In Pain

NPR Best Book of 2019 A bioethicist’s eloquent and riveting memoir of opioid dependence and withdrawal—a harrowing personal reckoning and clarion call for change not only for government but medicine itself, revealing the lack of crucial resources and structures to handle this insidious nationwide epidemic. Travis Rieder’s terrifying journey down the rabbit hole of opioid dependence began with a motorcycle accident in 2015. Enduring half a dozen surgeries, the drugs he received were both miraculous and essential to his recovery. But his most profound suffering came several months later when he went into acute opioid withdrawal while following his physician’s orders. Over the course of four excruciating weeks, Rieder learned what it means to be “dope sick”—the physical and mental agony caused by opioid dependence. Clueless how to manage his opioid taper, Travis’s doctors suggested he go back on the drugs and try again later. Yet returning to pills out of fear of withdrawal is one route to full-blown addiction. Instead, Rieder continued the painful process of weaning himself. Rieder’s experience exposes a dark secret of American pain management: a healthcare system so conflicted about opioids, and so inept at managing them, that the crisis currently facing us is both unsurprising and inevitable. As he recounts his story, Rieder provides a fascinating look at the history of these drugs first invented in the 1800s, changing attitudes about pain management over the following decades, and the implementation of the pain scale at the beginning of the twenty-first century. He explores both the science of addiction and the systemic and cultural barriers we must overcome if we are to address the problem effectively in the contemporary American healthcare system. In Pain is not only a gripping personal account of dependence, but a groundbreaking exploration of the intractable causes of America’s opioid problem and their implications for resolving the crisis. Rieder makes clear that the opioid crisis exists against a backdrop of real, debilitating pain—and that anyone can fall victim to this epidemic.

Part philosophical meditation, part cultural critique, The Body in Pain is a profoundly original study that has already stirred excitement in a wide range of intellectual circles. The book is an analysis of physical suffering and its relation to the numerous vocabularies and cultural forces--literary, political, philosophical, medical, religious--that confront it. Elaine Scarry bases her study on a wide range of sources: literature and art, medical case histories, documents on torture compiled by Amnesty International, legal transcripts of personal injury trials, and military and strategic writings by such figures as Clausewitz, Churchill, Liddell Hart, and Kissinger, She weaves these into her discussion with an eloquence, humanity, and insight that recall the writings of Hannah Arendt and Jean-Paul Sartre. Scarry begins with the fact of pain's inexpressibility. Not only is physical pain enormously difficult to describe in words--confronted with it, Virginia Woolf once noted, "language runs dry"--it also actively destroys language, reducing sufferers in the most extreme instances to an inarticulate state of cries and moans. Scarry analyzes the political ramifications of deliberately inflicted pain, specifically in the cases of torture and warfare, and shows how to be fictive. From these actions of "unmaking" Scarry turns finally to the actions of "making"--the examples of artistic and cultural creation that work against pain and the debased uses that are made of it. Challenging and inventive, The Body in Pain is landmark work that promises to spark widespread debate.

Imagine an orchestra in your brain. It plays all kinds of harmonious melodies, then pain comes along and the different sections of the orchestra are reduced to a few pain tunes. All pain is real. And for many people it is a debilitating part of everyday life. It is now known that understanding more about why things hurt can actually help people to overcome their pain. Recent advances in fields such as neurophysiology, brain imaging, immunology, psychology and cellular biology have provided an explanatory platform from which to explore pain. In everyday language accompanied by quirky illustrations, Explain Pain discusses how pain responses are produced by the brain: how responses to injury from the autonomic motor and immune systems in your body contribute to pain, and why pain can persist after tissues have had plenty of time to heal. Explain Pain aims to give clinicians and people in pain the power to challenge pain and to consider new models for viewing what happens during pain. Once they have learnt about the processes involved they can follow a scientific route to recovery. The Authors: Dr Lorimer Moseley is Professor of Clinical Neurosciences and the Inaugural Chair in Physiotherapy at the University of South Australia, Adelaide, where he leads research groups at Body in Mind as well as with Neuroscience Research Australia in Sydney. Dr David Butler is an international freelance educator, author and director of the Neuro Orthopaedic Institute, based in Adelaide, Australia. Both authors continue to publish and present widely.

An examination of the two most radical dissociation syndromes of the human pain experience—pain without painfulness and painfulness without pain—and what they reveal about the complex nature of pain and its sensory, cognitive, and behavioral components. In Feeling Pain and Being in Pain, Nikola Grahek examines two of the most radical dissociation syndromes to be found in human pain experience: pain without painfulness and painfulness without pain. Grahek shows that these two syndromes—the complete dissociation of the sensory dimension of pain from its affective, cognitive, and behavioral components, and its opposite, the dissociation of pain's affective components from its sensory-discriminative components (inconceivable to most of us but documented by ample clinical evidence)—have much to teach us about the true nature and structure of human pain experience. Grahek explains the crucial distinction between feeling pain and being in pain, defending it on both conceptual and empirical grounds. He argues that the two dissociative syndromes reveal the complexity of the human pain experience: its major components, the role they play in overall pain experience, the way they work together, and the basic neural structures and mechanisms that subserve them. Feeling Pain and Being in Pain does not offer another philosophical theory of pain that conclusively supports or definitively refutes either subjectivist or objectivist assumptions in the philosophy of mind. Instead, Grahek calls for a less doctrinaire and more balanced approach to the study of mind–brain phenomena.

This unique resource focuses on the diagnosis and treatment of painful conditions-both acute and chronic-from a multi-disciplinary perspective. Joined by a team of nearly 200 international contributors representing a wide range of specialties, Dr. Smith presents the best management options within and across specialties. Succinct treatment and therapy guidelines enable you to quickly access clinically useful information, for both inpatient and outpatient pain management, while a 2-color format enhances readability and ease of use and highlights key concepts. And, as an Expert Consult title, it includes access to the complete contents online, fully searchable, plus links to Medline and PubMed abstracts-providing rapid, easy consultation from any computer! Includes access to the complete text online, fully searchable, plus links to Medline and PubMed abstracts-providing quick and convenient reference from anyplace with an Internet connection. Offers a cross-discipline approach to pain management for a comprehensive view of the best treatment options within and across specialties including internal medicine, gynecology, physical medicine and rehabilitation, orthopedics, and family medicine. Provides succinct treatment and therapy guidelines, enabling you to locate useful information quickly. Organizes guidance on acute and chronic therapies in a templated format, to facilitate consistent, quick-access consultation appropriate for inpatient or outpatient pain management. Features a 2-color format that enhances readability and ease of use and highlights key concepts. Your purchase entitles you to access the web site until the next edition is published, or until the current edition is no longer offered for sale by Elsevier, whichever occurs first. If the next edition is published less than one year after your purchase, you will be entitled to online access for one year from your date of purchase. Elsevier reserves the right to offer a suitable replacement product (such as a downloadable or CD-ROM-based electronic version) should access to the web site be discontinued.

Chronic pain costs the nation up to $635 billion each year in medical treatment and lost productivity. The 2010 Patient Protection and Affordable Care Act required the Department of Health and Human Services (HHS) to enlist the Institute of Medicine (IOM) in examining pain as a public health problem. In this report, the IOM offers a blueprint for action in transforming prevention, care, education, and research, with the goal of providing relief for people with pain in America. To reach the vast multitude of people with various types of pain, the nation must adopt a population-level prevention and management strategy. The IOM recommends that HHS develop a comprehensive plan with specific goals, actions, and timeframes. Better data are needed to help shape efforts, especially on the groups of people currently underdiagnosed and undertreated, and the IOM encourages federal and state agencies and private organizations to accelerate the collection of data on pain incidence, prevalence, and treatments. Because pain varies from patient to patient, healthcare providers should increasingly aim at tailoring pain care to each person's experience, and self-management of pain should be promoted. In addition, because there are major gaps in knowledge about pain across health care and society alike, the IOM recommends that federal agencies and other stakeholders redesign education programs to bridge these gaps. Pain is a major driver for visits to physicians, a major reason for taking medications, a major cause of disability, and a key factor in quality of life and productivity. Given the burden of pain in human lives, dollars, and social consequences, relieving pain should be a national priority.

From neurobiology to public policy, examines the chronic pain crisis, which is a major national health concern, discussing the latest scientific discoveries and advances in treatments and providing a sensible plan of action.

Pain is an inevitable part of existence, but severe debilitating or chronic pain is a pathological condition that diminishes the quality of life. The Brain and Pain explores the present and future of pain management, providing a comprehensive understanding based on the latest discoveries from many branches of neuroscience. Richard Ambron—the former director of a neuroscience lab that conducted leading research in this field—explains the science of how and why we feel pain. He describes how the nervous system and brain process information that leads to the experience of pain, detailing the cellular and molecular functions that are responsible for the initial perceptions of an injury. He discusses how pharmacological agents such as opiates affect the duration and intensity of pain. Ambron examines new evidence showing that discrete circuits in the brain modulate the experience of pain in response to a placebo, fear, anxiety, belief, or other circumstances, as well as how pain can be relieved by activating these circuits using mindfulness training and other nonpharmacological treatments. The book also evaluates the prospects of procedures such as deep brain stimulation and optogenetics. Current and thorough, The Brain and Pain will be invaluable for a range of people seeking to understand their options for treatment as well as students in neuroscience and medicine.

Childhood pain is a widespread problem, yet it often goes untreated. Drawing on the latest research, two leading voices on pediatric pain show parents and medical practitioners how to handle children’s pain, from bumps and bruises to chronic illnesses, providing strategies that make a real difference in kids’ lives.

“Zeruya Shalev is one of my favorite contemporary writers, her work always spiky and original, and Pain is a searing book, a wild and ravenous story of family entanglement and impossible yearning.” —Lauren Groff, author of Florida and Fates and Furies A powerful, astute novel that exposes how old passions can return, testing our capacity to make choices about what is most essential in life. Ten years after she was seriously injured in a terrorist attack, the pain comes back to torment Iris. But that is not all: Eitan, the love of her youth, also comes back into her life. Though their relationship ended many years ago, she was more deeply wounded when he left her than by the suicide bomber who blew himself up next to her. Iris's marriage is stagnant. Her two children have grown up and are almost independent; she herself has become a dedicated, successful school principal. Now, after years without passion and joy, Eitan brings them back into her life. But she must concoct all sorts of lies to conceal her affair from her family, and the lies become more and more complicated. Is this an impossible predicament, or on the contrary a scintillating revelation of the many ways life's twists and turns can bring us to a place we would never have expected to be?