possible. Unfortunately, Poor Man did not make the final cut. That was hard for me because that story revealed a lot about who I am, and I thought it was important for me to share that with the reader. In the future, we’re likely to release that as a short story entitled The Missing Chapter; Ellen, a Man in Despair, and too Many in Pain.
My only goal in life is to make a difference. In that way, I choose to emulate my mother. Despite her broken body, she practiced something I call “kitchen table advocacy.” Armed with a phone and a desire to help others, she continually put the needs of others second to her own and, in doing so, she will always be my most important hero. Since publishing Needless Suffering, I have had the honor of meeting wonderful people all over the country, from all walks of life, and from all stations who do live up to my mom’s ideals. We can learn so much from each other. I am so thankful for these opportunities. My purpose is to advocate for those in need and for those who help them.
Thank you for reading. I look forward to our journey together. Together, we can make this a better, more caring place.
This article was first published on ProHealth.com on March 6, 2019 and was updated on September 10, 2019.
Dr. David Nagel is a physiatrist who, for the past 30 years, has specialized in pain management in Concord, New Hampshire. His special interests include doctor-patient communication and advocacy and social justice for those who live with chronic pain. He is the author of the book Needless Suffering: How Society Fails Those with Chronic Pain.
Described as a “self-help book for society” with the potential to change the way we talk about pain in America, Needless Suffering offers a broad sociological look at how we, as a culture, treat those who suffer, too often needlessly, and how, through public policy and personal behavior, we can do much better. Dr. Nagel is a member of the US Pain Foundation and the Pain Connection, both patient advocacy groups, and the NFL Players’ Association Pain Committee.