Understanding Pain: Exploring the Perception of Pain by Fernando Cervero (review)

Virginia Woolf had this advice for how to read a book: “Do not dictate to your author; try to become him. Be his fellow-worker and accomplice.” My suggestion for reading Understanding Pain is the same—read on, something will ring; one does not need to know every word to get the story. You’ll be vastly rewarded by the humor and humanity in this book about pain. There’s good pain and bad pain, and the book explains it all, with historical anecdotes and current neurological understanding, and not least pain’s entwined affair with philosophical and religious beliefs.

Equating the study of pain with that of memory and consciousness is an important point in this book. Pain, like consciousness, is a subjective perception, and cannot be independently measured, like body temperature. We might feel no pain from an injury if our body does not have the right cellular receptor for it—as with ultraviolet rays from the sun (the pain the day after is the result of tissue damage from the burn). The author has included the latest research—sadly, no bibliography is included or work attributed. These would have allowed interested readers to look further and, more importantly, the author could have spared us many of the anatomical details that only a neurologist would know. To its credit, this book can be of equal interest to medical students or general readers who could come away with an appreciation of pain’s complexity and intricacy.

Being a clinician and a professor of anesthesia (at Canada’s McGill University), Cervero is able to give vivid examples illustrating the causes and origins of many types of pain, such as phantom limb, where the patient continues to feel pain in a limb that has long been amputated; or visceral pain, which tends to wander from its original site of insult because the message hitches a ride with other nerves and the brain gets confused. From here, Cervero goes into brain systems involving multiple neural networks. This is where my initial warning, for the general reader, comes from: Do not be derailed by such detail. I do think it would have been helpful if there were a brief recap at the end of each chapter, summarizing the main ideas and conclusions.

One compelling story that tells the close relationship between pain and consciousness is Cervero’s chapter on pain perception in the brain and how pain ceases to become suffering. He cites the once popular surgery of lobotomy in which the patient’s main cognitive area, the frontal lobes, are severed from the rest of the brain. Rosemary Kennedy, the sister of U.S. President John F. Kennedy, had a lobotomy at age 23 and spent the rest of her life incapacitated. For gone with the pain of mood disorder and suffering was also the patient’s capacity to feel, think and learn.

My bit of discomfort arises in the final chapter called “A Pain Free World,” which is really meant as a question, a hope. Here an overview of the various tactics for dealing with pain is discussed, including a comprehensive list of drugs available to the patient, with pros and cons—there is no good drug for chronic pain: Long term use requires increasing doses and results in addiction, while placebos work equally well in many cases. His discussion of complementary (“alternative” is used here) medicine is almost dismissively brief, even as he points out the psychological investment of the patient, suggesting that chronic pain is a form of bad memory, or habit, often unconsciously reinforced by its sufferer and that certain image-guided therapies are effective for phantom limb syndrome.

The information in this book undoubtedly predicts the present success of integrative care, an approach that includes integrative physicians, psychologists, acupuncturists and an array of therapies from yoga to massage to energy practitioners and more. Each patient follows his or her own combination of treatments.

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