[Book Reviews] "Pain: The Science of Suffering"
I am very glad that I picked up Patrick Wall's "Pain: The Science of Suffering". For those unfamiliar with his work, Patrick Wall was one of the most honored medical researchers into pain, with over fifty years of field experience. He is also one of the inventors of the TENS unit, which many of you may have been so unfortunate as to experience in therapeutic contexts. This book, coming in at 177 pages or so, is his short and popular-science introduction to the current state of research and what is medically known about pain. There are times I regret no longer being a professional biologist... I can't justify the canonical textbook that Wall edited, even though I bet it's fascinating.
The first few chapters drew me in right away. Wall's descriptions of Israeli soldiers and their observable reactions to major trauma pretty closely reflected my own personal experiences with traumatic injuries -- down to each individual thinking that they were freakish for reacting that way. (Little pain at the immediate event, strong focus on getting yourself out of that situation and managing the rescue, freaking out and collapsing in pain once "safe".) I was fascinated by the studies which show the gap between how people actually experience pain (basically, the amount of pain you feel is not correllated with how bad the injury is) and how doctors treat it (they look at your injuries, determine how badly you "should" be hurting, and disbelieve you if it's above how bad they think it is). I'm usually one of the 20% of people who are underreporters -- in many cases, what I feel is less bad than what medical professionals would expect me to feel. I get funny looks for turning down prescription painkillers. But in the cases where I do feel pain more strongly than I'm "supposed to", I have experienced the incredible frustration of being disbelieved. ("No, really, it IS that bad.") The things that have hurt the most for me seem to follow the general run of 'worst' for most people -- exposed nerve is tops in my experience, cramps are second. Broken bones, lacerations, etc. are all way less bad than those. Deep internal core problems like cramps are up there on the pain scale for most folks; I was grimly amused and entirely unsurprised that cramps were classified in the same bin of severity as heart attacks.
There are some chapters that are a biogeek's delight, describing the different kinds of sensory nerves and how they interact with the spinal cord, motor nerves, and (only sometimes!) the brain. Those can get dry if biology is not your thing, but mostly Wall manages to keep the book moving and entertaining with anecdotes about etorphine (ten thousand times stronger than morphine) and elephants (the dose is one mg per ton of elephant), Queen Victoria's habit of pain relief via tincture of cannabis, the placebo effect and how it relates to the origins of the phrase "hocus pocus" (from "Hoc est corpus", in the opening of the Mass), and the nocebo effect (wherein it became a capital offense for British troops in East Africa to death curse a fellow soldier). Fun stuff, and it keeps you thinking about the history and evolution of palliative care and pharmacology.
Also of interest was the section on back pain -- 85% of cases of lower back pain, apparently, do not have a detectable physical cause. But as we've seen earlier, pain levels are unrelated to physical injury. Wall talks about the three(ish) percent of the population that have a slipped disc in their back... half of us have pain related to it, half of us are normally pain free. Apparently sixty percent of UK residents have taken more than a week off work at some point in their career due to back pain, and treatment in this area is still fairly primitive. There was also an interesting section on treatment by acupuncture versus treatment by local anaesthetic injection, and former President Kennedy's doctor discovering that just sticking in the needles to the injection site had the same effect. Finally, the section on learned response to doctors in relation to treatment of very young children was really disturbing... they don't forget pain at the hands of doctors as easily as we'd like to think, and that later affects the placebo/nocebo effect and their response to later treatment. Creepy stuff.
The fact that I'm regretting that I shouldn't spend $350 on the 1200 page more geeky version of this book should tell you what I thought of it. I do wish that it had been footnoted so that I could have looked up more particulars on each study, but I'm sure Google will serve if I'm really that interested. Four and a half overexcited axons out of five.
The first few chapters drew me in right away. Wall's descriptions of Israeli soldiers and their observable reactions to major trauma pretty closely reflected my own personal experiences with traumatic injuries -- down to each individual thinking that they were freakish for reacting that way. (Little pain at the immediate event, strong focus on getting yourself out of that situation and managing the rescue, freaking out and collapsing in pain once "safe".) I was fascinated by the studies which show the gap between how people actually experience pain (basically, the amount of pain you feel is not correllated with how bad the injury is) and how doctors treat it (they look at your injuries, determine how badly you "should" be hurting, and disbelieve you if it's above how bad they think it is). I'm usually one of the 20% of people who are underreporters -- in many cases, what I feel is less bad than what medical professionals would expect me to feel. I get funny looks for turning down prescription painkillers. But in the cases where I do feel pain more strongly than I'm "supposed to", I have experienced the incredible frustration of being disbelieved. ("No, really, it IS that bad.") The things that have hurt the most for me seem to follow the general run of 'worst' for most people -- exposed nerve is tops in my experience, cramps are second. Broken bones, lacerations, etc. are all way less bad than those. Deep internal core problems like cramps are up there on the pain scale for most folks; I was grimly amused and entirely unsurprised that cramps were classified in the same bin of severity as heart attacks.
There are some chapters that are a biogeek's delight, describing the different kinds of sensory nerves and how they interact with the spinal cord, motor nerves, and (only sometimes!) the brain. Those can get dry if biology is not your thing, but mostly Wall manages to keep the book moving and entertaining with anecdotes about etorphine (ten thousand times stronger than morphine) and elephants (the dose is one mg per ton of elephant), Queen Victoria's habit of pain relief via tincture of cannabis, the placebo effect and how it relates to the origins of the phrase "hocus pocus" (from "Hoc est corpus", in the opening of the Mass), and the nocebo effect (wherein it became a capital offense for British troops in East Africa to death curse a fellow soldier). Fun stuff, and it keeps you thinking about the history and evolution of palliative care and pharmacology.
Also of interest was the section on back pain -- 85% of cases of lower back pain, apparently, do not have a detectable physical cause. But as we've seen earlier, pain levels are unrelated to physical injury. Wall talks about the three(ish) percent of the population that have a slipped disc in their back... half of us have pain related to it, half of us are normally pain free. Apparently sixty percent of UK residents have taken more than a week off work at some point in their career due to back pain, and treatment in this area is still fairly primitive. There was also an interesting section on treatment by acupuncture versus treatment by local anaesthetic injection, and former President Kennedy's doctor discovering that just sticking in the needles to the injection site had the same effect. Finally, the section on learned response to doctors in relation to treatment of very young children was really disturbing... they don't forget pain at the hands of doctors as easily as we'd like to think, and that later affects the placebo/nocebo effect and their response to later treatment. Creepy stuff.
The fact that I'm regretting that I shouldn't spend $350 on the 1200 page more geeky version of this book should tell you what I thought of it. I do wish that it had been footnoted so that I could have looked up more particulars on each study, but I'm sure Google will serve if I'm really that interested. Four and a half overexcited axons out of five.