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An Anatomy of Pain: How the Body and the Mind Experience and Endure Physical Suffering
An illuminating, authoritative, and in-depth examination of the fascinating science behind pain that “combines a career’s worth of expertise with a long history of pain treatment” ( GQ )—from one of the internationally leading doctors in pain management.
Pain is a universal human experience, but we understand very little about the mechanisms behind it. We hurt ourselves, we feel pain, we seek help from a professional or learn to avoid certain behaviors that cause pain. But the story of what goes on in our body is far from simple. Even medical practitioners themselves often fail to grasp the complexities between our minds and bodies and how they interact when dealing with pain stimulus. Throughout history we’ve tried to prevent and mediate the effects of pain—which has only resulted in a highly medicated population and a booming opiates industry.
Written by a medical expert trained as an anesthesiologist, An Anatomy of Pain is the first book to clearly explain the current issues and complexities surrounding the treatment of pain and how society deals with those in pain, as well as how our bodies relate to pain. Common conception still equates pain with tissue damage but that is only a very small part of the story—the organ which produces pain is the brain. Case studies show that a woman who has undergone a c-section reports dramatically less pain than a patient who has had kidney stones removed in a similarly invasive operation. The soldier who drags himself or herself to safety after being shot deals with pain in a remarkably different way from someone suffering a similar injury on a street. The truth is that pain is a complex mix of nerve endings, psychological state, social preconceptions, and situational awareness.
Filled with case studies and medical history, this enlightening book offers a crash course in all aspects of pain, from chronic to acute, and walks us through the current landscape of pain treatments—from medication (including opioids) to electrical nerve stimulation. Whether it’s a mild ache or severe discomfort, we all encounter pain in our lives and “this splendid book—informative, empathic, and wise—about a universal experience will surely promote healing” ( Booklist , starred review).
Pain is a universal human experience, but we understand very little about the mechanisms behind it. We hurt ourselves, we feel pain, we seek help from a professional or learn to avoid certain behaviors that cause pain. But the story of what goes on in our body is far from simple. Even medical practitioners themselves often fail to grasp the complexities between our minds and bodies and how they interact when dealing with pain stimulus. Throughout history we’ve tried to prevent and mediate the effects of pain—which has only resulted in a highly medicated population and a booming opiates industry.
Written by a medical expert trained as an anesthesiologist, An Anatomy of Pain is the first book to clearly explain the current issues and complexities surrounding the treatment of pain and how society deals with those in pain, as well as how our bodies relate to pain. Common conception still equates pain with tissue damage but that is only a very small part of the story—the organ which produces pain is the brain. Case studies show that a woman who has undergone a c-section reports dramatically less pain than a patient who has had kidney stones removed in a similarly invasive operation. The soldier who drags himself or herself to safety after being shot deals with pain in a remarkably different way from someone suffering a similar injury on a street. The truth is that pain is a complex mix of nerve endings, psychological state, social preconceptions, and situational awareness.
Filled with case studies and medical history, this enlightening book offers a crash course in all aspects of pain, from chronic to acute, and walks us through the current landscape of pain treatments—from medication (including opioids) to electrical nerve stimulation. Whether it’s a mild ache or severe discomfort, we all encounter pain in our lives and “this splendid book—informative, empathic, and wise—about a universal experience will surely promote healing” ( Booklist , starred review).
256 pages, Hardcover
First published February 2, 2021
87 people are currently reading
1832 people want to read
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May 30, 2021
Author Dr. Abdul-Ghaaliq Lalkhen offers thoughtful, intelligent and enlightening observations on pain, and specifically persistent or chronic pain and current available treatments.
Early in the text, Dr. Lalkhen reflects:
“For every complex problem, there is a solution that is clear, simple and wrong.”
Mic drop 🎤 ⬇️
The point being that pain, particularly chronic pain is a complex phenomena with multivariate biological, psychological and social (bio-psycho-social) contributing factors.
And.
Simple, quick, reductive interventions are apt to be ineffective.
Yes 🙌
Treatment of chronic pain almost invariably necessitates comprehensive treatment plans that address each bio-psycho-social issue with an appropriate intervention.
Absolutely 🎯
In other words, recovery entails living in the solution.
This notion is common in addiction and mental health treatment.
But is not as commonly understood about pain.
Obviously, there is a biological component to pain.
Pain indicates some type of structural damage or neuropathic problem.
That being said, we do not perceive pain at the loci of damage, we perceive it as we do any other sense, in our brain.
And as such, it is a perceptual signal.
A signal can be appropriate to the situation, or it can be distorted and subsequently problematic.
Again that does not imply that chronic pain is not real. Chronic pain is real pain. But it is pain that doesn’t have an appropriate or adaptive function.
That is to say.
Pain signals can be acute, functional and proportionate to the issue.
If you put your hand on a hot stove.
It hurts bad.
It makes you pull your hand away.
Good!
But pain can be also be chronic, debilitating and disproportionate to the issue.
Regional chronic pain syndrome just makes you feel awful for no good reason.
And that is by any metric, not good.
Our beliefs about pain, and our mood can also influence our perception of pain, and our behavioral responses to pain.
In our culture, pain can sanction secondary gains, such as access to disability funds and opioids.
Becoming dependent and inactive exacerbates the problem.
Self judgment exacerbates the problem.
Social pressure and judgment exacerbates the problem.
And a downward spiral can ensue.
Again.
This is not to say that chronic pain isn’t real.
It is WAY real.
It’s just that there’s more to it than a simple, 1:1 damage = pain situation where by we can easily heal or fix the damage, and the pain goes away.
The right way to respond to acute pain, is the wrong way to respond to chronic pain.
For example.
If you tear your meniscus and experience subsequent acute pain.
- stay off it
- get a surgery
- take minimal pain medications for a brief period
If we respond to chronic pain by becoming inactive, with yet another surgery, or with more and more opioid pain medications, it digs you into a deeper and deeper hole.
- inactivity leads to de-conditioning
- opioids increase pain sensitivity in the long term
- ineffective surgeries = more pain and more opioids
For a lot of chronic pain, the best way to respond is with long term, healthy and sustainable behavioral and environmental change.
And that recovery process will almost invariably be assisted by good psychotherapy.
NOTE: good psychotherapy is hard to find. But it does exist. And it can really help.
Although I am not currently in chronic pain (beyond the ordinary existential pain of being a person).
I have a good reason to read this book (beyond simple curiosity).
I am a therapist and I currently serve as clinical director at a dual diagnosis treatment center.
We treat the issues at the intersection of addiction, trauma, mental health, and yes, frequently chronic pain.
When I first started treating chronic pain I was terrified.
Thats actually quite common.
Pain in others elicits distress in us (and vice versa).
Additionally, I’m a psychotherapist, and I didn’t initially understand how therapy could be useful with chronic pain.
I have come to understand many chronic pain issues have a bio-medical etiology, without a bio-medical soloution.
In cases such as these.
The only recourses are psychosocial training and behavioral change.
The individual in pain needs to become educated about the issue and retrain their nervous systems.
We need to normalize the problem, eat well, sleep enough and exercise regularly.
And we need to send safety signals to our brains and bodies with mindfulness and stress reduction.
Socioeconomic factors also play a HUGE role.
Incase you haven’t heard.
Grinding it out on the treadmill of late capitalism has its downsides.
And the later half of the book discusses some of the quandaries inherent in our medical system for both practitioners, and consumers alike.
Dr. Lalkhen offers this South African adage:
“We ruin our health in search of wealth, to seek, to have, to save, and then we spend our wealth in search of health only to find the grave.”
T R U E T H A T ! ! !
The book is problem focused.
But it’s hopeful.
If you are in chronic pain.
Or if you treat chronic pain.
Or if you're a human with a brain.
This book will serve you well.
4 stars ⭐️ ⭐️ ⭐️ ⭐️
Why 4/5 instead of 5/5 stars?
Honestly, I’m not entirely sure.
I think it’s because it felt a little like work to read it.
Maybe that’s because I work in the field.
Or maybe it’s hard (or just plain inappropriate) to make a book about pain fun.
But don’t let that stop you if you’re curious.
It’s a great book 📚
Early in the text, Dr. Lalkhen reflects:
“For every complex problem, there is a solution that is clear, simple and wrong.”
Mic drop 🎤 ⬇️
The point being that pain, particularly chronic pain is a complex phenomena with multivariate biological, psychological and social (bio-psycho-social) contributing factors.
And.
Simple, quick, reductive interventions are apt to be ineffective.
Yes 🙌
Treatment of chronic pain almost invariably necessitates comprehensive treatment plans that address each bio-psycho-social issue with an appropriate intervention.
Absolutely 🎯
In other words, recovery entails living in the solution.
This notion is common in addiction and mental health treatment.
But is not as commonly understood about pain.
Obviously, there is a biological component to pain.
Pain indicates some type of structural damage or neuropathic problem.
That being said, we do not perceive pain at the loci of damage, we perceive it as we do any other sense, in our brain.
And as such, it is a perceptual signal.
A signal can be appropriate to the situation, or it can be distorted and subsequently problematic.
Again that does not imply that chronic pain is not real. Chronic pain is real pain. But it is pain that doesn’t have an appropriate or adaptive function.
That is to say.
Pain signals can be acute, functional and proportionate to the issue.
If you put your hand on a hot stove.
It hurts bad.
It makes you pull your hand away.
Good!
But pain can be also be chronic, debilitating and disproportionate to the issue.
Regional chronic pain syndrome just makes you feel awful for no good reason.
And that is by any metric, not good.
Our beliefs about pain, and our mood can also influence our perception of pain, and our behavioral responses to pain.
In our culture, pain can sanction secondary gains, such as access to disability funds and opioids.
Becoming dependent and inactive exacerbates the problem.
Self judgment exacerbates the problem.
Social pressure and judgment exacerbates the problem.
And a downward spiral can ensue.
Again.
This is not to say that chronic pain isn’t real.
It is WAY real.
It’s just that there’s more to it than a simple, 1:1 damage = pain situation where by we can easily heal or fix the damage, and the pain goes away.
The right way to respond to acute pain, is the wrong way to respond to chronic pain.
For example.
If you tear your meniscus and experience subsequent acute pain.
- stay off it
- get a surgery
- take minimal pain medications for a brief period
If we respond to chronic pain by becoming inactive, with yet another surgery, or with more and more opioid pain medications, it digs you into a deeper and deeper hole.
- inactivity leads to de-conditioning
- opioids increase pain sensitivity in the long term
- ineffective surgeries = more pain and more opioids
For a lot of chronic pain, the best way to respond is with long term, healthy and sustainable behavioral and environmental change.
And that recovery process will almost invariably be assisted by good psychotherapy.
NOTE: good psychotherapy is hard to find. But it does exist. And it can really help.
Although I am not currently in chronic pain (beyond the ordinary existential pain of being a person).
I have a good reason to read this book (beyond simple curiosity).
I am a therapist and I currently serve as clinical director at a dual diagnosis treatment center.
We treat the issues at the intersection of addiction, trauma, mental health, and yes, frequently chronic pain.
When I first started treating chronic pain I was terrified.
Thats actually quite common.
Pain in others elicits distress in us (and vice versa).
Additionally, I’m a psychotherapist, and I didn’t initially understand how therapy could be useful with chronic pain.
I have come to understand many chronic pain issues have a bio-medical etiology, without a bio-medical soloution.
In cases such as these.
The only recourses are psychosocial training and behavioral change.
The individual in pain needs to become educated about the issue and retrain their nervous systems.
We need to normalize the problem, eat well, sleep enough and exercise regularly.
And we need to send safety signals to our brains and bodies with mindfulness and stress reduction.
Socioeconomic factors also play a HUGE role.
Incase you haven’t heard.
Grinding it out on the treadmill of late capitalism has its downsides.
And the later half of the book discusses some of the quandaries inherent in our medical system for both practitioners, and consumers alike.
Dr. Lalkhen offers this South African adage:
“We ruin our health in search of wealth, to seek, to have, to save, and then we spend our wealth in search of health only to find the grave.”
T R U E T H A T ! ! !
The book is problem focused.
But it’s hopeful.
If you are in chronic pain.
Or if you treat chronic pain.
Or if you're a human with a brain.
This book will serve you well.
4 stars ⭐️ ⭐️ ⭐️ ⭐️
Why 4/5 instead of 5/5 stars?
Honestly, I’m not entirely sure.
I think it’s because it felt a little like work to read it.
Maybe that’s because I work in the field.
Or maybe it’s hard (or just plain inappropriate) to make a book about pain fun.
But don’t let that stop you if you’re curious.
It’s a great book 📚
February 7, 2021
Originally from South Africa, Dr Lalkhen is an anaesthesiology and pain specialist based in Manchester. In a nutshell, his approach is “biopsychosocial,” meaning that he seeks to understand pain not just as a physical phenomenon resulting from acute injury or damage but as an ongoing process that is affected by emotional and psychological factors. Particularly in the context of chronic syndromes, he acknowledges that pain can continue even when its immediate cause has been repaired. Mental preparation can come into the equation: if a patient assumes they’ll wake up from surgery healed, they may be alarmed if pain persists. Lalkhen talks about managing patient expectations, perhaps with something as simple as the promise, “we’ll aim to get your pain down to a 4 after surgery.” In part, he blames Western society’s Cartesian philosophy for treating mind and body as separate rather than a system.
There are genetic and psychological reasons people might be predisposed to chronic pain. Pain itself can then change the brain chemistry, making the body more alert to pain signals. People can choose one of three paths, Lalkhen observes: “You can spend your time agitating about the alarm going off, you can try to ignore it (but the ignoring of it actually takes up more energy), or the final alternative is to learn to live with this deeply unpleasant situation.” Those who opt for pharmacological solutions can become addicted to opiates, which are less effective over time. Non-drug-related therapies involve the desensitization of nerves, the injection of anaesthetics or steroids, or the implanting of spinal cord stimulators. But all of these strategies have their limitations, and can diminish in efficacy. The patients he sees in his pain clinics may be disappointed that, rather than offering a panacea, he wants to wean them off their current pain relief and help them develop a new way of thinking about pain.
I felt I learned a lot from reading this. Lalkhen is careful to state that he is only referring to non-cancer pain (cancer pain in terminal patients will take all the morphine you can throw at it). Like many physicians, he worries about the modern epidemic of overtreatment and our obsession with wellness. I especially enjoyed the discussion of the understanding of pain and its treatment from the ancient world onward, and in particular the history of opiates. The prose is not literary, but this is an accessible and informational read if the subject matter draws you.
Originally published on my blog, Bookish Beck.
There are genetic and psychological reasons people might be predisposed to chronic pain. Pain itself can then change the brain chemistry, making the body more alert to pain signals. People can choose one of three paths, Lalkhen observes: “You can spend your time agitating about the alarm going off, you can try to ignore it (but the ignoring of it actually takes up more energy), or the final alternative is to learn to live with this deeply unpleasant situation.” Those who opt for pharmacological solutions can become addicted to opiates, which are less effective over time. Non-drug-related therapies involve the desensitization of nerves, the injection of anaesthetics or steroids, or the implanting of spinal cord stimulators. But all of these strategies have their limitations, and can diminish in efficacy. The patients he sees in his pain clinics may be disappointed that, rather than offering a panacea, he wants to wean them off their current pain relief and help them develop a new way of thinking about pain.
I felt I learned a lot from reading this. Lalkhen is careful to state that he is only referring to non-cancer pain (cancer pain in terminal patients will take all the morphine you can throw at it). Like many physicians, he worries about the modern epidemic of overtreatment and our obsession with wellness. I especially enjoyed the discussion of the understanding of pain and its treatment from the ancient world onward, and in particular the history of opiates. The prose is not literary, but this is an accessible and informational read if the subject matter draws you.
Originally published on my blog, Bookish Beck.
February 28, 2021
The opening chapters give you a historical perspective on pain and how it was approached by the ancients, both Western (Aristotle, etc.) and Eastern (Chinese and Indian medicine), all interesting stuff.
Lalkhen moves chronologically to the present, where there's a discussion of morphine and opiates and all manner of addictions vs. treatments vs. good for the patient and bad. The line is drawn between "chronic pain" as suffered by cancer patients and "chronic pain" for another reason. Oh. And for no reason. That medicine cannot figure out with all its much-vaunted blood tests and scans, I mean.
Supposedly 5 to 8% of the world's population suffers from chronic pain. Lalkhen has come to believe that pain needs to be approached from multiple angles, including psychological and physiological ones. He also has come to believe that doctors and patients alike have to admit that sometimes there's no way pain will ever end, so it's just a case of mitigating it by learning to live with it.
He's not a big fan of drugs, many of which have such a poor track record that he's astounded they're even prescribed. Among these are older anti-depressants and anti-epileptic medications, which are prescribed in the hopes that they will quell the brain's ability to signal pain wherever it may be experienced (brains being the symphony conductors of misery when it comes to pain). These drugs are effective in only 1 in 7 people, cause harm to 1 in 14, and provide only about 30 to 50 percent pain relief to the small percentage of people they actually "work" for.
Lalkhen turns a jaundiced eye even on NSAIDs and ibuprofen which, over the long haul, can pose real dangers to the body when that body's owner keeps popping them in an effort to blunt chronic pain.
Overall, quite informative. Some of the case studies wandered a bit, but in the long run the book proves just how little modern medicine can do if their present tests come up with "nothing" even though a patient is suffering from "something."
Lalkhen moves chronologically to the present, where there's a discussion of morphine and opiates and all manner of addictions vs. treatments vs. good for the patient and bad. The line is drawn between "chronic pain" as suffered by cancer patients and "chronic pain" for another reason. Oh. And for no reason. That medicine cannot figure out with all its much-vaunted blood tests and scans, I mean.
Supposedly 5 to 8% of the world's population suffers from chronic pain. Lalkhen has come to believe that pain needs to be approached from multiple angles, including psychological and physiological ones. He also has come to believe that doctors and patients alike have to admit that sometimes there's no way pain will ever end, so it's just a case of mitigating it by learning to live with it.
He's not a big fan of drugs, many of which have such a poor track record that he's astounded they're even prescribed. Among these are older anti-depressants and anti-epileptic medications, which are prescribed in the hopes that they will quell the brain's ability to signal pain wherever it may be experienced (brains being the symphony conductors of misery when it comes to pain). These drugs are effective in only 1 in 7 people, cause harm to 1 in 14, and provide only about 30 to 50 percent pain relief to the small percentage of people they actually "work" for.
Lalkhen turns a jaundiced eye even on NSAIDs and ibuprofen which, over the long haul, can pose real dangers to the body when that body's owner keeps popping them in an effort to blunt chronic pain.
Overall, quite informative. Some of the case studies wandered a bit, but in the long run the book proves just how little modern medicine can do if their present tests come up with "nothing" even though a patient is suffering from "something."
February 15, 2021
2 stars
I am someone that at the age of 32 has suffered from chronic pain for over half their life. In fact in the last 5 years there hasn't been one day that I haven't dealt with pain from my chronic illnesses (endometriosis, adenomyosis and interstitial cystitis). Because of this and my interest in medicine I was really looking forward to reading this book and learning more. Unfortunately it did not live up to my expectations.
I was expecting a book filled with interesting knowledge and facts about the science behind pain and ways to help said pain. Instead I got a 300 page medical journal that was mainly the medical memoir of the author. The book was rather repetitive and I found myself getting bored. My interest does not lie in knowing the structure of how a patient is seen by the author's clinic and this kind of information was repeated for many different scenarios. I felt it was rather self indulgent and more like a memoir.
At the beginning of the book there was some decent information about how we feel pain and the science surrounding it, which I found interesting. There was also some interesting passages about the use of opiates, other medication and other forms of pain relief such as nerve simulators. Unfortunately this information wasn't in the majority.
I have read many books surrounding chronic illness and pain and this was probably the driest of them all. There was no personality behind it and that is why it was more like a medical journal than a book.
Overall, this wasn't what I wanted or expected and I wouldn't recommend it to others as there are better books available.
Please note that I was gifted this book in exchange for an honest review.
I am someone that at the age of 32 has suffered from chronic pain for over half their life. In fact in the last 5 years there hasn't been one day that I haven't dealt with pain from my chronic illnesses (endometriosis, adenomyosis and interstitial cystitis). Because of this and my interest in medicine I was really looking forward to reading this book and learning more. Unfortunately it did not live up to my expectations.
I was expecting a book filled with interesting knowledge and facts about the science behind pain and ways to help said pain. Instead I got a 300 page medical journal that was mainly the medical memoir of the author. The book was rather repetitive and I found myself getting bored. My interest does not lie in knowing the structure of how a patient is seen by the author's clinic and this kind of information was repeated for many different scenarios. I felt it was rather self indulgent and more like a memoir.
At the beginning of the book there was some decent information about how we feel pain and the science surrounding it, which I found interesting. There was also some interesting passages about the use of opiates, other medication and other forms of pain relief such as nerve simulators. Unfortunately this information wasn't in the majority.
I have read many books surrounding chronic illness and pain and this was probably the driest of them all. There was no personality behind it and that is why it was more like a medical journal than a book.
Overall, this wasn't what I wanted or expected and I wouldn't recommend it to others as there are better books available.
Please note that I was gifted this book in exchange for an honest review.
March 23, 2021
Let me just lead with: This is not a self-help book. IF YOU ARE A CHRONIC PAIN SUFFERER OR CONCERNED LAYPERSON, THIS BOOK IS NOT WRITTEN WITH YOU AS THE INTENDED READER.
Which invites the question, Who is the intended audience? Dr. Lalkhen doesn't appear to have asked himself this question before he began writing it. Someone—his editor, his agent, a peer reviewer—should have asked it, and explained why it's important. Because it's apparently marketed toward people with a vested, personal interest in the experience of pain. This is misleading. Most of the time, it seems to be written with other pain management clinicians in mind, whether physicians, nurse practitioners, psychologists, or physical therapists (which is odd, because Lalkhen rarely passes up an opportunity to talk trash about members of these vocations unless they already agree with him). In those parts of the book, he discusses the physiology, electrochemistry, and pharmacology of the causes of pain and possible treatments at a fairly technical level. He details how his clinical practice is organized in terms of diagnostic criteria and daily praxis. Other parts of the book are more of a smug, self-regarding memoir. Where he does address the patient or sufferer more directly, he comes across as condescending and, frequently, exasperated by our common foibles and our unrealistic expectations of what his specialty is able to do. The overall effect is that of a dog-training manual that occasionally addresses itself to the dog, who is assumed to be lazy or ill-behaved.
This is all the more galling because smug, condescending, unrealistic, and unhelpful is how he typically characterizes other pain therapies and other members of his profession, those who do not agree with him. But self-awareness and humility are not his strong suits. He likes to point out the lack of evidence for the efficacy of most pharmaceutical pain remedies, yet he cherry-picks evidence that supports his own therapies in risibly obvious ways, or ignores evidence altogether: "There are no studies looking at the long-term outcomes of patients who have participated in a pain management program" is an actual sentence from the chapter in which he touts the good outcomes of his pain management program. Oh.
His buzzword is "biopsychosocial," as in "a biopsychosocial therapeutic approach," as opposed to a pharmacological treatment approach. Yet he doesn't manage to make the conceptual leap that the "-social" part of his pet neologism might need to entail... actual changes in society, such as doing away with the economic necessity of people to work jobs in which they often become injured, or to continue to report to work even when they're injured in order to earn a living. (The author's practice is in the UK, with its public healthcare system and more rational system for approving and allocating disability benefits and pensions; I won't speculate on how his approach would translate to the U.S., if it could at all.) The psychological portion of his therapy he seems to address mostly in terms of how his patients tend to resist it, or to resent (rightly) the implication that they are malingering, mentally ill, or suffering imaginary pain.
The strange fact is that I found myself of agreeing, in theory anyway, with much of Lalkhen's therapeutic approach. The problem is that what's good in it isn't particularly novel, and the way in which it's presented is off-putting, sometimes confusing, and not well-supported by data. Best avoided.
Which invites the question, Who is the intended audience? Dr. Lalkhen doesn't appear to have asked himself this question before he began writing it. Someone—his editor, his agent, a peer reviewer—should have asked it, and explained why it's important. Because it's apparently marketed toward people with a vested, personal interest in the experience of pain. This is misleading. Most of the time, it seems to be written with other pain management clinicians in mind, whether physicians, nurse practitioners, psychologists, or physical therapists (which is odd, because Lalkhen rarely passes up an opportunity to talk trash about members of these vocations unless they already agree with him). In those parts of the book, he discusses the physiology, electrochemistry, and pharmacology of the causes of pain and possible treatments at a fairly technical level. He details how his clinical practice is organized in terms of diagnostic criteria and daily praxis. Other parts of the book are more of a smug, self-regarding memoir. Where he does address the patient or sufferer more directly, he comes across as condescending and, frequently, exasperated by our common foibles and our unrealistic expectations of what his specialty is able to do. The overall effect is that of a dog-training manual that occasionally addresses itself to the dog, who is assumed to be lazy or ill-behaved.
This is all the more galling because smug, condescending, unrealistic, and unhelpful is how he typically characterizes other pain therapies and other members of his profession, those who do not agree with him. But self-awareness and humility are not his strong suits. He likes to point out the lack of evidence for the efficacy of most pharmaceutical pain remedies, yet he cherry-picks evidence that supports his own therapies in risibly obvious ways, or ignores evidence altogether: "There are no studies looking at the long-term outcomes of patients who have participated in a pain management program" is an actual sentence from the chapter in which he touts the good outcomes of his pain management program. Oh.
His buzzword is "biopsychosocial," as in "a biopsychosocial therapeutic approach," as opposed to a pharmacological treatment approach. Yet he doesn't manage to make the conceptual leap that the "-social" part of his pet neologism might need to entail... actual changes in society, such as doing away with the economic necessity of people to work jobs in which they often become injured, or to continue to report to work even when they're injured in order to earn a living. (The author's practice is in the UK, with its public healthcare system and more rational system for approving and allocating disability benefits and pensions; I won't speculate on how his approach would translate to the U.S., if it could at all.) The psychological portion of his therapy he seems to address mostly in terms of how his patients tend to resist it, or to resent (rightly) the implication that they are malingering, mentally ill, or suffering imaginary pain.
The strange fact is that I found myself of agreeing, in theory anyway, with much of Lalkhen's therapeutic approach. The problem is that what's good in it isn't particularly novel, and the way in which it's presented is off-putting, sometimes confusing, and not well-supported by data. Best avoided.
February 3, 2025
Very insightful book! I enjoyed it but nonfiction pains me (lol)
The author truly wants to heal the person, not the symptom and I respect that. The healthcare system is broken, and usually leads to new treatments that defy the medical normal is greatly shunned, since it would take a complete rewriting of the current system. Much like chemo being such a big “business” that we “haven’t” solved cancer yet.
Pain is different. There is no solution, no fix-all, despite multiple claims that there is. The best way to heal chronic pain is to change your lifestyle, become more mobile, focus on your mental health, and the people around you. You can’t fix a bad knee if you don’t lose weight, you can’t fix diabetes issues if you don’t first cut down sugar. Seems simple, but seems impossible for doctors to say. Don’t go somewhere that profits off your pain, and your continued suffering. Go to a practitioner that is funded by taxpayers, state-funded. Those are the people more focused on your getting better than anytbing.
“For every complex problem, there is a solution that is clear, simple, and wrong.”
Take this pain doctor, he prescribes people spinal cord stimulation that over half the time, permanently heals a patient of chronic pain. And yet most doctors won’t recommend it.
I’ve taken quite a bit from this book, and the major thing is how essential your brain is to pain. People who are more depressed experience higher pain levels. Anxious people tend to walk a certain way to avoid pain, while hurting the places that don’t get used as much. It’s not “all in your head,” but pain is very personal, and individual. Knowing your pain, and understanding where it comes from in all aspects is a great first way to manage it. Mental health matters, and it should be more prioritized in the health industry 🙏🏻
The author truly wants to heal the person, not the symptom and I respect that. The healthcare system is broken, and usually leads to new treatments that defy the medical normal is greatly shunned, since it would take a complete rewriting of the current system. Much like chemo being such a big “business” that we “haven’t” solved cancer yet.
Pain is different. There is no solution, no fix-all, despite multiple claims that there is. The best way to heal chronic pain is to change your lifestyle, become more mobile, focus on your mental health, and the people around you. You can’t fix a bad knee if you don’t lose weight, you can’t fix diabetes issues if you don’t first cut down sugar. Seems simple, but seems impossible for doctors to say. Don’t go somewhere that profits off your pain, and your continued suffering. Go to a practitioner that is funded by taxpayers, state-funded. Those are the people more focused on your getting better than anytbing.
“For every complex problem, there is a solution that is clear, simple, and wrong.”
Take this pain doctor, he prescribes people spinal cord stimulation that over half the time, permanently heals a patient of chronic pain. And yet most doctors won’t recommend it.
I’ve taken quite a bit from this book, and the major thing is how essential your brain is to pain. People who are more depressed experience higher pain levels. Anxious people tend to walk a certain way to avoid pain, while hurting the places that don’t get used as much. It’s not “all in your head,” but pain is very personal, and individual. Knowing your pain, and understanding where it comes from in all aspects is a great first way to manage it. Mental health matters, and it should be more prioritized in the health industry 🙏🏻
February 9, 2025
Dr. Abdul-Ghaaliq Lalkhen is South African anesthesiologist practicing the subspecialty of pain management in a National Health Service-administered outpatient practice in the UK. In his 2021 book An Anatomy of Pain, he writes about his practice philosophy, borne out of his own experience and those of his patients, in a way that I largely resonated with (as a fellow physician) but will likely turn off a subset of readers.
During medical school 10ish years ago, I had the opportunity to rotate for a month in a pain management clinic. It was eye-opening, but for all the worst reasons. The majority of the patients were prescribed opioids (many to the point of dependence), and a Purdue Pharma rep was in the office weekly handing out free Starbucks coffee to providers and staff. Procedures consisted largely of anesthetic nerve blocks, which are only meant to provide temporary relief (if any), though the providers I worked with never took the time to explain that to patients. The focus was not on improving pain or teaching patients to better cope with it, but on high volume and high profit, patient care be damned. Behind the scenes, providers and their staff referred to certain patients as drug seekers, dismissed diagnoses of chronic fatigue syndrome and fibromyalgia, and worse.
Dr. Lalkhen refers to similar pain management practices in the UK, mostly in the private setting for patients who can afford supplemental insurance in addition to the global NHS-provided coverage. Thankfully his philosophy on chronic pain management is more thoughtful and considered with patient benefit and nonmaleficence being the primary goal, with his practice providing psychosocial care as well as medical care. Though he seems floridly optimistic with the prospect of implantable nerve stimulation devices, he seems relatively balanced on other tools in the arsenal of chronic pain, with a well-grounded global perspective on systemic issues that can predispose to chronic pain.
My statistics:
Book 44 for 2025
Book 1970 cumulatively
During medical school 10ish years ago, I had the opportunity to rotate for a month in a pain management clinic. It was eye-opening, but for all the worst reasons. The majority of the patients were prescribed opioids (many to the point of dependence), and a Purdue Pharma rep was in the office weekly handing out free Starbucks coffee to providers and staff. Procedures consisted largely of anesthetic nerve blocks, which are only meant to provide temporary relief (if any), though the providers I worked with never took the time to explain that to patients. The focus was not on improving pain or teaching patients to better cope with it, but on high volume and high profit, patient care be damned. Behind the scenes, providers and their staff referred to certain patients as drug seekers, dismissed diagnoses of chronic fatigue syndrome and fibromyalgia, and worse.
Dr. Lalkhen refers to similar pain management practices in the UK, mostly in the private setting for patients who can afford supplemental insurance in addition to the global NHS-provided coverage. Thankfully his philosophy on chronic pain management is more thoughtful and considered with patient benefit and nonmaleficence being the primary goal, with his practice providing psychosocial care as well as medical care. Though he seems floridly optimistic with the prospect of implantable nerve stimulation devices, he seems relatively balanced on other tools in the arsenal of chronic pain, with a well-grounded global perspective on systemic issues that can predispose to chronic pain.
My statistics:
Book 44 for 2025
Book 1970 cumulatively
February 3, 2021
I almost put it down, about 30 pages in, when he started uncritically talking about Ayurvedic medicine and traditional Chinese medicine. Fortunately, overall, I'm glad I didn't. Dr. Lalkhen takes a holistic approach to modern pain management medicine and explains how he does that in most of the rest of the book, which is also a call for modern medicine in general to do more of this.
Along the way, he discusses how and why opioid addiction has surged, and how a management of pain that includes both lifestyle changes and a realization that much chronic pain is not curable, but can be ... that word, managed ... might be part of the battle against addiction.
It's also interesting, from the US, to read his take on the strengths (and weaknesses) of the NHS, as well as the strengths (and weaknesses) of private for-profit medical care in Britain.
Along the way, he discusses how and why opioid addiction has surged, and how a management of pain that includes both lifestyle changes and a realization that much chronic pain is not curable, but can be ... that word, managed ... might be part of the battle against addiction.
It's also interesting, from the US, to read his take on the strengths (and weaknesses) of the NHS, as well as the strengths (and weaknesses) of private for-profit medical care in Britain.
March 13, 2021
A compassionate, thoughtful long time National Health Service practitioner offers many interesting personal and scientific insights into a subject that touches everyone to some degree.
May 3, 2022
This book didn't know what it wanted to be. Really enjoyed the first part, which went into detail about historical perceptions of pain and how biologically humans feel pain. I was hoping for more. Like how people can power through seemingly insufferable pain or why some individuals are aroused by pain. But instead of continuing with this thread of scientific exploration, it turns into a memoir. The author has a lot of strong opinions which I did not sign up for. Went into great detail about stimulators and the limits of pain relievers and anti-inflammatories but had basically no concrete information to provide to back up his claims that an attitude change and mindfulness can help people with chronic pain (and actually said health/wellbeing/outlook for chronic pain sufferers was a choice??...although he is writing from a country with universal healthcare so). Odd vibes when he talks about topics like disability payments/government support and weight. Would not have read it if I had known what it was really about.
January 17, 2022
This book has a great introduction and becomes a slog as it continues. If nothing else just read the introduction-- boom. There you go.
April 5, 2023
I read this book for a neuroscience book club I co-run. Message me if you want our book report 😊
I think the biology and experience of pain is quite interesting, and a pretty under-explored topic in popular science writing, so I liked this book. Lalkhen is a physician specializing in pain management, and states that his aim in the book is to “explain pain in all its forms: pain from physical trauma, cancer pain, and pain that appears to continue in the absence of any physical damage.” He makes the point that pain is an ancient biological alarm system, but doesn’t operate with the specificity (location, intensity, or temporal) that we like to think it does in relation to tissue damage. He covers what is know about the physiology of pain, and what makes some people more prone to chronic pain than others (at the receptor level as well as mindset). He also speculates that one reason it’s so hard for us to understand pain in the absence of injury is our adherence to an atavistic Cartesian model of the mind being separate from the body. He discusses how pain has been seen over time in other cultures (I confess not the most interesting section to me), and the treatments we’ve devised to deal with pain (a litany of drugs, and more recently, spinal cord stimulation).
I enjoyed learning about the science and treatment of pain from this book, but Lalkhen’s attitude towards patients was both condescending and unrealistic.
Perhaps the most egregious thing the author said was his claim that if you do not drink alcohol, exercise regularly, follow a good diet, and live mindfully in the moment “then it is likely you need never darken the door of a hospital or your GP” nor “trouble our psychologists.”
So when I developed a mysterious and debilitating allergy and had to get extensive patch testing to figure it out, was that because I was drinking alcohol or not exercising enough? When the crime rate in my neighborhood shot up 300% during the pandemic and I developed an anxiety disorder, did I need several months of therapy to get back to normal because I wasn’t trying hard enough to live mindfully? Lalkhen seems to have a soft spot for older patients who he finds “more reflective about their pain and more understanding of the limitations of the science of suffering.” Sounds like bro got butthurt treating patients who actually expect to get substantially better. I agree with him that mindset plays a large role in the management of any health condition, but it would be hard for me to exercise that mindset with such a dismissive physician. If this dude was my doctor, I’d go full Karen and ask to speak to his manager.
Overall, interesting book about pain; very glad this guy isn’t my doctor.
I think the biology and experience of pain is quite interesting, and a pretty under-explored topic in popular science writing, so I liked this book. Lalkhen is a physician specializing in pain management, and states that his aim in the book is to “explain pain in all its forms: pain from physical trauma, cancer pain, and pain that appears to continue in the absence of any physical damage.” He makes the point that pain is an ancient biological alarm system, but doesn’t operate with the specificity (location, intensity, or temporal) that we like to think it does in relation to tissue damage. He covers what is know about the physiology of pain, and what makes some people more prone to chronic pain than others (at the receptor level as well as mindset). He also speculates that one reason it’s so hard for us to understand pain in the absence of injury is our adherence to an atavistic Cartesian model of the mind being separate from the body. He discusses how pain has been seen over time in other cultures (I confess not the most interesting section to me), and the treatments we’ve devised to deal with pain (a litany of drugs, and more recently, spinal cord stimulation).
I enjoyed learning about the science and treatment of pain from this book, but Lalkhen’s attitude towards patients was both condescending and unrealistic.
Perhaps the most egregious thing the author said was his claim that if you do not drink alcohol, exercise regularly, follow a good diet, and live mindfully in the moment “then it is likely you need never darken the door of a hospital or your GP” nor “trouble our psychologists.”
So when I developed a mysterious and debilitating allergy and had to get extensive patch testing to figure it out, was that because I was drinking alcohol or not exercising enough? When the crime rate in my neighborhood shot up 300% during the pandemic and I developed an anxiety disorder, did I need several months of therapy to get back to normal because I wasn’t trying hard enough to live mindfully? Lalkhen seems to have a soft spot for older patients who he finds “more reflective about their pain and more understanding of the limitations of the science of suffering.” Sounds like bro got butthurt treating patients who actually expect to get substantially better. I agree with him that mindset plays a large role in the management of any health condition, but it would be hard for me to exercise that mindset with such a dismissive physician. If this dude was my doctor, I’d go full Karen and ask to speak to his manager.
Overall, interesting book about pain; very glad this guy isn’t my doctor.
May 31, 2024
Dr Abdul-Ghaaliq Lalkhen’s ‘An Anatomy of Pain’ was incredibly informative and had me looking at human’s relationship to pain in a way that I never really stopped and considered. It was really exciting to consider things very human thing in an academic way.
I loved learning about how societies relationship to pain affects each of us individually, how the first healers were almost always women, and how pain used to be deemed as a necessity for success.
I will say that I appreciated how Dr Abdul-Ghaaliq Lalkhen writes; although I still felt it was just too technical for my brain at some points. It felt a bit repetitive. I did adore the acknowledgement and a peak behind the curtain regarding medical philosophies and attitudes that lead to powerful, human centred care.
I loved learning about how societies relationship to pain affects each of us individually, how the first healers were almost always women, and how pain used to be deemed as a necessity for success.
I will say that I appreciated how Dr Abdul-Ghaaliq Lalkhen writes; although I still felt it was just too technical for my brain at some points. It felt a bit repetitive. I did adore the acknowledgement and a peak behind the curtain regarding medical philosophies and attitudes that lead to powerful, human centred care.
August 2, 2023
An Anatomy of Pain by Dr. Abdul-Ghaaliq Lalkhen: Book Review
I sometimes find it difficult to read books written by MDs. It's as if they are operating from a thought bubble that no one else is privy to. But Dr. Lalkhen's book, An Anatomy of Pain, was insightful, sensitive, and intensely human.
Dr. Lalkhen gives a relatable overview of the way pain works in the body, the history of pain medicine, and the phenomenon that has now become an epidemic of chronic pain. In these pages, the author lays out a comprehensive understanding of the limitations of pain management and outlines the ways in which this sub-specialty has lost its way. I learned that pain management was not an exact science and found myself heartened that at least this medical professional was humble and knowledgeable enough to admit the many systemic failures that have led to increased pain chronicity in modern life.
He isn't afraid of calling for personal responsibility on the part of patients—and society as a whole—when it comes to health. There are too many "Doctor-fix-mes" and this demand, along with the typical hubris found in medicine, has introduced corrupting influences in pain management, made more complex by insurance companies and government entities such as the NHS (in the UK.) As for American healthcare, he doesn't come right out and say it, but it's implied that the corruption in medicine runs even deeper here. The author spends a lot of time on how the pain system works in our nervous systems, specifically how complex chronic pain is.
My only complaint, the reason for the four stars, was the author's parroting presumption that a chemical imbalance is what causes anxiety and depression. This false theory continues to be disproved, yet medical mainstream takes it as a gospel. While this isn't the main focus of the book, the author does weave this premise into his narrative on the role serotonin and norepinephrine play in pain, and it's a shame that this misinformation and bad science is being promulgated throughout medicine, not just in psychiatry. One chilling phrase used by doctors who reject scientific studies designed to reduce bias in favor of their own empirical and subjective experiences: "in my hands." I've known too many doctors like this—blinded by their self-importance and blind to the harm they cause.
That said, this book was written by a medical provider who seems to care deeply about his patients and about the health and welfare of our society. From the book: "…people exist in a context. Patients do not come to the pain clinic with just their pain." (p. 211)
Dr. Lalkhen clearly sees his patients as whole human beings and takes his work as a pain specialist seriously. The most fundamental part of his job, according to the book, rests in how he's able to explain chronic pain to his patients. Some hear him, some can't. He has seen the limitations of the medicalized model of pain relief, and what he offers, in particular, is a holistic approach in his practice that is both humane and honest. An Anatomy of Pain is an informative and relevant book for our increasingly unwell society. Written with passion and compassion, I highly recommend this book to anyone who suffers or knows the suffering of others.
I sometimes find it difficult to read books written by MDs. It's as if they are operating from a thought bubble that no one else is privy to. But Dr. Lalkhen's book, An Anatomy of Pain, was insightful, sensitive, and intensely human.
Dr. Lalkhen gives a relatable overview of the way pain works in the body, the history of pain medicine, and the phenomenon that has now become an epidemic of chronic pain. In these pages, the author lays out a comprehensive understanding of the limitations of pain management and outlines the ways in which this sub-specialty has lost its way. I learned that pain management was not an exact science and found myself heartened that at least this medical professional was humble and knowledgeable enough to admit the many systemic failures that have led to increased pain chronicity in modern life.
He isn't afraid of calling for personal responsibility on the part of patients—and society as a whole—when it comes to health. There are too many "Doctor-fix-mes" and this demand, along with the typical hubris found in medicine, has introduced corrupting influences in pain management, made more complex by insurance companies and government entities such as the NHS (in the UK.) As for American healthcare, he doesn't come right out and say it, but it's implied that the corruption in medicine runs even deeper here. The author spends a lot of time on how the pain system works in our nervous systems, specifically how complex chronic pain is.
My only complaint, the reason for the four stars, was the author's parroting presumption that a chemical imbalance is what causes anxiety and depression. This false theory continues to be disproved, yet medical mainstream takes it as a gospel. While this isn't the main focus of the book, the author does weave this premise into his narrative on the role serotonin and norepinephrine play in pain, and it's a shame that this misinformation and bad science is being promulgated throughout medicine, not just in psychiatry. One chilling phrase used by doctors who reject scientific studies designed to reduce bias in favor of their own empirical and subjective experiences: "in my hands." I've known too many doctors like this—blinded by their self-importance and blind to the harm they cause.
That said, this book was written by a medical provider who seems to care deeply about his patients and about the health and welfare of our society. From the book: "…people exist in a context. Patients do not come to the pain clinic with just their pain." (p. 211)
Dr. Lalkhen clearly sees his patients as whole human beings and takes his work as a pain specialist seriously. The most fundamental part of his job, according to the book, rests in how he's able to explain chronic pain to his patients. Some hear him, some can't. He has seen the limitations of the medicalized model of pain relief, and what he offers, in particular, is a holistic approach in his practice that is both humane and honest. An Anatomy of Pain is an informative and relevant book for our increasingly unwell society. Written with passion and compassion, I highly recommend this book to anyone who suffers or knows the suffering of others.
February 20, 2022
This is a fantastic book (five stars) for readers interested in medical history or anthropology or how the brain works. For people with pain who want insight into pain alleviation, the message can be life changing -- but you will need to slog through a lot of technical information. The book is easy to read, even for laypeople, and the author makes it interesting by reflecting on the development of his own thinking and specific patients from whom he learned. But I admit that I still did skip over large chunks of many chapters to extract the parts that were useful to me. I am taking away a deeper understanding of chronic pain, how it is experienced in the brain not the body, and the limitations of a western, biomedical approach that relies on high-cost tests, surgery, medications and other interventions -- all contradicting the author's well-documented contention that we need to think differently about pain. He doesn't say "it's all in our heads" but he does say that living with chronic pain requires us to think differently about our bodies and our health. I suspect that patients of Dr. Abdul-Ghaaliq Lalkhen consider themselves very, very fortunate.
November 11, 2022
There aren’t many books out there that talk about pain from the medical perspective yet sounding so human and written so smoothly.
This book read like fiction!
As someone who both works with pain and is directly affected by chronic pain, this book was a treat!
This is a must read for anyone who wants to understand pain and is interested in the history of pain treatment.
This will be a book I always turn to when referring to pain literature.
This book read like fiction!
As someone who both works with pain and is directly affected by chronic pain, this book was a treat!
This is a must read for anyone who wants to understand pain and is interested in the history of pain treatment.
This will be a book I always turn to when referring to pain literature.
March 10, 2023
I did not want to finish this disappointing, masturbatory book. I wanted to throw it across the room — preferably at the author's head. I kept reading in the hopes that the author would write something that would be redemptive, but that point never came.
I regret reading this book. There are far better balanced, more informative, dare I say – humane perspectives on pain, chronic pain, its origins, treatment and management.
Dr. Lalkhen seems to have a chip on his shoulder about youth in general, while he proudly holds his ageism up as a virtue. He comes across as quite judgmental and ableist in this book.
I doubt Dr. Lalkhen has ever experienced chronic pain. One should take care in writing a book titled How the Body and the Mind Experience and Endure Physical Suffering when one is personally inexperienced with it's actual intimacies. Something about living in glass houses and throwing stones? There was some interesting material, but it needs extensive editing to separate the selected facts and information from the prejudices and opinions that are unwelcome, unwanted and alienating.
I don't know the Doctor, perhaps he's excellent in that role, but reading this book, I would not *want* to know this person, and this book is distasteful.
Don't bother.
I regret reading this book. There are far better balanced, more informative, dare I say – humane perspectives on pain, chronic pain, its origins, treatment and management.
Dr. Lalkhen seems to have a chip on his shoulder about youth in general, while he proudly holds his ageism up as a virtue. He comes across as quite judgmental and ableist in this book.
I doubt Dr. Lalkhen has ever experienced chronic pain. One should take care in writing a book titled How the Body and the Mind Experience and Endure Physical Suffering when one is personally inexperienced with it's actual intimacies. Something about living in glass houses and throwing stones? There was some interesting material, but it needs extensive editing to separate the selected facts and information from the prejudices and opinions that are unwelcome, unwanted and alienating.
I don't know the Doctor, perhaps he's excellent in that role, but reading this book, I would not *want* to know this person, and this book is distasteful.
Don't bother.
March 2, 2021
Excellent read and a good history of pain. Dr. Abdul-Ghaaliq Lalkhen is an anesthesiologist and pain management doctor in the UK. He takes us through the history of pain and different types of pain, while explaining the science behind it and the many different methods of treatment that doctors have used across the century. He almost lost my attention when he started talking about alternative forms of pain management, but I'm glad I stuck with it since he was covering all aspects of pain management.
The conclusion is that while pain is a universal human experience, we still don't know much about it. I took a lot of notes and will reflect back on them once I've had a chance to review and think about what he has said in his book.
There are plenty of case studies to review in this book, so if you're looking for a book that explains all different types of pain as well as different treatments and what the current health landscape looks like for patients who experience pain, this book has every angle covered.
The conclusion is that while pain is a universal human experience, we still don't know much about it. I took a lot of notes and will reflect back on them once I've had a chance to review and think about what he has said in his book.
There are plenty of case studies to review in this book, so if you're looking for a book that explains all different types of pain as well as different treatments and what the current health landscape looks like for patients who experience pain, this book has every angle covered.
November 10, 2021
I think how much you take away from this will depend on your life experiences with pain. If you've only every had clear reasons why you are in pain, that resolved completely when those reasons heal up (lucky you!), I think the connections the author is making will seem hokey. If you have experienced chronic pain, un-diagnosable pain, or a Dr has ever told you "you've healed up nicely, so there's no reason why you are still in pain", then I think you will get something out of this book.
What I did take away was that very little is known about the processes of pain. And that when you are going through a painfully difficult time in your life, start seeing a psychologist/therapist. These specialists seem to be equally as important to pain management as the dr prescribing the meds.
What I did take away was that very little is known about the processes of pain. And that when you are going through a painfully difficult time in your life, start seeing a psychologist/therapist. These specialists seem to be equally as important to pain management as the dr prescribing the meds.
July 3, 2021
This is exactly the book the medical field needs right now. Simple, straightforward, honest. I learned a lot but was never bored. I appreciated Lalkhen’s acknowledgment of his shortcomings and his explication of the path he has paved to become a conscientious aide in the treatment of pain. I highly recommend this to anyone living with a chronic pain condition.
February 22, 2021
A good read for those experiencing chronic pain.
June 17, 2022
self-indulgent and repetitive
June 30, 2024
read this book!!
August 28, 2022
I would recommend this to non medical workers, or if you are just getting into the field.
March 12, 2021
Pain is ubiquitous in our existence as human beings. Although that is the case, we know very little about pain. Generally, pain is a response to injury. However, this description is inadequate for our needs.
Dr. Abdul-Ghaaliq Lalkhen explores the many facets of pain and our limited understanding of how it works. All pain exists in the brain. Dr. Lalkhen explains pain in excruciating and exquisite detail. For example, he discusses the video footage of when David Beckham tore his Achilles Tendon. Beckham doesn't notice his injury for a while. When he does notice it, it's too late to react to it, and he has to take a stoic approach.
Dr. Lalkhen also talks about how we battle pain with drugs that don't work as intended. Sometimes the pain signals overreact. Dr. Lalkhen compares it to a car alarm that goes off for no reason. This state leads to chronic pain, which is misunderstood.
Dr. Abdul-Ghaaliq Lalkhen explores the many facets of pain and our limited understanding of how it works. All pain exists in the brain. Dr. Lalkhen explains pain in excruciating and exquisite detail. For example, he discusses the video footage of when David Beckham tore his Achilles Tendon. Beckham doesn't notice his injury for a while. When he does notice it, it's too late to react to it, and he has to take a stoic approach.
Dr. Lalkhen also talks about how we battle pain with drugs that don't work as intended. Sometimes the pain signals overreact. Dr. Lalkhen compares it to a car alarm that goes off for no reason. This state leads to chronic pain, which is misunderstood.
February 22, 2021
I agree with Tilly's review. Also suffering from chronic pain, I got the book for the same reason as her. I also expected what Tilly was waiting for. Dry as dust, boring overall. Unless you're pre-med or already a doctor, take a pass on this one.
November 23, 2022
2 stars. I enjoyed the first 5 chapters, learning about how the body experiences pain and the history and mechanisms of common methods of pain relief. It was when the author began discussing chronic pain that I sensed a judgemental and ableist tone. That patients use treatments to justify their disability to the department of labor? He goes on to say all patients could be rehabilitated if they wanted to, but choose not to because their identity is so wrapped up in their chronic pain. That they would lose their disability checks or it would change their relationship dynamic and would no longer be the center of attention. However when discussing his clinic, he admits that not everyone is a good candidate for their program. In the same chapter about his clinic he decides to share with us his daily routine, starting with the gym at 6am. *eye roll* I felt like I could smell his ego rising off the page. The author may have a medical degree and years of experience, but you cannot help but notice he speaks as someone who has never experienced chronic pain personally.
April 4, 2023
This book provided me with a much deeper understanding of the causes and effects of chronic pain. Who knew there are so many different types of pain detectors in our body: some measure temperature damage, others physical trauma. Also fascinating were insights on the treatment available for those debilitated by pain. There is just so much we don’t know and the science is still in its infancy.
Lots of good information in the book, but goodness it was a terrible reading experience. This book had all the drama and pathos of a grocery list. The writing was stilted and professorial. This book could have been a fascinating journey of stories. Instead, it was a long slog of cold information.
Lots of good information in the book, but goodness it was a terrible reading experience. This book had all the drama and pathos of a grocery list. The writing was stilted and professorial. This book could have been a fascinating journey of stories. Instead, it was a long slog of cold information.
November 28, 2021
The author's voice is strong in this book, at times to a distracting degree. I think it's natural to expect a little bit more objectivity with such a complicated and divisive subject; in that sense, the book is a letdown and at times dismissive, vague, and imprecise. Dr. Lalkhen is often getting lost in the weeds, discussing the particulars of his practice, experiences, and struggles with healthcare structures that are specific to the UK. He can also come off as a cranky Luddite, grumbling that people just need to eat better, get better sleep, and log off Instagram. He speaks broadly of a society in pain, and points to sugar, sedentary lifestyles, and quick-fix medical solutions while ignoring the misery of the individuals who seek treatment.
What is most interesting about this book is its insistence on placing pain within a cultural context, a valuable shift in perspective. He is more interested in what pain means to a patient, and how this meaning influences their experience of suffering. His insistence that we are over-medicalized and suffer when we assign ourselves the role of the passive patient is convincing. "For every complex problem," he notes, "there is a solution that is clear, simple and wrong." Not only are we currently unable to offer easy solutions, he points out, it is cruel to pretend to patients that their cases will be solved. Pain is inevitable and targeting its diminishment at all costs is just as detrimental to a healthy life. "We need to accept that many aspects of modern life are damaging the people and that merely providing passive solutions from a healthcare point of view is at best futile and at worst unethical."
Many, especially chronic pain patients, would find these words to be harmful and unsympathetic. But I think it reflects something about the current state of pain management and may give individual sufferers a view into why their experiences are so often ignored — doctors have little else to give besides broad claims that: "This growth in chronic pain is aided and abetted by sugary inactivity and nihilism." Enjoy swallowing that bitter pill.
Notes
The graver the injury, or the more times it is inflicted, the more keys are made available and the more doors are opened, resulting in more information being sent from the spinal cord to the brain — a phenomenon called wind-up, which contributes to the persistence of pain even with the injury has healed. (PG. 12)
"Everything we hear is an opinion, not a fact, and everything we see is a perspective, not the truth." Marcus Aurelius
Self-efficacy: a personal conviction that one can successfully execute a course of action to produce a desired outcome in a situation
Avoidant coping, Avoidant behavior
Reinforcing disabling pattern
Deconditioning
Trigger conditions
The aim of rehabilitation is to increase tolerance to trigger situations, and psychology-based pain management utilizes the concept of behavioral activation, which encourages the individual do use approaching rather than avoiding behaviors and to become active despite their negative feelings or lack of motivation. Repeated practice in the same situation results in progressively reduce anxiety with each exposure… Behavioral activation uses the principles of operant conditioning or associative learning, reworking a patient’s association between an action and the likely consequences… (PG. 140)
The often undisclosed reality, However, is that once a society has moved beyond violence in the streets in the form of shootings and stabbings, once people have ceased clubbing each other over the head and if you live in a home that has a flushing toilet and have access to soap and water on a regular basis as well as appropriate nutrition, then you have probably already saved yourself from around 90 percent of the melodies that could affect you and for which you would need a hospital. (PG. 196)
Even as we become increasingly obsessed with well-being, there was a rise of people suffering from disabling chronic pain. As a society, we are seeing a growth in chronic pain aided and abetted by sugary inactivity and nihilism… there is little made of the role that a bio psycho social effect to the management of chronic pain could play in our society and no recognition for the work that should be done by health providers in improving the overall health of the population. (PG. 197)
We live such short lives and cower in the face of eternity, desperately engaged in immortality projects. Children, money, same, and the accumulation of stuff. In my view, this short lifespan gives us the unique but quite distorted perspective of ourselves and where we fit into the span of human history…
The greatest discomfort and times of discord have also been the greatest moments of learning in progress. We like to think that our choices are made in the fullness of joy and in moments of quiet reflection brought on by contentment. But the truth is, that as a species we often make dramatic steps forward when we are most uncomfortable. We therefore have a relationship with pain and suffering that is characterized not just by negatively but also by complexity and growth. (PG. 207)
We need to aqccept that many aspects of modern life are damaging the people and that merely providing passive solutions from a healthcare point of view is at best futile and at worst unethical. (PG. 215)
What is most interesting about this book is its insistence on placing pain within a cultural context, a valuable shift in perspective. He is more interested in what pain means to a patient, and how this meaning influences their experience of suffering. His insistence that we are over-medicalized and suffer when we assign ourselves the role of the passive patient is convincing. "For every complex problem," he notes, "there is a solution that is clear, simple and wrong." Not only are we currently unable to offer easy solutions, he points out, it is cruel to pretend to patients that their cases will be solved. Pain is inevitable and targeting its diminishment at all costs is just as detrimental to a healthy life. "We need to accept that many aspects of modern life are damaging the people and that merely providing passive solutions from a healthcare point of view is at best futile and at worst unethical."
Many, especially chronic pain patients, would find these words to be harmful and unsympathetic. But I think it reflects something about the current state of pain management and may give individual sufferers a view into why their experiences are so often ignored — doctors have little else to give besides broad claims that: "This growth in chronic pain is aided and abetted by sugary inactivity and nihilism." Enjoy swallowing that bitter pill.
Notes
The graver the injury, or the more times it is inflicted, the more keys are made available and the more doors are opened, resulting in more information being sent from the spinal cord to the brain — a phenomenon called wind-up, which contributes to the persistence of pain even with the injury has healed. (PG. 12)
"Everything we hear is an opinion, not a fact, and everything we see is a perspective, not the truth." Marcus Aurelius
Self-efficacy: a personal conviction that one can successfully execute a course of action to produce a desired outcome in a situation
Avoidant coping, Avoidant behavior
Reinforcing disabling pattern
Deconditioning
Trigger conditions
The aim of rehabilitation is to increase tolerance to trigger situations, and psychology-based pain management utilizes the concept of behavioral activation, which encourages the individual do use approaching rather than avoiding behaviors and to become active despite their negative feelings or lack of motivation. Repeated practice in the same situation results in progressively reduce anxiety with each exposure… Behavioral activation uses the principles of operant conditioning or associative learning, reworking a patient’s association between an action and the likely consequences… (PG. 140)
The often undisclosed reality, However, is that once a society has moved beyond violence in the streets in the form of shootings and stabbings, once people have ceased clubbing each other over the head and if you live in a home that has a flushing toilet and have access to soap and water on a regular basis as well as appropriate nutrition, then you have probably already saved yourself from around 90 percent of the melodies that could affect you and for which you would need a hospital. (PG. 196)
Even as we become increasingly obsessed with well-being, there was a rise of people suffering from disabling chronic pain. As a society, we are seeing a growth in chronic pain aided and abetted by sugary inactivity and nihilism… there is little made of the role that a bio psycho social effect to the management of chronic pain could play in our society and no recognition for the work that should be done by health providers in improving the overall health of the population. (PG. 197)
We live such short lives and cower in the face of eternity, desperately engaged in immortality projects. Children, money, same, and the accumulation of stuff. In my view, this short lifespan gives us the unique but quite distorted perspective of ourselves and where we fit into the span of human history…
The greatest discomfort and times of discord have also been the greatest moments of learning in progress. We like to think that our choices are made in the fullness of joy and in moments of quiet reflection brought on by contentment. But the truth is, that as a species we often make dramatic steps forward when we are most uncomfortable. We therefore have a relationship with pain and suffering that is characterized not just by negatively but also by complexity and growth. (PG. 207)
We need to aqccept that many aspects of modern life are damaging the people and that merely providing passive solutions from a healthcare point of view is at best futile and at worst unethical. (PG. 215)
May 19, 2021
Dr Lalkhen has written a marvelous book on pain and examines how it affects the human body and mind thereby creating the experience of suffering. He explores the modern biopsychosocial model of pain management. This model suggests that pain is a combination of an underlying physical pathology (bio), a person's thoughts and emotions towards that pathology (psycho) and the person's social factors like stress, family problems or trauma (social).
Pain often acts as a biological alarm system and lets the brain know that there is something happening to the body that needs attention. In such a situation, pain is needed to prevent unintentional harm towards the body. Such a type of pain is known as acute pain. Once the external stimulus for the pain is removed, acute pain tends to go away. The brain secretes inhibitory chemicals that propagate downwards through the spinal cord that reduce the pain.
However, in cases of chronic pain, this biological alarm system itself starts malfunctioning. What was once a useful element of protection becomes a nightmare to live with. What is more interesting is that in cases of chronic pain that is originating in the spine, MRI scans fail to show any irregularity compared to a normal spine. This doesn't really mean that the pain "is all in the head". It simply means that the pain is being experienced because the brain is misinterpreting signals. It is very much real.
In such cases, Dr Lalkhen emphasizes the importance of being able to maintain a positive outlook and a helpful environment. Psychological makeup of a patient becomes important because if a patient starts expecting or anticipating pain, it starts causing a whole host of other issues. The patient avoids trying to get into positions that may cause pain out of fear of triggering it. This leads to joint stiffness, reduced flexibility and diminished quality of life. It further sensitizes the pain pathways that inform the brain of pain and then even slight motions may start triggering the pain. This leads to a vicious cycle of ever increasing pain. A reason for this might be that catastrophizing or having negative thoughts leads to decreased levels of chemicals that can inhibit pain and therefore the pain inhibitory pathway becomes suppressed.
With a lot of relevant examples, Dr Lalkhen takes the reader through the landscape of pain management. He presents cases where patients have gone through a lot of doctors in their journey to get their pain treated but have inevitably failed. There have been patients whose surgery has gone perfectly but yet they suffer from post-operative chronic pain. The reader is introduced to various patients that he has dealt with in his career and how they react to him explaining his model of pain. He touches on the opioid crisis and how opioids just treat the exhibition of a symptom and not the underlying problem of improper management of pain. Treating the symptom without pain management is like going to the gym to get fit but not focusing on the diet. Towards the end, Dr Lalkhen expounds his model of pain management and how he ensures that patients get the most out of their visit.
The book is very relevant since everyone will experience some sort of pain sometime in their life. It can be acute pain like that of surgery, or chronic pain arising from inexplicable conditions. Women will face the pain of childbirth. Amateur and professional athletes will inevitable face injuries or pain from unclear conditions. In all these cases, it is important to understand that pain is more than just the underlying pathology causing the alarm system to blare. It will lead to an acceptance of the pain and an improved quality of life.
P.S: A very good complement to this book is Understanding Pain Understanding Pain. Check it out for a different (yet complementary) perspective on the same biopsyschosocial model.
Pain often acts as a biological alarm system and lets the brain know that there is something happening to the body that needs attention. In such a situation, pain is needed to prevent unintentional harm towards the body. Such a type of pain is known as acute pain. Once the external stimulus for the pain is removed, acute pain tends to go away. The brain secretes inhibitory chemicals that propagate downwards through the spinal cord that reduce the pain.
However, in cases of chronic pain, this biological alarm system itself starts malfunctioning. What was once a useful element of protection becomes a nightmare to live with. What is more interesting is that in cases of chronic pain that is originating in the spine, MRI scans fail to show any irregularity compared to a normal spine. This doesn't really mean that the pain "is all in the head". It simply means that the pain is being experienced because the brain is misinterpreting signals. It is very much real.
In such cases, Dr Lalkhen emphasizes the importance of being able to maintain a positive outlook and a helpful environment. Psychological makeup of a patient becomes important because if a patient starts expecting or anticipating pain, it starts causing a whole host of other issues. The patient avoids trying to get into positions that may cause pain out of fear of triggering it. This leads to joint stiffness, reduced flexibility and diminished quality of life. It further sensitizes the pain pathways that inform the brain of pain and then even slight motions may start triggering the pain. This leads to a vicious cycle of ever increasing pain. A reason for this might be that catastrophizing or having negative thoughts leads to decreased levels of chemicals that can inhibit pain and therefore the pain inhibitory pathway becomes suppressed.
With a lot of relevant examples, Dr Lalkhen takes the reader through the landscape of pain management. He presents cases where patients have gone through a lot of doctors in their journey to get their pain treated but have inevitably failed. There have been patients whose surgery has gone perfectly but yet they suffer from post-operative chronic pain. The reader is introduced to various patients that he has dealt with in his career and how they react to him explaining his model of pain. He touches on the opioid crisis and how opioids just treat the exhibition of a symptom and not the underlying problem of improper management of pain. Treating the symptom without pain management is like going to the gym to get fit but not focusing on the diet. Towards the end, Dr Lalkhen expounds his model of pain management and how he ensures that patients get the most out of their visit.
The book is very relevant since everyone will experience some sort of pain sometime in their life. It can be acute pain like that of surgery, or chronic pain arising from inexplicable conditions. Women will face the pain of childbirth. Amateur and professional athletes will inevitable face injuries or pain from unclear conditions. In all these cases, it is important to understand that pain is more than just the underlying pathology causing the alarm system to blare. It will lead to an acceptance of the pain and an improved quality of life.
P.S: A very good complement to this book is Understanding Pain Understanding Pain. Check it out for a different (yet complementary) perspective on the same biopsyschosocial model.
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