A physician who focuses on pain management illuminates his specialty.
After a chapter describing the nervous system and another on the history of pain relief—opium has been around since prehistory—British anesthesiologist Lalkhen takes up pain as experienced by patients and dealt with by doctors. The author makes it clear that both could use further education on the subject, which is undeniably complex. A sprained ankle is agonizing while soldiers suffering gruesome battle injuries sometimes feel little pain. In Chinese and Korean cultures, it’s often considered shameful to complain during childbirth, and few women receive analgesics; other cultures insist on “a more vocal response.” While it may be understandable for a patient to not fully comprehend the social and psychological factors that influence pain as much as the physical damage, it’s inexcusable for a doctor. New analgesic drugs have been appearing for more than two centuries, beginning with morphine in 1804. Although many surgeons remain casual about postoperative pain, the treatment of short-term pain remains straightforward. Chronic pain, however, is another story; sometimes it persists after the injury heals. In most cases of chronic back pain, neck pain, neuropathy, and even arthritis and in syndromes such as fibromyalgia, there is no injury and nothing to be “fixed”—but there are numerous ways to help. Sadly, many doctors continue to use procedures—e.g., surgery or nerve injections—that rarely work and prescribe drugs that produce side effects and addiction without relieving much pain. Lalkhen describes his multidisciplinary clinic, where doctors work with physiotherapists, nurses, psychologists, dieticians, and even alternative healers to help sufferers who often arrive addicted and desperate after undergoing repeated failed procedures. The author emphasizes that chronic pain is not curable, but a collaborative approach in which patients actively participate improves quality of life, self-confidence, and the ability to move, function, and return to work.
Readers won’t find miracles but rather a sensitive doctor who writes well about an ongoing epidemic.