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A Narrative Approach to Pain
582
Reviews
depression and the ‘‘palliative pearls’’ are very helpful. In summary, I think this book will be helpful for palliative care providers in the developing world. doi:10.1016/j.jpainsymman.2005.11.003
A Narrative Approach to Pain Judith A. Turner, PhD
Narrative, Pain, and Suffering. Volume 34 of Progress in Pain Research and Management Edited by Daniel B. Carr, John D. Loeser and David B. Morris Published by IASP Press, Seattle, Washington, USA 2005, 364 pages, US$ 89.00 (IASP Members US$ 69.00) This book grew out of an international conference on narrative approaches to pain medicine held at Bellagio, Italy in 2003. It is the 34th volume in the Progress in Pain Research and Management Series, published by IASP Press. The editors define narrative medicine as ‘‘medicine practiced with attention to the skills and competencies required to understand how patients and caregivers and health care providers regularly embody ‘tellings’ or stories or fragments of language inseparable from situations constructed through the relations among a teller (narrator), a tale (narrative), and an actual or implicit audience (narratee)’’ (p. 6). As John Loeser elaborates in the second chapter, individuals’ past experiences and present world strongly influence their responses to injury or illness, including pain and suffering, and the stories they
Judith A. Turner, PhD, is Professor, Department of Psychiatry & Behavioral Sciences and Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
Vol. 30 No. 6 December 2005
construct about their pain. ‘‘Understanding their pain and suffering requires listening to their narrative’’ (p. 18). The book is timely; the topic is of substantial importance in pain and palliative care. This volume is divided into six sections: Introduction; The Challenge of Narrative to Pain; Biological Substrate: Systems and Images; Biocultural Perspectives: Meanings and Practices; Sharing Pain: Uses and Limits of Narrative; and The Future of Pain Narrative. The chapters are quite diverse in authorship and focus. Chapters are contributed by a writer, a physician with Douleurs Sans Frontiers in Mozambique, and individuals from the fields of psychology, psychiatry, nursing, sociology, and anthropology, as well as various medical specialties. Topics include, among others, the impact of pain on quality of life, neurobiology of pain and emotion, brain imaging of pain, cancer pain management in China, and racial and ethnic differences in the experience of pain and access to care. In general, the chapters are well written and interesting. I will describe a few to illustrate the diversity of the chapters and to pique the interest of readers of this review. Rita Charon, an internist who teaches narrative medicine to medical students at Columbia University, provides a chapter that illustrates how narrative concepts can be applied by health care providers who treat patients with chronic pain. Dr. Charon explains why narrative medicine is particularly well suited for pain medicine and describes how this approach affects what the clinician knows about the patient and how this knowledge influences the clinician’s approach to the care of the patient. She poses several provocative questions and provides answers to them: Why is narrative particularly required by patients with chronic pain? Why do pain medicine practitioners need what narrative medicine can provide? How is pain medicine an exemplar for narrative medicine? Mark Sullivan, a psychiatrist with a Ph.D. in philosophy, and David Zucker, who practices rehabilitation medicine and counseling psychology, describe the technique of mindfulness (including an exercise in mindfulness that readers can try). They suggest directions for future studies to determine the mechanisms and effectiveness of mindfulness techniques as applied to pain.
Vol. 30 No. 6 December 2005
As Daniel Carr eloquently discusses in the book’s final chapter (Memoir of a Meta-Analyst: On the Silent ‘L’ in ‘Qualntitative’), patients wish to be heard, individuals respond differently to specific pain treatments, and conclusions of supposedly objective meta-analyses of scientific studies are influenced by qualitative decisions made by the meta-analysts. Carr cautions against rigid adherence to medical care based solely on quantitative data and argues persuasively for attention to experience, emotions, intuition, and anecdotal observations. This book will be of interest to clinicians and researchers who wish to learn more about the narrative approach to understanding patients and may well help to serve as a catalyst for increased attention to this approach in health care provider training, research into its value for quality of patient care, and application by seasoned clinicians who will benefit from this timely reminder of the importance of listening to their patients’ stories. doi:10.1016/j.jpainsymman.2005.11.001
Pain Management: An Expert Manual Knox H. Todd, MD, MPH
Expert Guide to Pain Management. ACP Expert Guides Series Edited by Bill McCarberg and Steven D. Passik Published by The American College of Physicians, Philadelphia, Pennsylvania, USA 2005, 357 pages, US$ 40.00 (softcover) (US$ 36.00 for ACP Members) Given the prevalence of pain, primary care physicians necessarily treat the vast majority
Knox H. Todd, MD, MPH, is director of the Pain and Emergency Medicine Institute, Department of Emergency Medicine, Beth Israel Medical Center, New York, New York; and Professor, Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.
Reviews
583
of patients with chronic pain. Unfortunately, medical academia provides very little in the way of education related to pain treatment, even within primary care training programs. This separation of academic medicine from the needs of practitioners and their patients is lamentable; however, pain physicians have stepped into the breach, providing educational opportunities for primary care physicians through a variety of continuing medical education channels. Intended for the primary care physician, Expert Guide to Pain Management is the latest in a series of American College of Physicians Expert Guides that provide generalist physicians with specialist perspectives on a variety of clinical topics. Edited by Bill McCarberg and Steven Passik, Expert Guide to Pain Management contains 14 chapters on a variety of pain topics, providing both a broad overview of pain medicine and practical information to guide therapies for a number of common chronic pain problems. There are 23 contributors representing a variety of disciplines, including pain medicine, family practice, general internal medicine, orthopedics, anesthesiology, neurology, rehabilitation medicine, pharmacology, family practice, psychiatry, addiction medicine, and law. The chapters cover chronic pain pathophysiology; chronic back pain; headache; osteoarthritis; fibromyalgia; neuropathic pain; pharmacological, injection-based and motivational therapies; complementary and alternative medicine; disability management; psychosocial factors; addiction; and medicolegal issues. The text is very reasonably priced. Because the scope of this text is broad, it cannot provide comprehensive coverage of pain issues for the generalist; however, in highlighting common chronic pain problems, it manages to cover a great deal of ground in an economical manner. The format is uniformly practical and concise. The organization of this book allows the reader to use it as a quick reference for specific questions but most will likely choose particular chapters of interest to obtain a general background on current understandings and therapies for the conditions covered. Chapter 1, a review of chronic pain pathophysiology by Dan Brookoff, and Chapter 14, on state medical board and DEA investigations, by Mary Baluss contain some particularly
Reviews
depression and the ‘‘palliative pearls’’ are very helpful. In summary, I think this book will be helpful for palliative care providers in the developing world. doi:10.1016/j.jpainsymman.2005.11.003
A Narrative Approach to Pain Judith A. Turner, PhD
Narrative, Pain, and Suffering. Volume 34 of Progress in Pain Research and Management Edited by Daniel B. Carr, John D. Loeser and David B. Morris Published by IASP Press, Seattle, Washington, USA 2005, 364 pages, US$ 89.00 (IASP Members US$ 69.00) This book grew out of an international conference on narrative approaches to pain medicine held at Bellagio, Italy in 2003. It is the 34th volume in the Progress in Pain Research and Management Series, published by IASP Press. The editors define narrative medicine as ‘‘medicine practiced with attention to the skills and competencies required to understand how patients and caregivers and health care providers regularly embody ‘tellings’ or stories or fragments of language inseparable from situations constructed through the relations among a teller (narrator), a tale (narrative), and an actual or implicit audience (narratee)’’ (p. 6). As John Loeser elaborates in the second chapter, individuals’ past experiences and present world strongly influence their responses to injury or illness, including pain and suffering, and the stories they
Judith A. Turner, PhD, is Professor, Department of Psychiatry & Behavioral Sciences and Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
Vol. 30 No. 6 December 2005
construct about their pain. ‘‘Understanding their pain and suffering requires listening to their narrative’’ (p. 18). The book is timely; the topic is of substantial importance in pain and palliative care. This volume is divided into six sections: Introduction; The Challenge of Narrative to Pain; Biological Substrate: Systems and Images; Biocultural Perspectives: Meanings and Practices; Sharing Pain: Uses and Limits of Narrative; and The Future of Pain Narrative. The chapters are quite diverse in authorship and focus. Chapters are contributed by a writer, a physician with Douleurs Sans Frontiers in Mozambique, and individuals from the fields of psychology, psychiatry, nursing, sociology, and anthropology, as well as various medical specialties. Topics include, among others, the impact of pain on quality of life, neurobiology of pain and emotion, brain imaging of pain, cancer pain management in China, and racial and ethnic differences in the experience of pain and access to care. In general, the chapters are well written and interesting. I will describe a few to illustrate the diversity of the chapters and to pique the interest of readers of this review. Rita Charon, an internist who teaches narrative medicine to medical students at Columbia University, provides a chapter that illustrates how narrative concepts can be applied by health care providers who treat patients with chronic pain. Dr. Charon explains why narrative medicine is particularly well suited for pain medicine and describes how this approach affects what the clinician knows about the patient and how this knowledge influences the clinician’s approach to the care of the patient. She poses several provocative questions and provides answers to them: Why is narrative particularly required by patients with chronic pain? Why do pain medicine practitioners need what narrative medicine can provide? How is pain medicine an exemplar for narrative medicine? Mark Sullivan, a psychiatrist with a Ph.D. in philosophy, and David Zucker, who practices rehabilitation medicine and counseling psychology, describe the technique of mindfulness (including an exercise in mindfulness that readers can try). They suggest directions for future studies to determine the mechanisms and effectiveness of mindfulness techniques as applied to pain.
Vol. 30 No. 6 December 2005
As Daniel Carr eloquently discusses in the book’s final chapter (Memoir of a Meta-Analyst: On the Silent ‘L’ in ‘Qualntitative’), patients wish to be heard, individuals respond differently to specific pain treatments, and conclusions of supposedly objective meta-analyses of scientific studies are influenced by qualitative decisions made by the meta-analysts. Carr cautions against rigid adherence to medical care based solely on quantitative data and argues persuasively for attention to experience, emotions, intuition, and anecdotal observations. This book will be of interest to clinicians and researchers who wish to learn more about the narrative approach to understanding patients and may well help to serve as a catalyst for increased attention to this approach in health care provider training, research into its value for quality of patient care, and application by seasoned clinicians who will benefit from this timely reminder of the importance of listening to their patients’ stories. doi:10.1016/j.jpainsymman.2005.11.001
Pain Management: An Expert Manual Knox H. Todd, MD, MPH
Expert Guide to Pain Management. ACP Expert Guides Series Edited by Bill McCarberg and Steven D. Passik Published by The American College of Physicians, Philadelphia, Pennsylvania, USA 2005, 357 pages, US$ 40.00 (softcover) (US$ 36.00 for ACP Members) Given the prevalence of pain, primary care physicians necessarily treat the vast majority
Knox H. Todd, MD, MPH, is director of the Pain and Emergency Medicine Institute, Department of Emergency Medicine, Beth Israel Medical Center, New York, New York; and Professor, Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.
Reviews
583
of patients with chronic pain. Unfortunately, medical academia provides very little in the way of education related to pain treatment, even within primary care training programs. This separation of academic medicine from the needs of practitioners and their patients is lamentable; however, pain physicians have stepped into the breach, providing educational opportunities for primary care physicians through a variety of continuing medical education channels. Intended for the primary care physician, Expert Guide to Pain Management is the latest in a series of American College of Physicians Expert Guides that provide generalist physicians with specialist perspectives on a variety of clinical topics. Edited by Bill McCarberg and Steven Passik, Expert Guide to Pain Management contains 14 chapters on a variety of pain topics, providing both a broad overview of pain medicine and practical information to guide therapies for a number of common chronic pain problems. There are 23 contributors representing a variety of disciplines, including pain medicine, family practice, general internal medicine, orthopedics, anesthesiology, neurology, rehabilitation medicine, pharmacology, family practice, psychiatry, addiction medicine, and law. The chapters cover chronic pain pathophysiology; chronic back pain; headache; osteoarthritis; fibromyalgia; neuropathic pain; pharmacological, injection-based and motivational therapies; complementary and alternative medicine; disability management; psychosocial factors; addiction; and medicolegal issues. The text is very reasonably priced. Because the scope of this text is broad, it cannot provide comprehensive coverage of pain issues for the generalist; however, in highlighting common chronic pain problems, it manages to cover a great deal of ground in an economical manner. The format is uniformly practical and concise. The organization of this book allows the reader to use it as a quick reference for specific questions but most will likely choose particular chapters of interest to obtain a general background on current understandings and therapies for the conditions covered. Chapter 1, a review of chronic pain pathophysiology by Dan Brookoff, and Chapter 14, on state medical board and DEA investigations, by Mary Baluss contain some particularly