The physical therapist who explains that you can live with pain "and still give it the finger."

We live in a society obsessed with avoiding pain , but many experts believe we've never been so ill-equipped to deal with it. In this context, Arpa publishing house is launching ¡J*der, qué duele! (Fuck, how it hurts!), which isn't intended to be just another book about pain, but rather the definitive manual for understanding it and learning to live with it without it controlling us.

In this work, Álvaro Pinteño debunks myths, mocks magic formulas, and confronts us with reality: pain is not just a physical problem, but a profoundly human experience, shaped by our biology, emotions, and social context.

With a blend of scientific rigor, personal anecdotes, and a straightforward, straightforward, and patronizing style , this book will teach you why pain doesn't always mean harm, why it's not the brain that deceives us when it comes to interpreting suffering, and why we can't trust all the miracle solutions we're sold.

If you've ever felt like the pain overwhelms you, that no one understands you, or that you've become a pilgrim in search of answers, this book aims to give you the tools to regain control. It's not a promise of immediate relief, but rather an invitation to change the way you experience it. Because it hurts... but there are ways to make it more bearable.

QUESTION: What motivated you to write this book?

ANSWER: Several things. The first was that I was a chronic pain patient. The second was that I saw several gaps in my consultations , several problems for which I had no answers, and the books and scientific articles, training courses, and so on that I had access to helped me, but they didn't fully give me many of the answers I was thinking of. So I tried to write that book, which I wish I had in my hands and had access to and read in order to study it. And it was also a part of me, of my own therapy and my own healing, that allowed me to give new meaning and purpose to the pain, to my own experience of pain that I was suffering at the time.

Q. Why is this message you convey important: that the goal isn't to live without pain, but to greet it and give it the finger?

A. I began to realize that pain is part of our lives. It's inherent to being human, it's inherent to being alive. I think it's only a matter of time before pain expresses itself in a new way.

Humans tend to cling to temporary situations as if they were permanent , and when we're in pain, we often tend to cling to it as if it were going to last longer than we think. We often also forget the concept of regression to the mean. I really like it because what it tells us is that the better we are, the more likely it is that we'll get a little worse again. And the worse we are, the more likely it is that we'll get a little better again.

It may be that many times we are or have been for months or even years in a seemingly endless pit, but perhaps it could be that this year winter and fall are dragging on longer than we'd like and it's raining more than we expected, like this year, for example, with the wool and all that. But hey, the sun can always come out. It's also true that there will be situations where there will be specific social determinants and other factors that may even prevent full recovery, that is, the complete remission of signs and symptoms. So, in this case, perhaps the only consolation, or what we have left, is to provide the person with strategies and tools to help them better cope with their problem and be able to offer that nod of approval, that greeting despite the pain.

It's basically like a metaphorical message that life is always going to be much bigger and worth living than pain itself, that even though it has the potential to tear away pieces of the life you enjoy and possibly the things you love the most, I think it's always worth having hope of finding a way to enjoy the thing we love the most again.

Q. Besides the title, the book has a colloquial tone. How important is this tone to reach people?

A. It's very important. Petrarca said that he didn't intend for what he had worked so hard to learn to be understood effortlessly and without any work. And it's true that we have to understand pain and understand this complex experience; it will always require work and effort, no matter how colloquially we choose to put it. For me, it was also a challenge , because one of the things we also talk about is that a person's acculturation and their level of knowledge will say a lot about their understanding. So these people are also often people who suffer from chronic pain. For me, it was also very important, without being reductionist, without being simplistic, without falling into a very categorical, very striking message, that they could penetrate, that all the nuances and limits be truly lost, and that I continue to transmit that hope.

Q. There's increasing talk about chronic pain, which appears almost like a silent pandemic, but it's poorly understood and poorly treated. What's failing in the current healthcare approach to addressing chronic pain?

A. The current healthcare system is a complex system, just as the experience of pain is complex.

The time available in public health systems to care for these types of patients is failing . It's impossible to take a good medical history in 10 minutes , when I can spend up to an hour with my patient just on the first session to conduct a thorough history. I also know that the perverse incentives that exist in the commercialization of health are failing, as they also constrain us to be interventionists, when often the point is not to intervene and to explain why intervention isn't necessary. And that also takes time, and it takes uncomfortable conversations.

Iatrogenesis is also failing, which in the United States is known to have become the third leading cause of death. What that means is: iatrogenesis is the negative consequences of medical treatments, and often the consequence ends up becoming a much bigger problem than the initial problem it was intended to solve. So, we're currently dealing with many consequences that could have been avoided. Consequences of overdiagnosis due to false positives, consequences also of overmedicalization. This whole conglomeration makes up a rather complex problem. And well, I don't think the solution lies in including more positions in the public system; for example, physical therapy is tremendously necessary. But if what we're going to include are professionals under the same conditions, under the same timeframe, and under an outdated, interventionist biomedical model, perhaps what we're going to do is worsen the problem even more.

We see how, paradoxically, despite increasing knowledge, technological advancement, and so on, cases are only increasing. It's also true that we're living longer, life expectancy is increasing, which can also lead to experiencing more pain as a result of other pathologies and comorbidities, and more secondary chronic pain. So, well, I don't have an answer, but I do believe that healthcare managers, politicians, and others should at least take into consideration these things that we know are failing and try to find a solution.

Q. Should we emphasize overmedication?

A. The number of deaths caused by the opioid crisis was in the news at the time. Also, the addiction problems they suffer from. I think human beings start from a position, from a more interventionist bias, where they need to have control over their situation, they need to believe they're doing something useful for their problem, and that's where medication fits perfectly. Much of pain medication shouldn't be prescribed for more than three months, and it can be a great tool during those three months, like a powerful therapeutic window to be able to do what truly needs to be done, which is to treat a person's pain-coping behavior. The problem is that when only medication is given, and once you become accustomed to it, what they propose is to continue increasing the dose, with all the negative consequences that entails, then it's clear that something is wrong.

Q. In the book, you talk about how pain is modulated not only by physical factors but also by emotional, social, and cultural factors. What misconceptions remain most common among patients and professionals?

A. Beyond what we've talked about, such as "I need something done," people still think there's a correct posture, an ideal posture, when we now know that perhaps the best posture is the one that lasts the shortest amount of time and is the most energy-efficient, and the one that doesn't make you constantly think about how you should be positioned to stop the pain. If you sit in front of a computer in the ideal ergonomic posture, and for a certain amount of time, depending on your tissue capacity, you'll likely experience pain due to tissue acidosis, where the pH of your blood changes, becomes more acidic, and your body begins to experience a series of symptoms that require you to change positions and move.

This doesn't mean that posture doesn't matter, but that it's always relative. In some very specific patients, there will be biomechanical and postural changes that may need to be addressed. There's also the myth that all pain is always due to a contracture. Contractures exist, but perhaps not what is commonly defined as a contracture. Often, a contracture is simply a process that usually resolves itself, regardless of whether you get a massage or not. That doesn't mean... well, also regarding massage: we still think we have to find something else, that there's something to correct here, things and so on, and basically what we're doing is interacting with the other person, with the nervous system. A series of chemical substances are released that are analgesic in the short term and can generate well-being. But if that person's current problem persists, if there are reinforcers, constraints in the environment, social determinants that continue to lead to this suffering, if there are no symptoms, it can often also aggravate the problem.

The problem with all of these things isn't so much the intervention itself , but the narrative that accompanies them, which can be one of dependency and fragility. Many patients feel like they need to come to the physiotherapist every two weeks or every month for a checkup, for adjustments, when often what's needed is to work with that person for a couple of months to give them the tools to learn to care for themselves. We should be more like health workers, problem managers, to help people become self-sufficient, and only in specific cases, when those tools aren't applicable to their personal situation, let them come back to us. But the thing about dependency...

Q. Much of the basis for this book is your experience as a professional. What have you learned from your patients?

A. Patients have saved me on more than one occasion. Not so much in terms of not abandoning this profession, which is often thankless due to our conditions, often. But they teach you a lot of things because, well, in my case, being a young person—right now I'm only 30—the problem is that you often say, "Well, who the hell am I to give advice to someone about something that's happening with me and so on?" So they teach you patience, they teach you to listen, they teach you compassion, they teach you how to have uncomfortable conversations. They also often unburden themselves to you about tremendously important personal problems.

Q. Where do you draw the line between empathy and over-involvement with patients?

A. On the level of affective empathy, it's very important to keep this in mind because, especially in chronic pain, you inevitably end up establishing a therapeutic bond that's a bit more intimate. But if you do things right and know where to draw the line in time, patients can identify very well : when they're in a session and when they're out of it.

Q. What would you like the person who finishes this reading to take away with them?

A. That he had some hope, that he might not have all the answers we long for and seek, and that he could help them, but that he might ask a more appropriate question. I think that would be enough to begin making better decisions regarding pain and suffering.