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Science is providing insights, and viable treatments are available. But millions of people are still without help.
Philip Kass spends 90% ofhis day lying on a twin bed in a sparsely decorated room that used to belong to his niece. He takes most meals with a plate balanced on his chest, and he usually watches television because reading is too stressful.
"I'm barely living," he told me on a warm night in June last year.
Ever since a back injury 23 years ago, pain has been eating away at Kass's life. It has cost him his career, his relationships, his mobility and his independence.
Now 55, Kass lives with his sister and her family in San Francisco, California. He occasionally joins them for dinner, which means he'll eat while standing. And once a day he tries to walk four or five blocks around the neighbourhood. But he worries that any activity, walking too briskly or sitting upright for more than a few minutes, will trigger a fresh round of torment that can take days or weeks to subside.
"It's just paralysed me," he says.
Some of what Kass describes is familiar. I have been pinned to the floor by spinal pain several times in my life. In my twenties, I was immobilized for three months. In my thirties and forties, each episode of severe pain lasted more than a year. I spent at least another half decade standing or pacing through meetings, meals and movies - for fear that even a few minutes spent sitting would result in weeks of disabling pain. For years, I read anything I could find to better understand why my pain persisted.
The picture that emerged was complex and surprising. Over the past few decades, a growing body of evidence has indicated that the very machinery that processes pain can help to sustain the sensation or make it worse. Some researchers have explored unexpected interactions between the immune and nervous systems, showing, for instance, that inflammation, long considered a provocateur of pain, might also be crucial for resolving it. Others have shown how depression, anxiety and other kinds of emotional distress can both feed - and feed off - the experience of pain.
Although there are treatments that acknowledge...