Rating: 
Summary: WOWZER!
Review: After reading the introduction I had great hopes of gaining some unique perspectives on pain from a teleologic standpoint. Unfortunately reading further only led to crushing disappointment.This is a book on pain that comes from a very narrow focus. Each chapter, opened with a clinical vignette, attempts to educate the reader as to the presumed cause of pain and then the treatment options. Written from the perspective of a neurosurgeon, it's no surprise where this all goes. Unfortunately not everything in the realm of pain is going to take on the appearance of a nail which the author enjoys using his hammer on at the conclusion of each chapter. Chronic pain is an elusive character and seldom conforms to our needs for a "structural" answer. The author has sadly limited his overview of pain to those situations where a "surgical answer" is awaiting. Those varieties of pain that so often elude us in Medicine, such as Fibromyalgia, are not even addressed. What's more distressing is that the emotional component of pain is given virtually no space in the book, and indeed is ignored. The Vignette on the malingerer is a case in point. The author's idea of therapy was to announce to the patient that "nothing's wrong" and go home. As much as malingering is a nuisance in any clinical setting, there still is pain--you just won't find it on an xray. As a primary care physician I am concerned about the tone of this book. Many patients in my practice are in chronic pain SINCE they underwent one of these fancy neurosurgical proceedures. It's clear to any of us that see patients in the aftermath of surgery that Medicine does not possess all the answers since it finds it distasteful to deal with the psychosomatic components of pain. The author only reinforces that viewpoint. In addition to the errors that the first reviewer noted I would like to add that acupuncture does not "treat the imagination" as the author smugly suggests. If a placebo effect were the only explanation than how does that explain the effects observed in veterenary settings? This is a book that may produce false hope in individuals with chronic pain.
Rating: 
Summary: lfootemd
Review: After reading the introduction I had great hopes of gaining some unique perspectives on pain from a teleologic standpoint. Unfortunately reading further only led to crushing disappointment. This is a book on pain that comes from a very narrow focus. Each chapter, opened with a clinical vignette, attempts to educate the reader as to the presumed cause of pain and then the treatment options. Written from the perspective of a neurosurgeon, it's no surprise where this all goes. Unfortunately not everything in the realm of pain is going to take on the appearance of a nail which the author enjoys using his hammer on at the conclusion of each chapter. Chronic pain is an elusive character and seldom conforms to our needs for a "structural" answer. The author has sadly limited his overview of pain to those situations where a "surgical answer" is awaiting. Those varieties of pain that so often elude us in Medicine, such as Fibromyalgia, are not even addressed. What's more distressing is that the emotional component of pain is given virtually no space in the book, and indeed is ignored. The Vignette on the malingerer is a case in point. The author's idea of therapy was to announce to the patient that "nothing's wrong" and go home. As much as malingering is a nuisance in any clinical setting, there still is pain--you just won't find it on an xray. As a primary care physician I am concerned about the tone of this book. Many patients in my practice are in chronic pain SINCE they underwent one of these fancy neurosurgical proceedures. It's clear to any of us that see patients in the aftermath of surgery that Medicine does not possess all the answers since it finds it distasteful to deal with the psychosomatic components of pain. The author only reinforces that viewpoint. In addition to the errors that the first reviewer noted I would like to add that acupuncture does not "treat the imagination" as the author smugly suggests. If a placebo effect were the only explanation than how does that explain the effects observed in veterenary settings? This is a book that may produce false hope in individuals with chronic pain.
Rating:
Summary: A terrible instrument
Review: C.S. Lewis said in his book, "The Problem of Pain": "Pain as God's megaphone is a terrible instrument." It gets our attention and warns us of danger. Unfortunately, some doctors don't listen to that same megaphone when treating their patients. According to a recent "New York Times" article, "More than a third of seriously ill patients who requested that doctors ease their discomfort instead of prolonging their lives appear to have had their wishes overlooked, a new study [published in the "Journal of the American Geriatrics Society"] reports". "Why We Hurt" claims that, "three of four cancer patients will die in poorly controlled pain, and the percentage climbs higher still for those succumbing to malignancies with a talent for invading bones and nerves, including cancers of the breast, prostate, rectum, pancreas, and cervix." This must be disquieting information for people who are suffering from terminal illnesses like cancer or AIDS, especially since doctors already tend to undermedicate for pain---think of all of the criminal and civil lawsuits pending for over-prescription of OxyContin, and it is easy to understand why some doctors avoid the heavy-duty painkillers or their prolonged usage. Dr. Vertosick has treated some nightmarish pain problems during his career as a neurosurgeon. This book contains many case histories of patients in agony, connected by the overarching theme of why it is necessary to feel pain. Each story explains why we are connected in such a hurtful way to our inner and outer worlds. According to Dr. Vertosick, "when stripped of pain's discipline, we neglect our bodies until they become battered beyond recognition....The hands and feet of longtime diabetics and paralytics...become deformed and covered with pressure sores. Patients with trigeminal neuralgia who have their corneas rendered numb by alcohol nerve blocks will ultimately go blind from unchecked corneal scarring." There is also the sad story of Jimmy, the boy who was born without the ability to feel pain. "Why We Hurt" is a book that both teaches and fascinates. I learned that neurosurgery can help at least some people (including cancer patients) who suffer from intractable pain. There are only a couple of areas where I found Dr. Vertosick to be overly optimistic. One concerns the efficacy of back surgery. Read this book, and then read the prologue to Dr. Jerome Groopman's "Second Opinions" for an example of where back surgery (spinal fusion) worsened the patient's condition. My own neurologist has told me that 60% of patients who underwent back surgery felt that it didn't do any good. The question of whether newborn babies feel pain is another gray area where this author tends toward optimism. He feels that they are not yet fully connected to sensations of pain. However, I've read research to the contrary: newborn infants who have been operated on without anesthesia not only feel pain, they remember it. These two small quibbles aside, please read this book. You may someday have to make choices on pain control, and this is a good place to start learning what those choices may entail, and (if it's any comfort) why it is `natural,' i.e. in accordance with human evolution, that you feel the way you do.
Rating:
Summary: A terrible instrument
Review: C.S. Lewis said in his book, "The Problem of Pain": "Pain as God's megaphone is a terrible instrument." It gets our attention and warns us of danger. Unfortunately, some doctors don't listen to that same megaphone when treating their patients. According to a recent "New York Times" article, "More than a third of seriously ill patients who requested that doctors ease their discomfort instead of prolonging their lives appear to have had their wishes overlooked, a new study [published in the "Journal of the American Geriatrics Society"] reports". "Why We Hurt" claims that, "three of four cancer patients will die in poorly controlled pain, and the percentage climbs higher still for those succumbing to malignancies with a talent for invading bones and nerves, including cancers of the breast, prostate, rectum, pancreas, and cervix." This must be disquieting information for people who are suffering from terminal illnesses like cancer or AIDS, especially since doctors already tend to undermedicate for pain---think of all of the criminal and civil lawsuits pending for over-prescription of OxyContin, and it is easy to understand why some doctors avoid the heavy-duty painkillers or their prolonged usage. Dr. Vertosick has treated some nightmarish pain problems during his career as a neurosurgeon. This book contains many case histories of patients in agony, connected by the overarching theme of why it is necessary to feel pain. Each story explains why we are connected in such a hurtful way to our inner and outer worlds. According to Dr. Vertosick, "when stripped of pain's discipline, we neglect our bodies until they become battered beyond recognition....The hands and feet of longtime diabetics and paralytics...become deformed and covered with pressure sores. Patients with trigeminal neuralgia who have their corneas rendered numb by alcohol nerve blocks will ultimately go blind from unchecked corneal scarring." There is also the sad story of Jimmy, the boy who was born without the ability to feel pain. "Why We Hurt" is a book that both teaches and fascinates. I learned that neurosurgery can help at least some people (including cancer patients) who suffer from intractable pain. There are only a couple of areas where I found Dr. Vertosick to be overly optimistic. One concerns the efficacy of back surgery. Read this book, and then read the prologue to Dr. Jerome Groopman's "Second Opinions" for an example of where back surgery (spinal fusion) worsened the patient's condition. My own neurologist has told me that 60% of patients who underwent back surgery felt that it didn't do any good. The question of whether newborn babies feel pain is another gray area where this author tends toward optimism. He feels that they are not yet fully connected to sensations of pain. However, I've read research to the contrary: newborn infants who have been operated on without anesthesia not only feel pain, they remember it. These two small quibbles aside, please read this book. You may someday have to make choices on pain control, and this is a good place to start learning what those choices may entail, and (if it's any comfort) why it is 'natural,' i.e. in accordance with human evolution, that you feel the way you do.
Rating: 
Summary: Good read, but not always right
Review: Dr. Vertosick has written a fine collection of vignettes of patients suffering from chronic pain, from his perspective as a practicing neurosurgeon. Detracting from his storytelling skills, however, are the errors of fact and intepretation which appear throughout the book. Most egregious is the confusion of nitrous oxide for nitric oxide, the molecule used ubiquitously in our bodies for vascular regulation and neurotransmission. This is not simply a spelling error, since Dr. Vertosick goes ahead and mistakenly identifies the subject of the 1998 Nobel prize (nitric oxide) as "laughing gas" (nitrous oxide). Despite the similarity in nomenclature, the two gases are completely different in their physiological roles and effects. Perhaps in an effort to justify the grandiose title, many appeals to evolutionary theory are made. These efforts are stretches at best, and wrong at times. For example, the speculation that the malaise produced by the flu may be adaptive to humans by limiting viral spread through social contact ignores the fact that the individual, not the group, is the most important locus of Darwinian selection. A more likely adaptive explanation for the clinical symptoms of the flu is that inactivity and fever allow the infected body to concentrate its physiological resources against the invaders. In a discussion on how nitroglycerin relieves the crushing chest pain (and myocardial ischemia) of angina, the explanation was given that the body's arteries dilate, thus making it easier for the suffering heart to pump blood forward. In fact. the major effect of nitroglycerin is to dilate the veins, providing the heart with lesser volumes of blood to pump. While lauding the pain relief given to his laboring wife by epidural analgesia, Dr. Vertosick reports that the epidural prolonged the birth process. Although there is a correlation between the use of an epidural and longer labor, the current medical literature attributes this to the likelihood that women with complicated- and longer - labor are more likely to request an epidural, not that an epidural prolongs the childebirth process. Finally, and this probably falls in the "nitpicking" category, the bacterium causing leprosy belongs to the same genus as that causing tuberculosis, not the same species as claimed in the book. I did not read the book with an intention to find errors, but there are mistakes which jump out at the biomedically literate reader. I would still recommend the book as a good introduction to the problem of chronic pain, written with sympathy and clinical insights. However, it is disturbing that a book written by a physician would contain so many factual errors of a biological or medical nature. I wish the author - or his editors - would clean up the text for a second edition.
Rating:
Summary: Good read, but not always right
Review: Dr. Vertosick has written a fine collection of vignettes of patients suffering from chronic pain, from his perspective as a practicing neurosurgeon. Detracting from his storytelling skills, however, are the errors of fact and intepretation which appear throughout the book. Most egregious is the confusion of nitrous oxide for nitric oxide, the molecule used ubiquitously in our bodies for vascular regulation and neurotransmission. This is not simply a spelling error, since Dr. Vertosick goes ahead and mistakenly identifies the subject of the 1998 Nobel prize (nitric oxide) as "laughing gas" (nitrous oxide). Despite the similarity in nomenclature, the two gases are completely different in their physiological roles and effects. Perhaps in an effort to justify the grandiose title, many appeals to evolutionary theory are made. These efforts are stretches at best, and wrong at times. For example, the speculation that the malaise produced by the flu may be adaptive to humans by limiting viral spread through social contact ignores the fact that the individual, not the group, is the most important locus of Darwinian selection. A more likely adaptive explanation for the clinical symptoms of the flu is that inactivity and fever allow the infected body to concentrate its physiological resources against the invaders. In a discussion on how nitroglycerin relieves the crushing chest pain (and myocardial ischemia) of angina, the explanation was given that the body's arteries dilate, thus making it easier for the suffering heart to pump blood forward. In fact. the major effect of nitroglycerin is to dilate the veins, providing the heart with lesser volumes of blood to pump. While lauding the pain relief given to his laboring wife by epidural analgesia, Dr. Vertosick reports that the epidural prolonged the birth process. Although there is a correlation between the use of an epidural and longer labor, the current medical literature attributes this to the likelihood that women with complicated- and longer - labor are more likely to request an epidural, not that an epidural prolongs the childebirth process. Finally, and this probably falls in the "nitpicking" category, the bacterium causing leprosy belongs to the same genus as that causing tuberculosis, not the same species as claimed in the book. I did not read the book with an intention to find errors, but there are mistakes which jump out at the biomedically literate reader. I would still recommend the book as a good introduction to the problem of chronic pain, written with sympathy and clinical insights. However, it is disturbing that a book written by a physician would contain so many factual errors of a biological or medical nature. I wish the author - or his editors - would clean up the text for a second edition.
Rating: 
Summary: Good stories and personal accounts, but a narrow viewpoint
Review: Dr. Vertosick's book has it's highpoints in the stories and vignettes about his patients, and the days of his life as a neurosurgeon. I enjoyed his candor and some of the attitudes he has toward himself and his work, but beyond that I found this book to have little value. Starting from his basic premise that physicians can't extend life ony make more it comfortable, he then looks at everything from that perspective. The concepts of healing, regeneration, and meaning don't find any ground in his mechanistic approach. Granted, he is involved with some paients in intractable pain and for them comfort and the ease of their suffering is the goal, but for most patients with chronic pain this is too limited a focus. As a practicing Chiropractor who emphasizes conservative care for patients with chronic pain conditions, I have had many patients who have sought the services of pain management programs and approaches(involving physical therapy, biofeedback, trigger point and cortisone injections,epidurals, TENS, counseling, IV muscle relaxants, medications, etc.) and neurosurgery. Unfortunately, most of them return have mediocre results, especially in the long term. The reason primarily is one of approach and this book explains why. Some examples: Migraine headaches were theorized as being strictly vascular in nature as Dr. Verpsick explains. However, the current explanation of migraines are that they form a continuum with tension headaches . Essentially there are 3 components involved in production of classic migraines (BTW, there are many types of migraines), somatic (musculoskeletal), neurological, and vascular. The somatic component ( involving the cervical spine, TMJ, etc) is prevalent in the side producing tension headaches, while the vascular component is prevalent in the side producing classic migraine. Common migraines have somewhat less vascular prevalence. The neurological pain inhibiting component varies in involvement. From this model it explains why spinal and cranial manipulation, acupuncture, biofeedback, etc. help migraine sufferers. Maintaining the vascular model of migraine production, all other non-drug therapies must be placebos. For herniated lumbar discs, Dr. Vertosick charaterizes Chiropractic care as ineffective for sciatica from disc disorders. This is a tremendous error. While there are some disc disorders that require neurosurgical attention (which I prefer over standard orthopedic surgery) most never reach the OR due to proper Chiropractic care. I especially refer to Canadian orthopedist Kirkaldy-Willis's book and research using Chiropractic and spinal mainpulation on pre-surgical back patients. Furthermore, there are many different divisions of Chiropractic care, some are very effective for disc disorders, and some not at all. To lump all of Chiropractic care together as generic is as erroneous as doing so to all surgical procedures (acupuncture too). Clearly specific approaches have greater merit in certain patients and conditions. Carpal Tunnel Syndrome (CTS)is also commonly multi-factorial, and NOT simply the result of a problem in the Carpal Tunnel requiring a simple surgical release. Commonly there are several entrapment points along the nerve. Chiropractic physicians who utilize Active Release Technique and have been demonstrated to get effective relief of CTS releasing these entrapments non-surgically. See Leahy's work. Not mentioned by Dr. Vertosick is that much chronic musculoskeletal pain is due to joint and muscular causes which can't be addressed by drugs or surgery. Nociceptive receptors (neurons that register the amount of tiisue damage) in joints are constantly firing as the body is continually replacing damaged cells. Normally we don't feel this, because Mechanorectors (neurons that register movement) override these signals. When joint restriction occurs these mechanorectors give off less impulses, so we feel the nocicptive signals as pain. Joint restriction also encourages further tissue destruction. Mobilization and manipulation to restore the mobility of the joints, along with exercise often effectively corrects this. In short, there are more ways to look at the problem of many patients with chronic pain than Dr. Vertosick offers. There are equally more options for care.
Rating:
Summary: Must Read if you're faced with chronic pain
Review: Extremely well written (with humor). If you or someone you know is dealing with chronic pain (arthritis, migraine, RA, etc) this book will help you understand and hopefully give you some control over the pain.
Rating: 
Summary: A well-written, engaging treatment of an important subject
Review: I bought this book without knowing much about it -- in the bookstore with my 8-year-old son, who suffers from migraines. We noticed it and, at his request, I began to read it to him -- then we had to buy it! I was quite impressed by the quality of the writing -- it's a book for grownups, but the ideas were accessible to a sensitive child with an interest in the subject. I certainly defer to other reviewers with medical knowledge about errors in the book, and I think much of his speculation about the potential evolutionary advantages of particular pains or genetic disorders is a little, well, speculative -- but we enjoyed reading and discussing them anyway. The preponderance of happy ending case-stories -- though generally with a lot of suffering before the resolution -- bothered me a little in my own appreciation of the work, but I think it was for the best in my discussions with my son -- he was able to face the issues without being overwhelmed by tragedy (and there's tragedy enough along the way).
Rating:
Summary: WOWZER!
Review: This is the best book ever! It's funny, yet tragic, distant, yet so close. I would recommend this book to everyone, not just to sufferers of chronic pain, or people with medical careers. A MUST READ!
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