Wall Street Journal: Chronic Pain, Broken Healthcare, & Luigi Mangione

Chronic Pain and the Fractured Reality of Healthcare: A Response to the WSJ Article

‍Melanie Thernstrom’s Wall Street Journal essay, “Chronic Pain Can Cause a Kind of Madness. I Know This Personally” (Jan. 3, 2025), offers a harrowing exploration of how unrelenting pain reshapes lives. Thernstrom delves into the tragic case of Luigi Mangione, whose struggles with chronic pain and the failings of the healthcare system culminated in a grim and violent unraveling. His story is not only a personal tragedy but also a stark reflection of systemic issues in pain management and healthcare.

For anyone who has experienced chronic pain or supported someone through it, Mangione’s story resonates on a visceral level. The isolation, frustration, and despair he endured are common among patients who face not only their symptoms but also the daunting challenge of navigating a healthcare system ill-equipped to meet their needs.

Many conditions, such as Ehlers-Danlos syndrome (EDS), Fibromyalgia, Complex Regional Pain Syndrome (CRPS), Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), and other neglected disorders, leave patients navigating a labyrinth of misdiagnoses, skepticism from providers, and denials from insurers. Chronic pain often goes hand-in-hand with other symptoms, such as brain fog, sleep disruption, and emotional distress, creating a vicious cycle that amplifies suffering.

Thernstrom’s essay captures this cycle vividly, describing how pain rewires the brain, dampens the capacity for joy, and fuels feelings of helplessness. As Dr. Sean Mackey, a neuroscientist and chief of pain medicine at Stanford, notes, the circuits in the brain associated with pain become abnormally wired, deepening the distress and hopelessness that many patients feel.

The Healthcare System’s Failures

The broader systemic failures Thernstrom highlights—insurance denials, inaccessible multidisciplinary care, and the stigma surrounding pain—are all too familiar to those living with chronic pain. Despite evidence supporting integrative approaches, including physical therapy, mindfulness, medication management, and psychological support, such care remains out of reach for most patients.

Insurance companies often deny coverage for pain treatments, citing the lack of definitive diagnostic tests or the chronic nature of these conditions. This leaves patients like Mangione, who struggled with spondylolisthesis and underwent spinal fusion surgery, with limited options. As Thernstrom notes, even this last-resort procedure can lead to long-term complications, including recurring pain and biomechanical changes in the spine.

Mangione’s frustration with the system reflects a broader sense of betrayal among chronic pain patients. Many find themselves trapped in a cycle of unaffordable treatments, invalidated experiences, and systemic neglect. The financial burden alone—such as the $1,150-per-session bills for physical therapy mentioned in the article—can plunge patients into despair.

Reframing the Narrative

Thernstrom’s essay also challenges the stigma surrounding chronic pain. Pain is often invisible, making it easy for others to dismiss or downplay the severity of a patient’s experience. This stigma can extend to healthcare providers, insurers, and even patients’ own families, compounding the emotional toll of living with chronic illness.

To address these issues, we must:

1. Prioritize multidisciplinary care: Evidence-based pain management strategies should be accessible to all, not just those with the financial means to afford them.
2. Increase awareness and education: Chronic pain should no longer be an “orphan” in medical curricula or public discourse. Greater understanding among healthcare providers and the general public can reduce stigma and improve outcomes.
3. Advocate for policy reform: Insurance companies must be held accountable for providing coverage for proven treatments. Policymakers should work to expand access to care and address the inequities that leave so many patients without support.

A Call to Action

Mangione’s story, though extreme, serves as a wake-up call. It is a stark reminder of the human cost of our healthcare system’s inadequacies and the urgent need for change. Thernstrom’s essay amplifies the voices of millions of patients who, like Mangione, feel abandoned by a system that prioritizes profit over compassion.

Chronic pain is not just a personal burden; it is a public health crisis. By investing in comprehensive, accessible care and dismantling the stigma surrounding pain, we can begin to address the profound suffering chronic pain patients endure. As Thernstrom and experts like Dr. Mackey remind us, the brain can heal—but only if patients are given the tools and support they need.

Let Mangione’s story and Thernstrom’s words be a rallying cry for reform. We owe it to the millions of people living in pain to create a system that recognizes their humanity and prioritizes their care.

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