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Meanings of Pain

Smith-Straesser, Emily E. MD; Kleiman, Amanda M. MD

doi: 10.1213/ANE.0000000000002464
Books, Multimedia, and Meeting Reviews

Published ahead of print September 12, 2017.

Department of Anesthesiology, University of Virginia, Charlottesville, Virginia,

Published ahead of print September 12, 2017.

Pain, although a universal human experience, is unique to each individual, suggesting that the “meaning” of pain is likewise a distinct entity comprised of objective and subjective details, rooted in the perception of pain by both our patients and ourselves. While countless previous texts have aimed to report the physiologic and pathologic effects of pain, Meanings of Pain tackles the lesser covered aspects including the psychological, sociological, and epidemiologic effects of pain and, as the title would suggest, the true “meaning” of pain. Edited by Simon van Rysewyk, the text offers author contributions from various disciplines including philosophy, psychology, psychiatry, bioethics, radiology, and epidemiology from throughout Europe, Asia, and Australia. While the majority of authors are not physicians, the book offers valuable insight into the experience, treatment, and study of pain, which may not be inherently obvious to the clinician.

The text is offered as an eBook and a hardcover text spanning 401 pages with identical content and the ability to zoom in on the figure matter. Consulted individually or read as a whole, the 23 chapters read easily, each focusing on a slightly different aspect of pain from neural plasticity to the use of metaphor to bridge the communication divide with patients. The chapters are assembled to cover 5 comprehensive topics: the relationship between pain experiences and the brain, scientific methodology to study meanings of pain, extended pain-related feelings in chronic pain, meanings of pain and their application to clinical practice, and the study of meanings of pain in nonhuman subjects. Overall, the book is well written and the chapters are well organized and easy to read.

Unique to this book is coverage of the effect of pain on the health care worker as well as the researcher. Chapter 21 is dedicated to the social aspects of pain including empathic pain and vicarious pain in health care workers. Meanwhile, Chapter 11 investigates whether researchers are coparticipants in their own studies through introspection. Conversely, this book also discusses the effect of health care professionals’ personal care of patients on their own chronic pain process, as seen in Chapter 18. Anecdotes and case reports are often used with good effect to both anchor these topics and add to the approachability of the text.

Extensively covered is the scientific study of pain focusing on the challenges and potential benefits of animal tests and models for translational research in pain and validation of methods, and the ethics of animal studies. Chapter 23 delves into the “otherness” of animal pain and its reflection of the obstacles of appreciating the pain and suffering of patients with whom you share neither a common understanding nor social or cultural background. The authors stress the need to define and acknowledge “animal pain” to fully understand human pain.

Pertinent on a practical basis to the clinician managing a patient with chronic pain, the importance of the incorporation of lived meanings of pain into a patient’s personalized management strategy is thoroughly explored. Chapter 14 specifically applies this concept to chronic low back pain and the impact of pain-related fear on a patient’s overall well-being. Application of a fear avoidance model and the incorporation of a common sense perspective rather than a phobic response is proposed to improve clinician–patient mutual understanding and communication surrounding pain-related fear.

For a clinician primarily trying to develop an everyday multimodal approach to pain treatment and prevention, the density of the text, particularly with regard to complex psychological theories, may prove daunting and overwhelming. A significant amount of theory is discussed that towers over the body of the practical application of these theories provided in the text. Additionally, the book, specifically the eBook version, falls flat with its application of supplemental figures to bolster this complex discussion. In that regard, this book is more useful to physicians consistently managing the treatment of chronic pain and seeking to further develop their understanding of the underlying intricacies of the pain experience.

In summary, Meanings of Pain offers an intriguing investigation into the implications of the psychological, sociological, and personal lived meanings of pain for the overall management of patients struggling with this chronic condition. A large portion of the text is dedicated to describing current research and findings and proposing future research methodologies to more adequately explore the complex effect of pain on the individual and society. While this book does not offer any groundbreaking research into the physiologic basis of pain, it may prove invaluable to the physician struggling to understand the intricacies of the patient pain experience, facilitating improved comprehensive pain therapy.

Emily E. Smith-Straesser, MDAmanda M. Kleiman, MDDepartment of AnesthesiologyUniversity of VirginiaCharlottesville,

Copyright © 2017 International Anesthesia Research Society