If you’re a patient who’s outraged at the way you’ve been treated—or not treated—for your pain, Chapter 1 is a must-read. Chronic pain is a problem of staggering proportions, yet many people with chronic pain feel utterly alone.
If you truly, deeply, absolutely hate science, just skim through Chapter 2 on how the body turns acute pain into chronic pain and Chapter 3 on the genes that rev pain up or damp it down. Even just skimming these chapters should convince you that, no matter what you’ve been told, your pain is not all in your head. If you’re a physician, these chapters are a must-read—chances are that much of the research discussed was never taught in medical school.
If you’re a woman and believe your pain has been dismissed in part because of your gender, Chapter 4 is for you. Especially if you believe the myth that women don’t feel pain as much as men!
Even if you don’t have kids, Chapter 5 is an eye-opener because of the appalling way we have undertreated—and still undertreat pain in children.
Researching Chapter 6, the mind–body section, was one of the highlights of this book for me. You’ll read about the complex overlap between pain and depression, how the habit of “catastrophizing” (fearing the worst) can make pain worse, and how cognitive behavior therapy, distraction, meditation, hypnosis, and biofeedback can make it better. Significantly better.
Chapters 7 and 8 are about the “opioid wars,” the clash between two epidemics—the epidemic of undertreated pain and the epidemic of prescription pain reliever abuse. You’ll see that, while opioids can be abused, they are nowhere near as addictive as most people, including doctors, think. You’ll learn the difference between dependence and addiction, about the mixed results of government efforts to monitor prescription pain relievers, and about the limits of opioids themselves. Sadly, opioids are not nearly as effective, especially in the long term, as one would hope. Clearly, something better is needed.
One such “something” is the focus of Chapter 9, which lays out an entirely new approach to treating pain not with opioids, but with drugs that act on specialized immune cells called glial cells. It’s news to most people, but the immune system actually interacts with the nervous system to turn acute pain into chronic pain. This is good news because it gives scientists new drug targets, potentially reducing the need for opioids.
I decided to include an entire chapter (Chapter 10) on marijuana because it is so often overlooked in pain management. The science behind marijuana’s efficacy for pain is fascinating. In fact, our bodies actually make our own marijuana-like substances. I explore in detail the risks and benefits of marijuana, as well as the political challenges to its wider use.
In Chapter 11—traditional Western treatments for pain—I assess the safety and effectiveness of a wide range of treatments including electrical stimulation, transcranial magnetic stimulation, injections, nerve-killing techniques, surgery, and new drugs in the pipeline. Hopefully, you will find some options that you may not have tried.
In Chapter 12—complementary and alternative treatments—I again take a strongly evidence-based look, this time at acupuncture, massage, energy healing, spinal manipulation (chiropractic), diet and vitamins, and even magnets and magnet field therapy. You may be surprised, as I was, at what I found.
Chapter 13 on exercise is a big upper. The evidence in favor of exercise for pain relief is very strong: In many, if not most, cases of chronic, non-cancer pain, exercise not only does not do damage—people’s biggest fear—it can often make pain so much more manageable that life becomes livable, and fun, again.
Chapter 14 suggests a way forward to make better pain care a higher national priority. I argue that better pain management is a fundamental human right, and that failure to treat pain amounts to “torture by omission.” I argue that the government should establish an institute or center for pain research within the National Institutes of Health. That medical schools should dramatically increase the hours dedicated to pain education. That licensing and accrediting organizations should be held accountable for making pain education a requirement for continued licensure of physicians.
Finally, I urge people with chronic pain to do as people with disabilities, breast cancer, and AIDS have done so successfully in recent years—to shed their isolation and shame and make their voices heard for the pain control they deserve.