Randall H. Duckett

In 1995, the British Medical Journal (BMJ) reported the case of a 29-year-old construction worker who was rushed to the emergency department after falling onto a 6-inch nail. It went all the way through his boot and the tip was visible on the top. 

He was stunned and terrified. Any small movement caused terrible pain, so doctors had to give him fentanyl (a powerful painkiller) and midazolam to sedate him before they pulled the nail out from the sole.

When the boot was removed, doctors noticed there was no blood and the worker’s skin was intact. The nail had passed harmlessly between his toes. No physical damage had been done, yet he still felt excruciating pain. 

Who’s to say that his pain was not real? It was, but the worker did not need painful physical damage to feel it — there was none. All he needed was the pain centers in his brain to become activated. 

This is actually good news, because it shows that if the pain system can be activated just by believing there is a threat, it can also be deactivated by believing that the threat is removed.

This real-life story illustrates something that many people do not know about pain: that pain isn’t just about physical damage. It is also about expectations formed by one’s conscious and unconscious mind, a person’s memory, attitudes, values, and experiences. 

As a pain specialist for the more than 30 years, I have seen firsthand how chronic pain can be devastating to individuals, to their families, friends, and to society. I am a MD, PhD, professor of medicine at the University of Toronto, and author of 8 Steps to Conquer Chronic Pain: A Doctor’s Guide to Lifelong Relief. I’ve created scores of videos explaining chronic pain on my YouTube channel (@DrAndreaFurlan) and on my website (doctorandreafurlan.com). 

Pain affects about one in five individuals worldwide, including children. I have helped many people to overcome and conquer their pain by thinking about it differently and making lifestyle changes, but it is up to each of my patients to put my advice into practice. 

What I ask of them is very simple, but they might be the most challenging steps for them: retrain their brain, control their emotions, get quality sleep, adjust their diet, seek help from others, reduce their medication use, exercise more, and focus on their goals.

Pain is a biopsychosocial construct shaped in the brain. The brain’s function is to preserve the status quo, and it does this by predicting the future (the next second, minute, day, year, etc.). Like in the case of the construction worker, when the brain perceives “danger” (whether real or not), it triggers an alarm, which can manifest as pain. Sometimes it may also trigger extreme fatigue, dizziness, tremors, a heart palpitation, or shortness of breath. We cannot separate the body from the mind, or pain from our emotions. It is impossible to conquer pain, especially chronic pain, if the person suffering pain does not recognize these relationships. The first step to conquer chronic pain is to understand it.

Reading Chronic Pain Chronicles by Randall H. Duckett brought back memories of hundreds of stories I’ve heard from my patients over the past more than three decades of practicing as a pain doctor. Randall is both an accomplished journalist and lifelong pain sufferer, and this unique combination makes his book both a pleasure to read and a fascinating learning journey. Writing about one’s own suffering and emotional battles is never easy, yet Randall does so with openness, poetry, self-awareness, and compassion. This work is more than just a valuable resource for people living with chronic pain, or the autobiography of someone enduring persistent and frustrating discomfort. It is also a profound chronicling of the experience of having chronic pain. For that, I warmly congratulate Randall. I think you’ll find his book as enlightening as I did. Enjoy.