[.ca] Why We Hurt: The Natural History of Pain (ISBN 0156014033)

From Amazon.com:
If you've been paying attention, you've noticed by now that pain and suffering infiltrate nearly every part of life. Whether it's an executive nursing a quiet ulcer in the boardroom or a wailing child holding a skinned knee on the playground, this uniquely unpleasant signal must be important; if it weren't, we could more easily ignore it. Neurosurgeon Frank T. Vertosick Jr. explains the evolutionary, physiological, and psychological reasons for pain in Why We Hurt: The Natural History of Pain. Not a paean to despair, the book helps to ease suffering through understanding and learning just how far we've come in the short history of palliative practice. Vertosick's long experience working with sufferers of hideously intractable pain, and his own long battle with migraine, provides depth and illustrative stories that draw the reader into what might otherwise be dry medicalese. It's heartening to see more surgeons like Dr. Vertosick coming to accept the often-strong psychological basis of pain and appropriate nonsurgical, nonpharmacologic treatments for it. Certainly, as in the case of the woman whose trigeminal nerve was eroded by a circulatory tangle, cutting and suturing have their appropriate place. And the author found several years ago that simple acetaminophen was all he needed to stave off his headaches. His gentle explanations and usually uplifting stories help us prepare for our own episodes of suffering. Though it might seem like small comfort, learning Why We Hurt can be as powerful as the strongest narcotic, with no side effects. --Rob Lightner

WOWZER!:
This is the best book ever! It's funny, yet tragic, distant, yet so close. I would recommend this book to everyone, not just to sufferers of chronic pain, or people with medical careers. A MUST READ!

The Best Book!:
This is the best book! I love'd it. It was tragic, yet funny, educational and inspirational. The Best, A read for All!

Good stories and personal accounts, but a narrow viewpoint:
Dr. Vertosick's book has it's highpoints in the stories and vignettes about his patients, and the days of his life as a neurosurgeon. I enjoyed his candor and some of the attitudes he has toward himself and his work, but beyond that I found this book to have little value. Starting from his basic premise that physicians can't extend life ony make more it comfortable, he then looks at everything from that perspective. The concepts of healing, regeneration, and meaning don't find any ground in his mechanistic approach. Granted, he is involved with some paients in intractable pain and for them comfort and the ease of their suffering is the goal, but for most patients with chronic pain this is too limited a focus. As a practicing Chiropractor who emphasizes conservative care for patients with chronic pain conditions, I have had many patients who have sought the services of pain management programs and approaches(involving physical therapy, biofeedback, trigger point and cortisone injections,epidurals, TENS, counseling, IV muscle relaxants, medications, etc.) and neurosurgery. Unfortunately, most of them return have mediocre results, especially in the long term. The reason primarily is one of approach and this book explains why. Some examples: Migraine headaches were theorized as being strictly vascular in nature as Dr. Verpsick explains. However, the current explanation of migraines are that they form a continuum with tension headaches . Essentially there are 3 components involved in production of classic migraines (BTW, there are many types of migraines), somatic (musculoskeletal), neurological, and vascular. The somatic component ( involving the cervical spine, TMJ, etc) is prevalent in the side producing tension headaches, while the vascular component is prevalent in the side producing classic migraine. Common migraines have somewhat less vascular prevalence. The neurological pain inhibiting component varies in involvement. From this model it explains why spinal and cranial manipulation, acupuncture, biofeedback, etc. help migraine sufferers. Maintaining the vascular model of migraine production, all other non-drug therapies must be placebos. For herniated lumbar discs, Dr. Vertosick charaterizes Chiropractic care as ineffective for sciatica from disc disorders. This is a tremendous error. While there are some disc disorders that require neurosurgical attention (which I prefer over standard orthopedic surgery) most never reach the OR due to proper Chiropractic care. I especially refer to Canadian orthopedist Kirkaldy-Willis's book and research using Chiropractic and spinal mainpulation on pre-surgical back patients. Furthermore, there are many different divisions of Chiropractic care, some are very effective for disc disorders, and some not at all. To lump all of Chiropractic care together as generic is as erroneous as doing so to all surgical procedures (acupuncture too). Clearly specific approaches have greater merit in certain patients and conditions. Carpal Tunnel Syndrome (CTS)is also commonly multi-factorial, and NOT simply the result of a problem in the Carpal Tunnel requiring a simple surgical release. Commonly there are several entrapment points along the nerve. Chiropractic physicians who utilize Active Release Technique and have been demonstrated to get effective relief of CTS releasing these entrapments non-surgically. See Leahy's work. Not mentioned by Dr. Vertosick is that much chronic musculoskeletal pain is due to joint and muscular causes which can't be addressed by drugs or surgery. Nociceptive receptors (neurons that register the amount of tiisue damage) in joints are constantly firing as the body is continually replacing damaged cells. Normally we don't feel this, because Mechanorectors (neurons that register movement) override these signals. When joint restriction occurs these mechanorectors give off less impulses, so we feel the nocicptive signals as pain. Joint restriction also encourages further tissue destruction. Mobilization and manipulation to restore the mobility of the joints, along with exercise often effectively corrects this. In short, there are more ways to look at the problem of many patients with chronic pain than Dr. Vertosick offers. There are equally more options for care.

A well-written, engaging treatment of an important subject:
I bought this book without knowing much about it -- in the bookstore with my 8-year-old son, who suffers from migraines. We noticed it and, at his request, I began to read it to him -- then we had to buy it! I was quite impressed by the quality of the writing -- it's a book for grownups, but the ideas were accessible to a sensitive child with an interest in the subject. I certainly defer to other reviewers with medical knowledge about errors in the book, and I think much of his speculation about the potential evolutionary advantages of particular pains or genetic disorders is a little, well, speculative -- but we enjoyed reading and discussing them anyway. The preponderance of happy ending case-stories -- though generally with a lot of suffering before the resolution -- bothered me a little in my own appreciation of the work, but I think it was for the best in my discussions with my son -- he was able to face the issues without being overwhelmed by tragedy (and there's tragedy enough along the way).

A terrible instrument:
C.S. Lewis said in his book, "The Problem of Pain": "Pain as God's megaphone is a terrible instrument." It gets our attention and warns us of danger. Unfortunately, some doctors don't listen to that same megaphone when treating their patients. According to a recent "New York Times" article, "More than a third of seriously ill patients who requested that doctors ease their discomfort instead of prolonging their lives appear to have had their wishes overlooked, a new study \opublished in the "Journal of the American Geriatrics Society"\c reports". "Why We Hurt" claims that, "three of four cancer patients will die in poorly controlled pain, and the percentage climbs higher still for those succumbing to malignancies with a talent for invading bones and nerves, including cancers of the breast, prostate, rectum, pancreas, and cervix." This must be disquieting information for people who are suffering from terminal illnesses like cancer or AIDS, especially since doctors already tend to undermedicate for pain---think of all of the criminal and civil lawsuits pending for over-prescription of OxyContin, and it is easy to understand why some doctors avoid the heavy-duty painkillers or their prolonged usage. Dr. Vertosick has treated some nightmarish pain problems during his career as a neurosurgeon. This book contains many case histories of patients in agony, connected by the overarching theme of why it is necessary to feel pain. Each story explains why we are connected in such a hurtful way to our inner and outer worlds. According to Dr. Vertosick, "when stripped of pain's discipline, we neglect our bodies until they become battered beyond recognition....The hands and feet of longtime diabetics and paralytics...become deformed and covered with pressure sores. Patients with trigeminal neuralgia who have their corneas rendered numb by alcohol nerve blocks will ultimately go blind from unchecked corneal scarring." There is also the sad story of Jimmy, the boy who was born without the ability to feel pain. "Why We Hurt" is a book that both teaches and fascinates. I learned that neurosurgery can help at least some people (including cancer patients) who suffer from intractable pain. There are only a couple of areas where I found Dr. Vertosick to be overly optimistic. One concerns the efficacy of back surgery. Read this book, and then read the prologue to Dr. Jerome Groopman's "Second Opinions" for an example of where back surgery (spinal fusion) worsened the patient's condition. My own neurologist has told me that 60% of patients who underwent back surgery felt that it didn't do any good. The question of whether newborn babies feel pain is another gray area where this author tends toward optimism. He feels that they are not yet fully connected to sensations of pain. However, I've read research to the contrary: newborn infants who have been operated on without anesthesia not only feel pain, they remember it. These two small quibbles aside, please read this book. You may someday have to make choices on pain control, and this is a good place to start learning what those choices may entail, and (if it's any comfort) why it is 'natural,' i.e. in accordance with human evolution, that you feel the way you do.