Book:  The Truth About Chronic Pain:  Patients And Professionals On How To Face It, Understand It, Overcome It
Author:  Arthur Rosenfeld
Publisher:  Basic Books, April 2003, 320 pages
Rating:  3 out of 5

Before starting this book - one of the few books I've read about pain or chronic disease - I wasn't sure what to expect from it.  The title implies a how to book with advice from experts and patients, and revelations about the latest thinking on pain and pain management, but that is not what this book is.  There is very little in the way of practical advice and the revelations tend to focus more on the societal issues surrounding the use of opioids than on the latest pain research.  The Truth referenced in the title is the author's belief that many people suffer needlessly from doctors reluctant to treat pain and out of a misplaced sense of stoicism.

Despite the misleading title, this book is an interesting look at how different types of people - patients, doctors, and thinkers -  view the same subject, chronic pain.  The book is organized as 36 interviews - 12 with patients in pain, 12 with caregivers on pain, and 12 with thinkers about pain.  Each interview is only a few pages long, so the book lends itself well to reading a few pages at a time.  Conversely, the interview structure doesn't work well for long reading sessions as the format tends to become boring and repetitious.

The first section - patients in pain - was the most difficult to read.  The subjects represent a variety of conditions, from cancer in the CSF system to severe pain from football to unexplained headaches.  Some readers will feel a sense of validation in hearing about other people's problems, such as doctors not believing in their pain, pharmacies that treat them like drug addicts, and friends and family who don't understand what they are going through.  Some people - myself included - however, will find the stories depressing as they tend to focus on extreme cases and highlight people for whom pain has taken over their life and in some cases destroyed it.  There are a couple of stories about people who have managed to either successfully control their pain or persevere through it, but the bright spots are overshadowed by the darkness of this section.

The second section - caregivers on pain - is the most interesting and enlightening.  The interviews reveal a number of truths about the state of our healthcare system and the difficulties chronic pain patients encounter.  It is interesting to hear  from medical professionals with different points of view, as the medical community is often reluctant to disagree in public.  These interviews provide valuable insights into how doctors think and why they act as they do.  For example, doctors who have suffered from severe or chronic pain themselves tend to go through an awakening regarding what chronic pain is really like and will completely change their attitudes in dealing with pain patients.  It is also enlightening to realize the pressures doctors are under regarding the treatment of pain.  In California, a physician can get in trouble not only for prescribing too many pain medicines, but also for not prescribing enough. 

The third section - thinkers on pain - is a bit more abstract and philosophical.  While there are some insights, the section suffers from its selection of thinkers.  Why is Marilyn Vos Savant, the Parade columnist, weighing in on the subject?  In contrast, Dr. Robert Jarvik, the artificial heart doctor, equates his experiences with patients who adjust well to an artificial heart to how to adjust to chronic pain.  In one of the few, true pieces of advice in the book, Dr. Jarvik stresses the importance of accepting the reality and limitations of the situation, and encourages people to not waste energy hoping for a cure or thinking about their past life.  He believes that by accepting the situation, people are better able to enjoy their life going forward.

Overall, the author does a decent job in crafting the interviews, however his biases clearly show  in the questions he asks.  Rosenfeld believes that people suffer needlessly because doctors aren't compassionate enough and society is not accepting enough of people in pain.  Virtually every interview touches on the subjects of  lack of compassion among doctors, a misplaced societal sense of stoicism, and how the war on drugs has negatively influenced the use of pain medicines.  While these issues are important, the book would have benefited from a more diverse approach to the subject matter.

Anyone who has to deal with the medical community regarding pain issue will find this book of value in learning  what doctors themselves think about treating pain.  However, if you are looking for a practical guide to coping strategies and are interested in the latest research on pain management, you should look elsewhere.

- Rick Labuda