Drug Story with Thomas Goetz

Episode: On Chronic Pain
Date: February 24, 2026

Episode Overview

In this episode, host Thomas Goetz uses the story of a sufferer named Paul—and the newly approved drug Jornavix—as a lens to explore the complex landscape of chronic pain and its treatment. With help from expert Dr. Antja Barveldt and personal insights from Thomas’s wife, Whitney Wright, the episode traces the history, science, and messy reality of pain management—from the struggles of desperate patients to the opioid crisis, medical innovation, and the frustrating limits of what insurance will pay for.

Key Discussion Points & Insights

1. Paul’s Story: The Relentlessness of Chronic Pain

[00:04–03:24]

• Paul’s comic-yet-devastating origin story: chronic, testicular pain began suddenly when his dog sprang off him, and never let up.
  • “It sort of felt like somebody had hit me in the nuts and it just never went away. Sort of felt like I was in a vise. And then a couple of times a minute, it kind of felt like I was getting hit by lightning. It would be so sharp that I couldn't breathe.” — Paul [00:21]
• Years of unrelenting pain, countless unsuccessful treatments:
  • Surgeries (nerve severance, ablation), three spinal cord stimulators, physical/pelvic floor therapy, talk therapy, yoga, yoga, (yes, yoga again), medication ranging from antidepressants, anticonvulsants, opioids, THC, CBD.
  • “If anybody said that some supplement helped them, I tried it. Really the only things that have worked, opioids kind of take the edge off. THC kind of distracts me from the pain. I haven't said no to a medication or a treatment because as you can imagine, it's pretty desperate for a solution.” — Paul [02:29]
• Deep social and psychological impact:
  • “You have to fake it...I had to quit my job because my body just couldn't handle it anymore. Sleeping is very difficult. We're met with a lot of distrust...so many medical professionals, so many nurses have kind of treated me like I'm a drug addict.” — Paul [03:24]

2. Understanding Chronic Pain as a Condition

[04:35–15:31]

• Pain's invisibility: Unlike other conditions, pain doesn't show up on diagnostic tests.
  • “Pain is invisible. It doesn't show up on an Xray or a CT scan. So is pain real? Is it all in your head? Well, in a way, yes. That's where the brain is.” — Thomas Goetz [05:05]
• Brief history of pain science:
  • Dr. John Bonica, physician and wrestler, pioneered “pain as a condition.” Founded pain clinics in the 1940s, wrote the first pain textbook, and held the first symposium to define “chronic pain.”
  • “It was the first time that the term chronic pain was used to describe a specific affliction...Pain was a distinct condition, not just a symptom.” — Thomas Goetz [12:09]
• The multidisciplinary “pain clinic” model emerges.

3. The Modern Understanding of Chronic Pain

[15:12–17:39]

• Pain is a blend of physical and psychological factors—malfunction in the central nervous system.
  • Dr. Antja Barveldt: “As pain goes up, anxiety goes up, and as anxiety goes up, pain goes up. So they kind of feed off of each other. And then if we overlay that with a trauma experience, other life stressors, we know that if those are not well managed, then it's really hard to also have a good handle on the pain.” — Dr. Barveldt [15:12]
• Pain’s impacts ripple into every aspect of life: relationships, work, self-image, even one’s sense of being human.
  • “For so very long, we've focused our medical education... but we've never really put pain at the focus of our treatment and preventative strategies...I think for a long time, it's really that pain just didn't necessarily have a home.” — Dr. Barveldt [16:13]

4. How Medicine Failed—and Harmed—People with Pain

[17:39–29:42]

• “Fifth vital sign” movement (pain scale from 0–10) made pain care a priority—but also led to simplistic metrics and over-prescribing.
  • “The large part of the criticism towards pain as the fifth vital sign is that we were treating a number and not a patient. And that may have led to a potential over treatment with medications such as opioids because we were chasing that number.” — Dr. Barveldt [20:37]
• Rise and tragedy of opioids, especially OxyContin:
  • Purdue Pharma’s aggressive, misleading marketing fueled the epidemic; “risk of addiction less than 1%” was wildly inaccurate.
  • The fallout: over a million American deaths by opioid overdose since 1995.
  • “None of this was true. Oxycontin created a wave of addiction and abuse that destroyed communities, families and individuals...one of the greatest disasters of public health in the past century, a crisis created entirely by humans.” — Thomas Goetz [27:01]
  • “It took the opioid epidemic for people to pay attention to pain...They're very effective. They just come with so many risks and consequences. We've been a pretty pill happy culture...” — Dr. Barveldt [29:42]

5. A New Hope: Non-Opioid Pain Drugs and the Cost Barrier

[30:37–35:36]

• Paul’s experience with Jornavix (Vertex Pharmaceuticals): a peripheral-acting, non-opioid pain drug, approved in 2025 for acute pain—but used off-label for chronic pain.
  • “To say it's been a miracle has been an understatement...I feel like I'm getting my life back. And yeah, I had this, this moment during the first week where I realized I wasn't in pain. And it was just like this, this overwhelming feeling just washed over me that, you know, this is how normal people live their life. Somebody had finally flipped that switch.” — Paul [31:11 & 31:49]
  • “Jornavix is the first drug approved to treat pain in 20 years and significantly, not an opioid.” — Thomas Goetz [32:23]
  • “It only works on the peripheral system...it does not have addictive potential.” — Whitney Wright, Vertex CEO [32:45]
• Pragmatic challenges: Jornavix is $900/month, off-label chronic pain use isn’t covered by insurance beyond a short supply, limited patient assistance.

6. Navigating Treatments: Options, Tradeoffs & Access

[36:31–47:10]

• Dr. Barveldt’s “toolbox” approach: comprehensive treatment can include meds (pills, topicals, injections), PT/OT, exercise, behavioral therapies, alternative medicine, surgery, etc.
  • “Thinking about pain medicine really is having that kind of comprehensive approach and then never forgetting the sort of social aspects of pain too. Identifying reasons that patients may have challenges to access.” — Dr. Barveldt [38:31]
• The patient struggle: trial and error, lack of clear path, prohibitively expensive or inaccessible care for many, insurance obstacles.
  • “I remember this sports medicine doctor told me I needed to do more AB work. Well, this was after I was a Golden Gloves boxer. I was the best shape of my life...so that wasn't the issue.” — Whitney Wright [39:55]
  • “You feel very hopeless when someone says, well, there is no test to tell me where this pain is coming from...Is this all in my head?” — Dr. Barveldt [40:48]
  • “It's almost like the insurer is directing care. I didn't become a physician to be told what I can and can't do by an insurance company, but that's how it feels.” — Dr. Barveldt [45:09, 46:21]

7. The Personal Is Universal: Whitney’s Experience

[39:10–48:41]

• Whitney, Thomas’s wife, shares her struggle with chronic pain: decades of unhelpful medical advice, eventual relief through a pain clinic, and the importance of being truly listened to.
  • “I didn't know about pain clinics. I didn't know they existed. And it was actually, I had a dinner party...a friend who was there, and she was a pain doctor, and she's the one who gave me the information...for the first time, somebody got it, they understood and he knew what questions to ask.” — Whitney Wright [42:48]
  • On invisibility: “When you have a broken arm, you have a cast on it...But with pain, it's invisible. So most people I know have no idea that I cope with chronic pain. I don't talk about it. I try not to define myself around it, but it's definitely a huge part of my life. Just keep in mind that we. We don't want to be in pain...I guess I want some patience when I can't do something.” — Whitney Wright [47:50]
  • Sign-off: “I would love to be able to, for my experience, to help other people with chronic pain because it's a total pain in the ass.” — Whitney Wright [48:41]

Notable Quotes & Moments

• On the desperation and reality of chronic pain:
  • “You have to fake it...kind of pretending you're not in pain.” — Paul [03:24]
• On the limitations of numerical pain scales:
  • “We were treating a number and not a patient.” — Dr. Barveldt [20:37]
• On the opioid tragedy:
  • “None of this was true. Oxycontin created a wave of addiction and abuse that destroyed communities...” — Thomas Goetz [27:01]
• On medical culture:
  • “We've been a pretty pill happy culture that we just kind of want a medication to fix everything and don't necessarily think about lifestyle changes and other decisions that we make.” — Dr. Barveldt [29:42]
• Hope for the future:
  • “Jornavix suggests that there are still new ideas out there and new treatments to be discovered. Hopefully, Jornavix is just the first of several new treatments for pain, things that really work, drugs or otherwise, because there are millions of people out there suffering in silence…” — Thomas Goetz [47:10]
• On invisibility:
  • “With pain, it's invisible...most people I know have no idea that I cope with chronic pain. I don’t talk about it. I try not to define myself around it, but it’s definitely a huge part of my life.” — Whitney Wright [47:50]

Timestamps for Important Segments

• [00:04] – Paul’s chronic pain story begins
• [03:24] – Paul on faking and living with chronic pain
• [04:35]–[14:00] – History of pain as a medical condition (Dr. Bonica, pain clinics)
• [15:12] – Dr. Barveldt on pain and anxiety
• [17:39] – Medical training and the “knowledge–practice gap” in medicine
• [20:37] – Pain as “fifth vital sign” problems
• [23:40–29:42] – Opioid crisis history and impact
• [31:11] – Paul’s breakthrough with Jornavix
• [32:45] – Whitney (Vertex CEO) on Jornavix: how it works
• [36:31] – Dr. Barveldt outlines pain treatment toolbox
• [39:10] – Whitney’s chronic pain journey
• [40:48] – Dr. Barveldt on feeling hopeless as a patient
• [42:48] – Whitney discovers and benefits from a pain clinic
• [45:09] – Dr. Barveldt on insurance-driven care
• [47:10] – Thomas Goetz on hope for future treatments
• [47:50] – Whitney on the invisibility of pain and need for patience

Episode Tone

The episode moves from wry humor (Paul’s injury story), to measured explanation (history and science of pain), righteous indictment (opioid crisis), and finally warm empathy—especially in the closing conversation with Whitney. The voices of real patients, the unvarnished struggles of clinicians, and sharp historical perspective combine for a balanced, sometimes raw, but ultimately hopeful take on a deeply challenging topic.

For Listeners Seeking More

• Books: Dopesick, Empire of Pain
• Documentary: HBO’s The Crime of the Century
• Check out DrugStory.co for sources and show notes.