Cramp: A Doctor's Notes on Pain

Cramp began with two chance discoveries for Dr. Shulman. The first came in the clinic. Many of the children whose families arrived seeking a diagnosis did not have the autoimmune diseases he had been trained to treat. They had chronic pain, conditions that sit at the edge of what medicine can name, real, disabling, and stubbornly invisible on a scan. The second discovery was the missing piece of his own life: a thirty-year history of athletic injuries had progressed to muscle cramping and pain that made work, parenting, and ordinary days harder than they should have been. A medical investigation ended with a rare neuromuscular condition that had a name: cramp fasciculation syndrome.

But it came with no specific treatment and no prognosis. At forty-seven, and still looking for answers, he did something few doctors ever do: he became a patient at the children’s hospital where he works.

Throughout the book, two perspectives are central: the doctor at the exam table and the patient across from him. From this framework, Dr. Shulman sets out to clarify what chronic pain really is: why it has become a public health crisis and how the interplay of body and mind makes pain both intensely personal and universal. He explains the science clearly, including intriguing cases of people born without the ability to feel pain, and details the research that led to the first new non-opioid pain medications in decades. He is honest about what medications can and cannot do, and about the opioid era that began, in part, with a well-meaning campaign to treat pain as the fifth vital sign.

At the book’s heart are his patients. There is Kayla, thirteen, whose rolled ankle on the soccer field became a case of complex regional pain syndrome, in which even the weight of a bedsheet was unbearable. There is Tyler, the ballplayer from the opening pages, whose arm pain was initially treated as an overuse injury, took years to fully explain, and was finally clarified by a single genetic clue. He grew into an advocate for other kids like him. There is Mia, who learned to walk into an exam room prepared to be doubted and to insist on being heard. Their stories carry the questions the book returns to again and again: what a diagnosis is really worth, what it costs a child not to be believed, and how a family keeps living when the tests come back without answers but the pain goes on.

Around those stories, Cramp opens outward. Chapters move through the history and public-health weight of chronic pain, the science of how pain is made and felt, the new medications and complementary therapies patients try when medicine falls short, the psychology of living with pain, the lessons of elite athletes who train at its edge, and the questions of spirituality and religion that pain eventually forces. Each thread is woven through the lives of his patients and his own. What holds it together is a single conviction, learned from both chairs in the exam room: an accurate diagnosis matters, but it is not the destination. A life can still be built and lived well even when a cure is not on the horizon.