Pain: The Culture and Science of Pain

A thorough study of pain is presented in Pain: The Culture and Science of Pain by Connie Faltynek PhD. Looking back at history, the author examines how pain was perceived and treated. She also examines the various medications and alternative treatments currently available. Faltynek explores the many advancements on the horizon in pain management. Additionally, ingrained biases, cultural perspectives, and the complexity of treating pain are discussed. Here is the book's chapter breakdown.

Contents

Introduction

Chapter 1: What is Pain? A Primer

1. Types of Pain

2. Mechanisms of Pain Transmission

3. PAIN: It is All in Your Head!

4. Impact of Emotions and Thoughts on Pain Sensation

5. Conclusion

Chapter 2: Pain and Pain Relief Prior to the 19th Century

1. Ancient Western World

2. Early Christian Era

3. Middle Ages

4. 16th, 17th, and 18th Centuries

5. Historical Views About Pain in the Muslim and Jewish Worlds

6. Conclusion

Chapter 3: Pain and Pain Relief in the 19th and 20th Century

1. Early 19th Century

2. Discovery of Anesthesia in the Mid-19th Century

3. Conflict Between Religion and Advances in Medicine in the 19th Century

4. Emergence of "Faith Cure" and the Christian Science Church

5. Conflict Between Religious Views and Pain Relief Continued in the 20th Century

6. Gender Bias in Pain Relief

7. Rise in Use of Opioids for Pain Relief

8. Pain Relief in the Latter Part of the 20th Century

9. Conclusion

Chapter 4: Pain in Animals

1. Historical Views Regarding Animal Pain

2. Surgical and Post-Surgical Pain in Animals in the 20th Century

3. Management of Painful Diseases and Conditions in Animals in the 20th Century

4. Pain Control in Animals in the 21st Century

5. Conclusion

Section II. Treatment of Pain Today

Chapter 5: Pain and Pain Relief in the 21st Century

1. Management of Acute Pain in Hospitals

2. Chronic Pain

3. Pain Management in Infants and Children

4. Diminished Emphasis on Pain Relief in the 21st Century

5. Lack of Availability of Strong Pain-Relieving Medications Worldwide

6. Racial Disparities in Pain Management in the United States

7. Pain Can Not be Measured Objectively

8. Reluctance of Patients to Use Pain-Relieving Medications

9. Limited Pain Education Contributes to Unrelieved Pain

10. Conclusion

Chapter 6: How Good Are Current Medications in Relieving Pain?

1. Medications for Non-Neuropathic Pain

2. Medications for Neuropathic Pain

3. Medications for Migraine

4. Other Pain Medications

5. Conclusion

Chapter 7: Prescription Opioids: Essential Medications for Pain Relief or Evil Drugs?

1. Short-Term Use of Opioids to Relieve Severe Acute Pain

2. Opioids: Important Drugs for Acute Pain, But What About Chronic Pain?

3. Current Opioid Crisis

4. How Great Are the Risks of Taking Opioids for Pain Relief?

5. "Opiophobia"

6. Balancing Risks vs Pain-Relieving Benefits of Prescription Opioids

7. The Criminalization Model and the War on Drugs

8. Abuse-Deterrent Opioid Products

9. Urgent Need to Expand Treatment for Those Addicted to Opioids

10. Conclusion

Chapter 8: Recent Research to Identify New Pain Medications

1. 101 Modern Drug Discovery

2. Marijuana/Cannabis

3. Capsaicin Receptor

4. Sodium Channels

5. Nerve Growth Factor

6. Recent Opioid Research

7. Other Ongoing Research

8. Why So Little Progress

9. Conclusion

Chapter 9: Alternative Methods to Manage Pain

1. Spinal Manipulation and Exercise

2. Acupuncture

3. Electrical Stimulation

4. Nerve Ablation

5. Psychological Methods to Relieve Pain

6. The Placebo Effect

7. Conclusion

Chapter 10: The Future of Pain Management

1. Attempts to Reduce Opioid Abuse

2. Use of Naloxone to Prevent Deaths from Opioid Overdoses

3. Is There a "Magic Bullet" Waiting to be Discovered?

4. Barriers to Use of Alternative Methods to Relieve Pain

5. Efforts to Develop Objective Measures of Pain

6. The Future of Brain Imaging in Pain Management

7. Role of Genetics in Pain and Pain Relief

8. Conclusion: There is Hope for the Future!

My goal is to highlight key points throughout the book that I found to be particularly insightful, helpful, or eye-opening. Due to the large number of highlights throughout the book, I will have to pick and choose what to share.

• Low threshold nerve fibers, known as Aβ fibers, cause a non-painful sensation. High threshold nerve fibers, called Aδ and C fibers, generate pain.

• In physical terms, pain is the result of defined processes. Pain sensations can be affected by one's thoughts and emotional state.

• Roman Emperor Marcus Aurelius in 170-180 CE wrote a treatise entitled Meditations. He wrote, "If you suffer pain becasue of some external cause, what troubles you is not the thing but your decision about it, and this is in your power to wipe out at once. Whosoever therefore is not himself indifferent to pain..., which Univeral Nature employs indifferently, plainly commits sin."

• In the 1980s, newborns undergoing surgery received only minimal anesthesia and were not treated for pain afterwards.

• The late Margo McCaffery was a pioneer within the Pain Management Nursing field in the United States in the later part of the 20th century. She stated, "Pain is whatever the experiencing person says it is and exists whenever he says it does."

• Pain was designated as the fifth vital sign by the American Pain Society in 1996. There were four vital signs: pulse rate, respiration rate, temperature, and blood pressure.

• Disagreements between patient reports of pain and those assessed by clinicians often lead to questions about the existence of pain.

• Unrelieved pain persists despite significant advancements in many fields of medicine. Pain science lags behind most medical conditions. Pain is rarely adequately relieved, whether it is chronic or acute.

• There are two broad types of pain: neuropathic pain and non-neuropathic pain.

• With regard to opioids the author states, "I would argue that it is extremely reckless to deny prescription opioids to patients with severe pain that has not been relieved by other medications or alternative methods."

• Why are pain medication studies limited? Patients have different types of pain, different types of pain can vary in response to a particular medication, pain is complex, and pain is highly individualized. What works for one person may not work for another with a similar type of pain.

• It is important to make the distinction between drug abuse, drug dependency, and drug addiction.

• Opiophobia - excessive fear of prescrition opioids.

• The only truly new pain medications with a novel mechanism of action are the CGRP antagonists approved for migraines.

• The FDA approved Olinvyk in August 2020. In a hospital or clinic setting, it is used as a short-term IV treatment for moderate to severe pain. The oral compound TRV734 has been entered into clinical trials, but it is currently being used to suppress withdrawal symptoms associated with opioid use.

• Among the alternative methods of managing pain are chiropractic, exercise, massage, acupuncture, meditation, behavioral modification, and electrical stimulation.

• A variety of research is being conducted and new treatments are on the horizon, including brain imaging, genetic testing, personalized treatments, and new medications.

Pain: The Culture and Science of Pain is an excellent book. The book would be beneficial to medical professionals, chronic pain sufferers, those with loved ones suffering from chronic pain, and anyone interested in learning more about pain. As someone who suffers from chronic pain, I learned a great deal from this book. This is definitely a book I'd recommend.