Working Together when Facing Chronic Pain

Working Together when Facing Chronic Pain

A book designed for patients and written by their health professionals.

With very few exceptions, everybody hurts. And everybody knows that when they are hurting, they are keen to not hurt anymore. In fact, everybody knows that the more they are hurting, the keener they are to not hurt any longer.

This fundamental capacity of pain to make us behave in a certain way is exactly what makes pain our most sophisticated, effective and complex protective device. Pain is, in this sense, our greatest ally. However, pain can persist after the tissues of the body have healed. Pain can become chronic. It can “have a mind of its own.” It can take over your life and lead you into a downward spiral of disability, depression and agony.

How does this happen? How can pain exist in the absence of injury? How, for that matter, can injury occur without pain? These questions are of fundamental importance to the 20% of Westerners who are currently disabled to some extent by a chronic pain problem.

The past four decades of research into pain have taught us much about these questions. Perhaps the most fundamental insight we have gained is the fact that activity in the nerves that carry danger messages from the tissues to the brain — the so-called “nociceptors”— is not pain, nor is it suffi cient for pain or, in fact, even necessary for pain. In fact, pain depends on the brain’s evaluation of everything that might be relevant for evaluating danger to body tissue. This means that pain is a measure of the brain’s perception of threat to tissues, not the actual threat.

Importantly, this process of perceiving threat occurs unconsciously. The pain is the conscious bit — the end product or output of the brain. It is no longer defensible to consider chronic pain as a sign of chronic injury. Instead, we must embrace the true complexity of the human body and consider all of the possible contributions to the brain’s evaluation of danger to body tissue. This is not an easy task. To presume pain is simply a message from the body is deliciously simplistic, but it is, alas, fundamentally wrong.

We know that understanding the true complexity of pain reduces its impact. Think of how remarkable this really is — if you understand that pain is the result of a complex biological process in the brain, your pain then reduces and affects your life less. There are also very well established methods to help you manage your own pain yourself and the pain of others. That is where books such as this one are critical.

By gathering experts from across pain-relevant fi elds — more than 50 of them no less — and convincing them to write something for this book, editor Louise O’Donnell-Jasmin has been able to put together a remarkable resource. This resource will be helpful for people in pain and their carers, loved ones and clinicians. I imagine that there is no wider coverage of the management of pain anywhere else — I certainly haven’t seen one. I suggest that this book be given pride of place in your library because it stands to be “that book” to which one turns when feeling stuck in the journey of returning from pain-related disability to normal life. I heartily commend Louise for what is a most impressive achievement — to get contributions from so many people who are already squeezing the last milliseconds out of their busy clinical or scientifi c schedules to “add their bit” is a testament to the critical importance of this book and the wonderful tenacity of its editor.