Understanding Pain: Exploring the Perception of Pain
By Fernando Cervero
The MIT Press, Cambridge, London, 2012
172 pp., illus. b/w. Trade, $24.95
ISBN: 978-0-262-01804-3
Reviewed by Cecilia Wong Independent writer, Los Angeles. Web address: Eyes-wide.com
Virginia Woolf had this advice for how to read a book: “Do not dictate to your author; try to become him. Be his fellow-worker and accomplice”. My advice in reading Understanding Pain is the same – just read on, something will ring – one does not need to know every word to get the story. You’ll be vastly rewarded by the humor and humanity in this book about pain. There’s good pain and bad pain and the book explains them all, with historical anecdotes and current neurological understanding; and not least pain’s entwined affair with philosophical and religious beliefs.
Equating the study of pain with that of memory and consciousness is an important point in this book. Pain, like consciousness, is a subjective perception, and cannot be independently measured, like body temperature. We could also feel no pain with injury if our body does not have the right cellular receptor for it – like ultraviolet ray from the sun (the pain the day after is the result of tissue damage from the burn). The author has included the latest research – sadly, no bibliography is included or work attributed. It would have allowed interested readers to look further, and more importantly, the author could have spared us many of the anatomical details that only a neurologist would know. To its credit, this book can be of equal interest to medical students, or general readers who could come away with an appreciation of its complexity and intricacy.
Being a clinician and a professor of anesthesia (at Canada’s Magill University), Cervero is able to give vivid examples illustrating the causes and origins of many types of pain, like phantom limb, where the patient continues to feel pain on an arm that has long been amputated; or visceral pain, which tends to wander from its original site of insult because the message hitches a ride with other nerves and the brain gets confused. From here, Cervero goes into brain systems, involving multiple neural networks. This is where my beginning warning comes from: for the general reader, do not be derailed by such detail. And hence I think it would have been helpful if there is a brief recap at the end of each chapter, summarizing the main ideas and conclusions.
One compelling story that tells the close relationship between pain and consciousness is his chapter on pain perception in the brain, and how pain ceases to become suffering. He cites the once popular surgery of lobotomy in which the patient’s main cognitive area, the frontal lobes are severed from the rest of the brain. Rosemary Kennedy, the sister of President John F. Kennedy, had lobotomy at age 23, and spent the rest of her life incapacitated. For gone with the pain of mood disorder and suffering was also a patient’s capacity to feel, think and learn.
My main discomfort arises in the final chapter called A Pain Free World which is really meant as a question, a hope. Here an overview of the various tactics for dealing with pain is discussed, including a comprehensive list of drugs available to the patient, with pros and cons – there is no good drug for chronic pain: long term use requires increasing doses and results in addiction; while placebos work equally well in many cases. His discussion of complementary (‘alternative’ is used here) medicine is almost dismissively brief, even as he points out the psychological investment of the patient, suggesting that chronic pain is a form of bad memory, or habit, often unconsciously reinforced by its sufferer; and that certain image-guided therapies are effective for phantom limb syndrome.
The information in this book undoubtedly predicts the present success of integrative care, an approach that includes integrative physicians, psychologists, acupuncturists, and an array of therapies from yoga to massage to energy practitioners and more. Each patient follows his or her own combination of treatments. See report from BraveNet, a free access article from Biomedcentral.com.
Under the 2010 Patient Protection and Affordable Care Act (ObamaCare), the Institute of Medicine is charged with examining pain as a public health problem. The institute suggests that among the “steps to improving care, healthcare providers should increasingly aim at tailoring pain care to each person’s experience, and self-management of pain should be promoted”.
Dr. Cervero’s own accounts confirm the potential of such an approach, emphasizing the patient’s own expectations and beliefs in curing pain. In that sense, this is a valuable resource for understanding pain from which we could indeed embark upon the journey to a pain free world, empowered by our own belief in our consciousness, with its learning and remembering abilities.
