Uncovering the mystery of pain

'The Painful Truth: The new science of why we hurt and how we can heal', by Monty Lyman (Bantam Press; £20), reviewed by Talia Drew.

The almost universal experience of pain often seems a mystery. With so many people living with chronic pain, it is amazing that age old myths are only now being dispelled. Pain science has typically delivered the message that pain equals tissue damage, though new research has started to disprove this. Why do we feel pain when we are sad? What is pain communicating to us? How can we help patients with chronic pain manage this experience? These questions and more are explored in Monty Lyman’s brilliant book, The Painful Truth.

Lyman, a medical doctor, writes anecdotally and formally about personal and professional experiences that traverse the realm of pain. Rich and emotional stories about life with and without pain are told through interviews, metaphors, and scientific explanations. Lyman’s gripping, entertaining and sincere writing conveys complex concepts and key arguments, including that pain is a protective mechanism.

This mechanism may signal more than physical injury, communicating psychological and emotional distress too. For example, psychological disorders such as Post Traumatic Stress Disorder may exacerbate experiences of pain. In such conditions, our brain is repeatedly flooded with neurochemicals like adrenaline and cortisol to protect us, enabling us to remain alert to identify and avoid threats within our environment, but which in turn may lead to muscle tension, hyperarousal and other experiences related to physical pain. This process is seen in other conditions such as anxiety and helps to explain the common co-occurrence of chronic pain and mental illnesses.

Stepping outside of the medical model, where pain has predominantly resided, Lyman considers the social, cultural and psychological implications of living with chronic pain. Stressful jobs, sedentary lifestyles, uncertainty, and a global sense of unease contribute to the experience and maintenance of chronic pain. The common perceptions of pain are systematically discounted with research and evidence, enabling the reader to question the dominant narratives we have been given. Lyman outlines holistic treatments for chronic pain such as psychological therapy and physical activity, moving away from medical interventions including medicines. The central idea is that people need to feel safe in order to start understanding and treating their chronic pain.

Having worked in a pain service prior to starting my clinical training, much of what I read resonated strongly. Lyman is a brilliant and engaging storyteller, and this book feels incredibly important. It is a beacon of hope for those in pain, those supporting a loved one, and healthcare professionals in this field.

- Reviewed by Talia Drew, Trainee Clinical Psychologist

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