Ever since Bobbie Wert was 8 years old, her stomach has ached. Wert is part of a vast and mysterious panorama of pain that is increasing, sometimes with no obvious physical cause. And while chronic pain is a global problem, it is particularly puzzling in America. In other wealthy countries, it's the elderly who report the most chronic pain, which makes some sense. But in the United States it's the middle-aged especially the jobless and people like Wert, who did not graduate from high school " who suffer the most. It is a plague on the less educated. All this raises the question: Is this physical suffering a canary in the coal mine warning us of larger dysfunction in our society? Chronic pain is not just a result of car accidents and workplace injuries but is also linked to troubled childhoods, loneliness, job insecurity and a hundred other pressures on working families. "People's lives are coming apart, and this leads to huge increases in physical pain," said Angus Deaton, a Nobel Prize winner in economics who with Anne Case popularized the term "deaths of despair." Americans die from deaths of despair " drugs, alcohol and suicide " at a rate of more than a quarter-million a year, and the number of walking wounded is far greater. Acute pain typically has a specific anatomical source " such as the shock you feel when you touch a hot stove " while chronic pain sometimes, not always, originates in the brain rather than the body.