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Adevărul despre durere. Noua știință a durerii și modul în care ne putem vindeca
Recunoaștem durerea când o simțim. Ne este teamă de ea și încercăm s-o evităm. Dar știm ce înseamnă ea cu adevărat?
În prezent, știința durerii a atins un nivel nemaivăzut până acum. În ultimii ani, cunoștințele noastre despre durere s-au schimbat atât de mult încât putem afirma că tot ceea ce credeam că știm despre durere este greșit.
Așa cum ne explică doctorul Monty Lyman, înțelegem greșit durerea și asta cu consecințe dăunătoare.
În această carte, autorul explorează studii de cercetare și subiecte de ultimă oră, printre care durerea-fantomă sau durerea persistentă, folosindu-se, printre altele, de interviuri cu supraviețuitori, dar și cu persoane care nu au simțit niciodată durere. În plus, ne explică faptul că durerea poate fi redusă și controlată și ne ajută să ajungem la o înțelegere mai profundă a ceea ce înseamnă să fim oameni. Aceasta este povestea nespusă a durerii, cel mai evaziv sentiment.
În prezent, știința durerii a atins un nivel nemaivăzut până acum. În ultimii ani, cunoștințele noastre despre durere s-au schimbat atât de mult încât putem afirma că tot ceea ce credeam că știm despre durere este greșit.
Așa cum ne explică doctorul Monty Lyman, înțelegem greșit durerea și asta cu consecințe dăunătoare.
În această carte, autorul explorează studii de cercetare și subiecte de ultimă oră, printre care durerea-fantomă sau durerea persistentă, folosindu-se, printre altele, de interviuri cu supraviețuitori, dar și cu persoane care nu au simțit niciodată durere. În plus, ne explică faptul că durerea poate fi redusă și controlată și ne ajută să ajungem la o înțelegere mai profundă a ceea ce înseamnă să fim oameni. Aceasta este povestea nespusă a durerii, cel mai evaziv sentiment.
392 pages, Paperback
First published July 15, 2021
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Displaying 1 - 30 of 33 reviews
July 6, 2022
I find it hard to read books written by doctors but Dr. Monty Lyman turned out to be an exception. He is a medical doctor, author and research fellow at the University of Oxford. When an old injury started to hurt again, I thought I would read up on the pain which led me to this book: The Painful Truth. In this book, Dr. Lyman looks at the various aspects of the pain which are quite uncommon but make a lot of sense and I don't think that most of the doctors pay attention to the various facets of pain discussed in the book. A few things I've learned from the book:
• Pain is a protector, not a detector.
• Pain is not a measure of injury.
• Pain is a decision made by the brain and has a memory.
• Pain is both sensory and emotional.
• Short-term pain is good for us; it is necessary for survival.
• Hypnosis can help in alleviating the pain in some cases.
• Opioids are good for short-term pain, but harmful when used for long-term.
• The experience of pain can enhance the pleasure of the reward.
• If you see someone in pain, your body tends to react to that pain.
• Social media has magnified our social pain.
• How much pain a person feels also depends upon his cultural upbringing.
• Our expectations powerfully influence our perception of pain.
As Dr. Lyman says, "Pain is an integral part of human existence." He suggests to learn about the pain, change your thinking about it which makes the brain less reactive to pain. Everyone feels pain differently and each one of us have different threshold levels of pain. We all have to live with pain from time to time. There are no quick fixes. Healing from pain is a gradual process and learning about is the first step we can take.
• Pain is a protector, not a detector.
• Pain is not a measure of injury.
• Pain is a decision made by the brain and has a memory.
• Pain is both sensory and emotional.
• Short-term pain is good for us; it is necessary for survival.
• Hypnosis can help in alleviating the pain in some cases.
• Opioids are good for short-term pain, but harmful when used for long-term.
• The experience of pain can enhance the pleasure of the reward.
• If you see someone in pain, your body tends to react to that pain.
• Social media has magnified our social pain.
• How much pain a person feels also depends upon his cultural upbringing.
• Our expectations powerfully influence our perception of pain.
As Dr. Lyman says, "Pain is an integral part of human existence." He suggests to learn about the pain, change your thinking about it which makes the brain less reactive to pain. Everyone feels pain differently and each one of us have different threshold levels of pain. We all have to live with pain from time to time. There are no quick fixes. Healing from pain is a gradual process and learning about is the first step we can take.
June 8, 2023
„Dacă durerea este foc, atunci emoțiile sunt gaz.”
„Durerea nu este în corp, dar nici nu se găsește doar în minte: durerea este în persoană. Pentru a trata durerea, trebuie să tratăm omul în persoană.”
Multe informații valoroase am aflat citind această carte și as vrea să împărtășesc câteva dintre ele cu voi. Știați că:
- durerea nu este detectată de creier, ci este un produs al său, creat de un tipar de activitate care implică mai multe regiuni ale creierului ( se activează mai multe zone care au legătură cu senzorialul, emoționalul, cognitivul). Acest tipar se numește neurosemnătură
- nu există semnale de durere care să călătorească din țesuturi până în creier, ci receptori de pericol numiți nociceptori, care au rolul de a detecta vătămările provocate de stimuli nocivi (mecanici, termici, chimici)
- lipsa durerii se numește analgezie congenitală și nu este o binecuvântare, ci un chin care se poate dovedi letal
- la polul opus, eritromelalgia primară este starea în care intensitatea durerii ajunge repede la apogeu și este simțită în permanență de către cel care are această afecțiune cumplită
- creierul se poate modifica prin așteptări, efectul placebo putând schimba simptomele resimțite la nivelul creierului. Efectul nocebo are și el consecințe, însă negative
- cuvintele negative și mediul tensionat afectează creierul, starea psihică și pe cea fizică. Cuvintele pot răni la propriu !
-lumea modernă este un teren fertil pentru durere, fiind o lume a izolării, a rețelelor sociale, a sedentarismului. Este o lume a stresului, iar stresul duce la durere și la creșterea consumului de opioide
„Durerea nu este în corp, dar nici nu se găsește doar în minte: durerea este în persoană. Pentru a trata durerea, trebuie să tratăm omul în persoană.”
Multe informații valoroase am aflat citind această carte și as vrea să împărtășesc câteva dintre ele cu voi. Știați că:
- durerea nu este detectată de creier, ci este un produs al său, creat de un tipar de activitate care implică mai multe regiuni ale creierului ( se activează mai multe zone care au legătură cu senzorialul, emoționalul, cognitivul). Acest tipar se numește neurosemnătură
- nu există semnale de durere care să călătorească din țesuturi până în creier, ci receptori de pericol numiți nociceptori, care au rolul de a detecta vătămările provocate de stimuli nocivi (mecanici, termici, chimici)
- lipsa durerii se numește analgezie congenitală și nu este o binecuvântare, ci un chin care se poate dovedi letal
- la polul opus, eritromelalgia primară este starea în care intensitatea durerii ajunge repede la apogeu și este simțită în permanență de către cel care are această afecțiune cumplită
- creierul se poate modifica prin așteptări, efectul placebo putând schimba simptomele resimțite la nivelul creierului. Efectul nocebo are și el consecințe, însă negative
- cuvintele negative și mediul tensionat afectează creierul, starea psihică și pe cea fizică. Cuvintele pot răni la propriu !
-lumea modernă este un teren fertil pentru durere, fiind o lume a izolării, a rețelelor sociale, a sedentarismului. Este o lume a stresului, iar stresul duce la durere și la creșterea consumului de opioide
August 1, 2021
I’m a Physiotherapist with a background in persistent pain and Monty Lyman has nailed every single chapter here. You couldn’t pick a better book to get a more thorough, evidence-based understanding of the topic of persistent pain.
Recommend for anyone with a nervous system.
Recommend for anyone with a nervous system.
March 23, 2023
Neuroplasticitate in sens invers. Se pare ca si durerea e emoțională si cognitivă, nu e un răspuns la o rană sau o boală, ci mai degrabă un sistem de protecție al creierului, care se obișnuiește cu familiaritatea durerii si o transmite către corp, chiar si atunci cand corpul e vindecat. Daca ne schimbam modul de a gândi, se pare ca ne putem influența si durerea in corp. Mi se par niste idei extraordinare si greu de acceptat, dar nu despre asta vorbim? De a învața mereu lucruri noi, de a ne schimba mintea si implicit viața. Ce privilegiu sa trăim in aceste timpuri, cu acces la toata aceasta informație. 😊
“At the deepest layer of the onion, we are getting the brain ti change itself. Persistent pain is caused by our changeable, neuroplastic brain becoming more efficient at creating pain. An efficient tratament against pain is to make the brain feel safe in its body. To soothe it.”
“At the deepest layer of the onion, we are getting the brain ti change itself. Persistent pain is caused by our changeable, neuroplastic brain becoming more efficient at creating pain. An efficient tratament against pain is to make the brain feel safe in its body. To soothe it.”
November 23, 2024
Ca orice om, mă interesează și pe mine subiectul durerii. Cartea a fost interesantă, dar presupun că nu s-a aliniat perfect cu așteptările mele de la ea. Ceea ce este perfect în regulă. Îmi place că vorbește foarte divers despre durere și atinge multe aspecte importante care vizează prejudecățile noastre (și, din păcate, și ale persoanelor care lucrează în sistemul medical) cu privire la durerea în sine și la durerea diferențiată de rasă/sex. Am mai citit despre astfel de lucruri și prin alte părți. Mă pot gândi acum la „Vrăjitoare” de Mona Chollet unde vorbește, printre altele, despre modul descartian în care funcționează sistemul medical, în același timp atrăgând un semnal de alarmă față de modul diferit și crud în care tratăm femeile când vorbesc despre durere. Despre aceste lucruri vorbește și Monty Lyman la un moment dat, recunoscându-și prejudecățile pe care nici nu știa că le avea. Analizând problema, a ajuns la concluzia că este adevărat, bărbații și femeile sunt tratați diferit când vorbesc despre durere la medic. Ai zice că asta e ceva specific unor societăți străine, nu la noi, dar mă tem că nu pot fi de acord. E suficient să mă gândesc doar la experiența mea și a femeilor pe care le cunosc îndeaproape. E suficient să îmi amintesc, de exemplu, cum în ziua în care s-a născut fiica mea și mă plângeam că mă doare îngrozitor de tare, o asistentă mi-a răspuns plină de scârbă că „dacă mă doare acum, mai târziu ce fac, chiar nu sunt capabilă să suport?” Asta, doar așa, ceva care stă rent-free in my mind, dar am multiple și diverse alte exemple din experiențele prin care am trecut la medic vorbind despre durere, femeile sunt crezute mai greu, li se dau analgezice mai greu și sunt tratate, în general, mai rău când vine vorba despre asta. Dar hai să nu deschidem cutia pandorei. Monty Lyman atinge și subiectul acesta, ceea ce mi s-a părut corect și responsabil din partea lui, dar acesta e totuși doar un subpunct al cărții. Încearcă să demonteze anumite mituri cu privire la durere și să încerce să ne aducă o perspectivă întrucâtva mai umanistă. Nu m-a convins total cartea din pricina tonului motivațional și a absenței unui aparat critic mai convingător, până la urmă rămâne o carte interesantă despre subiecte generale privind durerea, dar nu mi-a adus neapărat o perspectivă extraordinară în direcția asta.
https://ramona.boldizsar.ro/ce-am-cit...
https://ramona.boldizsar.ro/ce-am-cit...
June 5, 2022
If you suffer from pain (as I do) then this book is essential reading. It could change your life.
My own pain comes from spinal injuries suffered in 2017. Some of the injuries were repaired (but with rods, screws and cages which is quite invasive and alien to the body), some are irreparable. Like many people, I continue to get chronic pain from the injuries that were repaired and/or healed with time, due to the pain system staying on 11 even after the threat had gone. It is this type of pain to which Monty Lyman refers, in the main. But as well as ‘chronic’ pain from repaired injuries, I continue to suffer severe pain from the irreparable injuries. Monty Lyman is less sure footed in this area, but is still worth reading / listening to (his Audible reading is superb) as even acute pain is worsened by some of the causes of chronic pain.
The book is not a self help treatise. It’s aim is to raise the knowledge of the reader to ‘expert’ (in terms of our current understanding of the subject) and point them at treatments and therapies that have helped others with the same problems. Following up on Lyman’s references will be necessary if you are to get better. But you can get better, and that is the main thing to take away from The Painful Truth. Even when the medical establishment just gives you opioids, ketamine, gabapentin and spinal injections and hopes you will disappear and stop spoiling their statistics, people like Monty Lyman give us hope - and it is real hope not false hope.
My own pain comes from spinal injuries suffered in 2017. Some of the injuries were repaired (but with rods, screws and cages which is quite invasive and alien to the body), some are irreparable. Like many people, I continue to get chronic pain from the injuries that were repaired and/or healed with time, due to the pain system staying on 11 even after the threat had gone. It is this type of pain to which Monty Lyman refers, in the main. But as well as ‘chronic’ pain from repaired injuries, I continue to suffer severe pain from the irreparable injuries. Monty Lyman is less sure footed in this area, but is still worth reading / listening to (his Audible reading is superb) as even acute pain is worsened by some of the causes of chronic pain.
The book is not a self help treatise. It’s aim is to raise the knowledge of the reader to ‘expert’ (in terms of our current understanding of the subject) and point them at treatments and therapies that have helped others with the same problems. Following up on Lyman’s references will be necessary if you are to get better. But you can get better, and that is the main thing to take away from The Painful Truth. Even when the medical establishment just gives you opioids, ketamine, gabapentin and spinal injections and hopes you will disappear and stop spoiling their statistics, people like Monty Lyman give us hope - and it is real hope not false hope.
December 4, 2021
In 1995, a twenty-nine-year-old British builder was clambering down a building’s scaffolding and, when he was near enough to the ground, decided to jump down onto a plank of wood. What he didn’t realize was that there was a fifteen-centimetre nail protruding up from the plank, which went straight through his left boot. The builder and his nail were brought into hospital; the man was in so much agony that he had to be given the powerful pain reliever fentanyl as well as a sedative. The builder’s boot was carefully cut away by the medical team, revealing the nail to have penetrated between his toes, causing no injury whatsoever.
Pain is necessary for life. But pain can also be life-ruining. Persistent pain pandemic is widespread and growing, and the medical profession is poorly equipped for it. Persistent pain is also perplexing: there is overwhelming evidence that in most cases the pain persists well after an injury has healed. Although certain cases of persistent pain are caused by a persistent injury in the tissues, in the majority of cases pain itself has become the disease.
Even if we know, deep down, that pain isn’t a measure of tissue damage, many of us act (and many health professionals treat their patients) as though pain is produced in the body and detected by the brain. Pain is a conscious translation of our unconscious brain’s decision that the body is in danger.
In most cases of persistent pain, our brain has – over time – become overprotective, creating pain even when the damage has gone. This might seem utterly illogical, but it makes sense when we look at the painful truth: pain is a protector. If we pull a muscle in our back, it will almost always completely heal. But, in many cases, in a well-meaning attempt to protect the precious spinal cord, the brain begins to interpret any movement in that area as something potentially threatening, creating pain even though this time there is no damage. And the more the brain does this, the better it gets at ‘learning’ pain, even long after the original tissue damage has healed. In most cases of persistent pain, pain stops being the symptom and becomes the disease. Importantly, this makes the pain no less agonizing, and no less real.
We need to understand that pain can easily exist in the absence of injury, and overprotection is often the root cause of chronic, persistent pain. The most effective, evidence-based treatments for chronic pain are ones that provide our brain with evidence of safety and reduce the evidence of threat. Trying to ‘fight’ pain with anger or denial never works, and therapies designed to remove a supposed ‘issue in the tissue’ rarely work, or rarely work in the way they purport to.
In SnowWorld - a virtual world, burns sufferers hurl snowballs while undergoing their notoriously painful wound care - diversion is a potent pain reliever.
Even placebo treatment increases the release of opioids across a range of pain-relevant brain areas. The mere expectation of pain relief – the belief that you will feel less pain – is enough for our brain to unlock its own drug cabinet and dispense a strong dose of wonderful opioids such as endorphins – essentially, non-addictive morphine. In clinical trials, the word placebo is associated with failure: if a new drug doesn’t perform better than a placebo in early trials, it has effectively exploded on the launch pad. But we are missing something precious if we ignore the pain-relieving power of expectation itself.
In 1944, American and British troops had landed on the beaches of Anzio in a daring attempt to outflank the heavily fortified German lines. The Allies had achieved the element of surprise in the amphibious landing, but the Germans rapidly moved all available forces to form a ring around the beachhead. From their vantage points in the surrounding hills, the Germans rained down a maelstrom of artillery fire on the Allies’ vulnerable position. It was a bloodbath. In the hospital at Anzio, medical officers were engulfed by wave after wave of wounded. One of these medics was the young Henry Beecher, and what he saw would lead him to become a pioneer of pain medicine. As each wounded man arrived at the hospital, Beecher would ask if they were in pain and whether they wanted any morphine. To his shock, over 70 per cent of the men – some severely injured – didn’t report any pain. After the war, Beecher saw the opposite in civilians in Boston wounded by car crashes or industrial accidents: a similar percentage answered ‘yes’ to these questions. In a paper analysing the two populations, Beecher found that the difference between the groups was not the extent of the injuries, but the meaning behind them, as perceived by the sufferers. On the Anzio beachhead, if a wounded soldier had reached hospital, he knew he was in a place of safety and would probably be shipped home. He was more likely to survive by being injured than not; the chances of survival out on the battlefield were slim. The injured Bostonian civilians, however, were moving from a position of safety to one of danger, so their brains naturally created pain. This is an extreme example – there aren’t many instances where being injured is beneficial – but it shows how pain is made by the perception of danger and soothed by safety.
With such anecdotes and along with the recent scientific work on what pain is, the author explains the most accepted pain theory: the bio-psycho-social model of pain, that is when it comes to pain, everything counts.
Pain is necessary for life. But pain can also be life-ruining. Persistent pain pandemic is widespread and growing, and the medical profession is poorly equipped for it. Persistent pain is also perplexing: there is overwhelming evidence that in most cases the pain persists well after an injury has healed. Although certain cases of persistent pain are caused by a persistent injury in the tissues, in the majority of cases pain itself has become the disease.
Even if we know, deep down, that pain isn’t a measure of tissue damage, many of us act (and many health professionals treat their patients) as though pain is produced in the body and detected by the brain. Pain is a conscious translation of our unconscious brain’s decision that the body is in danger.
V. S. Ramachandran, the eminent Indian–American neuroscientist, puts it well: ‘Pain is an opinion on the organism’s state of health rather than a mere reflective response to injury.’
In most cases of persistent pain, our brain has – over time – become overprotective, creating pain even when the damage has gone. This might seem utterly illogical, but it makes sense when we look at the painful truth: pain is a protector. If we pull a muscle in our back, it will almost always completely heal. But, in many cases, in a well-meaning attempt to protect the precious spinal cord, the brain begins to interpret any movement in that area as something potentially threatening, creating pain even though this time there is no damage. And the more the brain does this, the better it gets at ‘learning’ pain, even long after the original tissue damage has healed. In most cases of persistent pain, pain stops being the symptom and becomes the disease. Importantly, this makes the pain no less agonizing, and no less real.
We need to understand that pain can easily exist in the absence of injury, and overprotection is often the root cause of chronic, persistent pain. The most effective, evidence-based treatments for chronic pain are ones that provide our brain with evidence of safety and reduce the evidence of threat. Trying to ‘fight’ pain with anger or denial never works, and therapies designed to remove a supposed ‘issue in the tissue’ rarely work, or rarely work in the way they purport to.
In SnowWorld - a virtual world, burns sufferers hurl snowballs while undergoing their notoriously painful wound care - diversion is a potent pain reliever.
Even placebo treatment increases the release of opioids across a range of pain-relevant brain areas. The mere expectation of pain relief – the belief that you will feel less pain – is enough for our brain to unlock its own drug cabinet and dispense a strong dose of wonderful opioids such as endorphins – essentially, non-addictive morphine. In clinical trials, the word placebo is associated with failure: if a new drug doesn’t perform better than a placebo in early trials, it has effectively exploded on the launch pad. But we are missing something precious if we ignore the pain-relieving power of expectation itself.
In 1944, American and British troops had landed on the beaches of Anzio in a daring attempt to outflank the heavily fortified German lines. The Allies had achieved the element of surprise in the amphibious landing, but the Germans rapidly moved all available forces to form a ring around the beachhead. From their vantage points in the surrounding hills, the Germans rained down a maelstrom of artillery fire on the Allies’ vulnerable position. It was a bloodbath. In the hospital at Anzio, medical officers were engulfed by wave after wave of wounded. One of these medics was the young Henry Beecher, and what he saw would lead him to become a pioneer of pain medicine. As each wounded man arrived at the hospital, Beecher would ask if they were in pain and whether they wanted any morphine. To his shock, over 70 per cent of the men – some severely injured – didn’t report any pain. After the war, Beecher saw the opposite in civilians in Boston wounded by car crashes or industrial accidents: a similar percentage answered ‘yes’ to these questions. In a paper analysing the two populations, Beecher found that the difference between the groups was not the extent of the injuries, but the meaning behind them, as perceived by the sufferers. On the Anzio beachhead, if a wounded soldier had reached hospital, he knew he was in a place of safety and would probably be shipped home. He was more likely to survive by being injured than not; the chances of survival out on the battlefield were slim. The injured Bostonian civilians, however, were moving from a position of safety to one of danger, so their brains naturally created pain. This is an extreme example – there aren’t many instances where being injured is beneficial – but it shows how pain is made by the perception of danger and soothed by safety.
With such anecdotes and along with the recent scientific work on what pain is, the author explains the most accepted pain theory: the bio-psycho-social model of pain, that is when it comes to pain, everything counts.
September 11, 2025
Foarte, foarte interesantă și utilă!
February 7, 2022
This is a great book and has really enhanced my understanding of pain. The main message is that pain is a useful protective mechanism of the body that can go into overdrive and pain is in the brain (and still real!), not the bit of the body that hurts. I enjoyed the author’s personal stories, reflecting on his learning and early scepticism - it came across as warm and authentic. Fascinating cases and interviews, including people who re born unable to feel pain (not as good as it sounds) and mirror-touch synesthesia. Would recommend.
May 22, 2022
Very exciting and interesting book! I think every healthcare worker should read this, or better yet, be thought these things in medical school.
Can't wait to read it again.
Can't wait to read it again.
June 11, 2023
I would like every medical professional to read this book. Also probably even person who deals with persistent pain. It's a gem.
Want to read
August 9, 2021Reviewed by Andrew Robinson for Nature books 27 July 2021:
Why is pain, a universal experience, so poorly understood by both doctors and patients, asks clinician-researcher Monty Lyman. He relieved his irritable bowel syndrome through self-hypnosis, including visualizing his bowels changing from “rocky rapids to the languid Oxfordshire Thames”. But hypnotherapy went unmentioned at his medical school — probably owing to an outdated view that pain arises only from injury to the body. Lyman’s compelling mix of science and anecdote shows that persistent pain is “messy, complex and human”.
Why is pain, a universal experience, so poorly understood by both doctors and patients, asks clinician-researcher Monty Lyman. He relieved his irritable bowel syndrome through self-hypnosis, including visualizing his bowels changing from “rocky rapids to the languid Oxfordshire Thames”. But hypnotherapy went unmentioned at his medical school — probably owing to an outdated view that pain arises only from injury to the body. Lyman’s compelling mix of science and anecdote shows that persistent pain is “messy, complex and human”.
August 12, 2022
The painful truth by Monty Lytham looks at how so many of us suffer pain without truly understanding what it is and how it impacts on us. The best way to look at pain is as something that is a protective mechanism to help us deal with things that we may not be aware of going on inside the body. These are some of my takeaway ideas from this wonderful book:
- The book starts with the quote ‘the good news is there is nothing physically wrong with you’ which can sometimes lead to patients thinking that a medical professional thinks it's all in the mind (or psychosomatic) but we also need to develop our awareness of the brain and how it can cure and make people ill. Just being stressed can turn food into creating increased calories in the body and turn healthy fats associated with nuts into bad fats. Our bodies and the brain's role in how we heal and harm is remarkable.
- All pain manifests itself in the brain, and the brain can change the physical behaviour of your body. Think fight or flight, where fear response can cause eyes to dilate, veins to contract (so we might bleed less if cut), the heart to beat faster so that we can either fight or run faster than without it. Sadness can manifest itself with the physical manifestation of wet tears from our eyes.
- The brain contains a chemistry set that can manage and feel pain, full of neurotransmitters such as dopamine, opioids and cortisol which as this book explains, is a protective mechanism.
- All pain is created in the mind, no matter where we feel the pain. In soldiers in the Second World War who reported shellshock and injuries they often felt that they weren't perceiving the pain in the same way that people in a car crash might, because they were about to go home and be safe and it was better than being on the battlefield. Their pain was reduced.
- People who do not feel pain often will die young and have so many injuries because pain is a protective mechanism designed to help a person know an injury has occurred and to then serve to protect us and save us from further injury and seek help, despite the fact that we may think otherwise. On a personal note, I once worked with a girl who used to rub her eyes so much that they would fall out of her eye socket and she didn’t seem to feel anything.
- The author explains how hypnotherapy helped him with irritable bowel syndrome syndrome and research is showing hypnotherapy can work on some elements of pain.
- The placebo effect which could be nothing more than a sugar pill can change the way our mind perceives and works on the mindbody connection. This is such an important factor in how our body can respond to pain as well as healing in certain conditions. The placebo can change and alter the chemistry in our brain with neurotransmitters like dopamine and opioids in our brain and allows us to release these neurotransmitters which can then influence and reduce the impact and effects of pain.
- The belief in something working and its expectations can have an incredible effect on healing and pain. Even the colour of a sugar pill can have an impact on how we perceive and heal - blue pills might work better with depression and red pills for anxiety. Even fake surgery (where patients think surgery has occurred but a doctor has merely cut the skin) have worked as well as actual surgery. Studies on acupuncture done correctly and sham acupuncture where a practitioner just takes a needle, placing it in all the wrong places works just as effectively if the person believes that this treatment would work and when compared to the proper acupuncture treatment occurring.
- Also the confidence of the person giving the medication is also crucial to its effectiveness. “An experiment where patients were having wisdom-tooth removal. The first, fentanyl, is a strong opioid that should relieve pain. The second, naloxone, is an opioid blocker that definitely shouldn’t relieve pain. The third, saline, is the placebo. One group of dentists were told that they were giving either fentanyl or a placebo to their patient. The other group were told that they were giving either naloxone or a placebo. When the pain-relieving effect of the placebo in both groups was compared, the results were astounding. When the dentist thought that there was a 50 per cent chance the patient might get the fentanyl, the placebo resulted in a 30 per cent decrease in pain, whereas in the group where the dentists thought there was a 0 percent chance of the patient receiving fentanyl (because the patient would get only naloxone or saline), there was a 20 per cent increase in pain in the placebo group. Confidence is contagious; a patient can pick up the subtlest nonverbal cues, and that can strongly influence their expectation of pain relief.” The brain will subconsciously pick up on the cues of confidence and those given by the practitioner administering a possible fake medicine placebo can have dramatic effects on the management of pain. And we need to think about the impact of the placebo because when we do trials random controlled trials
- It's also important to be aware of the Nocebo effect which is the placebo’s negative cousin which can also occur where you believe something won't work and do you harm - it can!. It's also useful to know that if you're an optimist and a person you can have confidence in something you are more likely to have the power of the placebo to work more effectively.
- Our brains are a prediction solving piece of equipment and the potential outcomes matter more than what their actual reality might be. We can see this in illusions all the time and how our brains trick us. The important thing to remember is that our brains try to make predictions about everything and the same to be true in regards to how predicting something like a placebo might work is able to change our perception of pain..
- Some soldiers who have been tortured or scarred by war fare can suffer post-traumatic stress disorder when the brain suddenly becomes hyper vigilant in trying to manage pain by just making you aware of it all the time. This is often the result of cortisol constantly flooding the brain and impacting on the amygdala (a small almond shape of the brain that manages our emotional responses such as anxiety). Emotional responses have a massive impact on how we perceive the pain and how it can manifest itself later on in life in our own sense of being and how we deal with pain and fear. It is one of our greatest emotions and powerful
- Back Pain is one of the most common causes of pain in the world and yet many people who have structural abnormalities in the spine often do not have any back pain. Yet many people have back pain who don’t appear to have anything structurally wrong that can be noted.
- There appears to be a difference between people seeking pleasure and avoiding pain but actually the true analogy is people seeking rewards and avoiding punishment. Some of us find pain to be pleasurable, think of people who do marathon runs, or like me, love hot chilli peppers. And somebody who might think a mouldy piece of bread is disgusting when they are fully fed might consider it a pleasure or a reward to those who have been starving for two days.
- It's worth reading the chapter and information around the neurotransmitters opioids and dopamine which both perform important tasks in how we perceive pain. Often a dopamine will release a sort of pleasure in allowing us to seek something but also is released when pain has been removed and released from us so it gives us another additional pleasure hit. These two neurotransmitters are absolutely essential to understanding how the human mind and behaviour work.
- By using the same mechanism where we find pleasure when we have had some form of pain can often be the same reason the people who might feel the severe numbness in the form of depression and find pleasure in self harming or doing other reckless activities. By looking at it that way you can understand why some people self harm as a relief. There is a wealth of evidence that self harm isn't seeking attention but finding pleasure and the same things might be true of people with depression. Self-harming can reduce the pain the person feels.
- People with low self esteem are often much better at managing pain or do not feel as much pain as others. It's almost as if they're immune to the pain. In experiments, these people can put their hands in an ice cold bucket of water for longer periods of time than subjects who have higher self esteem.
- It's also interesting how some people can really feel pain when we might see someone else in pain. Think how we might wince when somebody falls over and hurts themselves. However in psychopathy these people when shown using brain imaging will not really feel another person's pain although they can empathise with their own. However empathy and mirror neurons can often indicate how much we are going to feel another person's pain but it might be just part of our brain chemistry and make up.
- Understanding and emphasising with other people's pain and feeling helps us as a protective measure to look after others and care for others also. Another reason why pain is a protective mechanism. However, just because somebody might feel somebody else's pain and empathise, it does not necessarily mean compassion and sometimes doctors or other professionals will have to be able to distance themselves from someone else to be able to treat them effectively.
- The author also describes the social pain which many have felt, whether it be rejection or hearing cruel words from another person. And now that we live in the age of social media we are all just one heartbeat away from an angry word, isolation and rejection and all of these things can cause hurt and pain. This is another example where pain is a protective measure that helps us to avoid isolation or rejection and deal with emotional issues.
- When animals have had damage or surgery to remove sources of pain in the brain such as on the anterior cingulate cortex (ACC) then hamster mothers will no longer try to keep their pups nearby and baby squirrel monkeys with similar neural damage will no longer cry when separated from their mothers. So pain and brain chemistry can be shown how the importance of the brain can help us care and look after others.
- There is lots of interesting information on the value of social relationships including things in synchronicity like singing. Fascinating information around bias around race even in medical students. And in women where much of the 20th century they were given hysterectomies when they were said to be in pain and that pain was not treated in the same way as it might've been had they been male. The value and role of isolation is as significant as the risk of smoking 15 cigarettes a day. So we need to find ways that we can synchronise and help people socialise and not feel that isolation. The link between isolation and pain is very real. Showing once again the impact of emotions, feelings and expectation
- The book also looks at pain management in babies of which happened to be the prevailing thinking as recently as 1985, everybody thought the babies do not feel pain. However studies show that when given fentanyl during operations, that these babies made better outcomes than when babies were not given pain management and that babies are often treated without medication when in trauma early on in life will go on to develop later issues around pain suppression. Another interesting fact is regarding the role of touch which is an effective approach that can dampen and manage pain in babies.
- The mind manifestation can change physical response and that's not just in tears when sad but also on the flight and flight response where the whole body will alter into a completely different physiological response. This includes changes to a blood system, our eyes dilate, and we have the ability to reduce the amount of blood that might be released if we are bleeding.
- Although we no longer live in a world where as many of us are harmed by physical threats and warfare as in the past, we are nowadays much more taken by mental exhaustion and physical stress which will drip, drip, drip, slowly and cause more pain and result in increased pain as well.
- A reason we should try to maintain a healthy weight isn't just because increased weight adds to stress on our bones and muscles but also because it increases diseases within our fat cells.
- Sleep also plays a part in managing pain and should be looked at in all circumstances and lack of sleep can impact even on managing pain physically as well as drugs and lack of sleep
- It's worth considering that pain is like a thorny weed growing in a garden - it feeds on the soil and causes tissue damage but to grow, it also needs more watering, which can be increased through stress, lack of sleep, poor diet, smoking and this can cause the thorny weed to grow stronger.
- Persistent pain once it occurs due to an actual physical injury, the brain then becomes overly sensitive to new forms of pain occurring and if something twinges and it stops actually manifesting through response to pain and begins to manifest pain that isn't real and just triggers off something like a sensory alarm going off - similar to how some people respond who might have had their house broken into and things stolen. They just become too sensitive to the threat of it occurring again.
- The brain contains 86 - 100 billion nerves and possibly as many as 10,000 billion connections but we can rewire our brains. The more we use certain brain receptors and how they communicate with one another through neurotransmitters then the body begins to remember the feeling of new pain rather than actual physical pain.
- It's important to state that pain is very real, but the brain can become hypersensitive to pain received and that persistent pain continues can be something that remains in the head. Some people have had amputations but can have something that's called phantom limb syndrome. Even though they have an arm or leg that has been removed, they can still feel pain in that part of the body which shows that pain is created in the brain. Three-quarters of all amputees can experience phantom pain syndrome. Simple psychological programs can reduce the pain by creating an illusion where they see an imagined arm that they believe is real and scratch it or rub it and the pain can be reduced or even disappears.
- The author then talked about the value of simple, repetitive movements that can release serotonin through such simple approaches carrying out art and craft activities or knitting in particular which can help people reduce the feeling of pain. Through small repetitive movements, pain can become much more manageable in how we deal with percieve pain.
- Pain needs to be treated using the whole person. Not only sleep deprivation but also social isolation can impact on how pain is managed and felt and using more movement, social interaction, better sleep, and actions like knitting can dramatically improve the pain that someone feels and reduce the expectation being created in the brain. By taking it out of our mind we can better manage pain
- The book ends with a number of approaches to manage pain. It begins with motion to improve emotion - the power of gentle movement whether it be taking a walk or some exercise such as knitting can help manage and reduce pain.
- Another approach is to breathe correctly, which can stimulate the vagus nerve. To do this, breathe through the nose for 5 seconds, pause for 1 second and breath out for slightly longer (7 seconds). And when breathing, breathe through the nose and use your diaphragm and not your chest and lungs to breathe slowly and steadily this has a massive impact on the vagus nerve and relaxing and reducing
- Another approach is to accept the pain we feel by becoming a non-judgmental observer - instead of trying to control or defeat it. This can be done through mindfulness. This might sound like madness but I have tried it and have felt it works.
- Drug therapy and surgery are often only effective in only 30% of cases and we need to stop managing pain by dealing with surgery or pills and look at a more holistic approach to managing pain when we think and how the placebo and other effects could really have a dramatic effect on how we deal with pain.
- This was a remarkable book which has changed how I feel about and respond to pain. I would highly recommend it.
- The book starts with the quote ‘the good news is there is nothing physically wrong with you’ which can sometimes lead to patients thinking that a medical professional thinks it's all in the mind (or psychosomatic) but we also need to develop our awareness of the brain and how it can cure and make people ill. Just being stressed can turn food into creating increased calories in the body and turn healthy fats associated with nuts into bad fats. Our bodies and the brain's role in how we heal and harm is remarkable.
- All pain manifests itself in the brain, and the brain can change the physical behaviour of your body. Think fight or flight, where fear response can cause eyes to dilate, veins to contract (so we might bleed less if cut), the heart to beat faster so that we can either fight or run faster than without it. Sadness can manifest itself with the physical manifestation of wet tears from our eyes.
- The brain contains a chemistry set that can manage and feel pain, full of neurotransmitters such as dopamine, opioids and cortisol which as this book explains, is a protective mechanism.
- All pain is created in the mind, no matter where we feel the pain. In soldiers in the Second World War who reported shellshock and injuries they often felt that they weren't perceiving the pain in the same way that people in a car crash might, because they were about to go home and be safe and it was better than being on the battlefield. Their pain was reduced.
- People who do not feel pain often will die young and have so many injuries because pain is a protective mechanism designed to help a person know an injury has occurred and to then serve to protect us and save us from further injury and seek help, despite the fact that we may think otherwise. On a personal note, I once worked with a girl who used to rub her eyes so much that they would fall out of her eye socket and she didn’t seem to feel anything.
- The author explains how hypnotherapy helped him with irritable bowel syndrome syndrome and research is showing hypnotherapy can work on some elements of pain.
- The placebo effect which could be nothing more than a sugar pill can change the way our mind perceives and works on the mindbody connection. This is such an important factor in how our body can respond to pain as well as healing in certain conditions. The placebo can change and alter the chemistry in our brain with neurotransmitters like dopamine and opioids in our brain and allows us to release these neurotransmitters which can then influence and reduce the impact and effects of pain.
- The belief in something working and its expectations can have an incredible effect on healing and pain. Even the colour of a sugar pill can have an impact on how we perceive and heal - blue pills might work better with depression and red pills for anxiety. Even fake surgery (where patients think surgery has occurred but a doctor has merely cut the skin) have worked as well as actual surgery. Studies on acupuncture done correctly and sham acupuncture where a practitioner just takes a needle, placing it in all the wrong places works just as effectively if the person believes that this treatment would work and when compared to the proper acupuncture treatment occurring.
- Also the confidence of the person giving the medication is also crucial to its effectiveness. “An experiment where patients were having wisdom-tooth removal. The first, fentanyl, is a strong opioid that should relieve pain. The second, naloxone, is an opioid blocker that definitely shouldn’t relieve pain. The third, saline, is the placebo. One group of dentists were told that they were giving either fentanyl or a placebo to their patient. The other group were told that they were giving either naloxone or a placebo. When the pain-relieving effect of the placebo in both groups was compared, the results were astounding. When the dentist thought that there was a 50 per cent chance the patient might get the fentanyl, the placebo resulted in a 30 per cent decrease in pain, whereas in the group where the dentists thought there was a 0 percent chance of the patient receiving fentanyl (because the patient would get only naloxone or saline), there was a 20 per cent increase in pain in the placebo group. Confidence is contagious; a patient can pick up the subtlest nonverbal cues, and that can strongly influence their expectation of pain relief.” The brain will subconsciously pick up on the cues of confidence and those given by the practitioner administering a possible fake medicine placebo can have dramatic effects on the management of pain. And we need to think about the impact of the placebo because when we do trials random controlled trials
- It's also important to be aware of the Nocebo effect which is the placebo’s negative cousin which can also occur where you believe something won't work and do you harm - it can!. It's also useful to know that if you're an optimist and a person you can have confidence in something you are more likely to have the power of the placebo to work more effectively.
- Our brains are a prediction solving piece of equipment and the potential outcomes matter more than what their actual reality might be. We can see this in illusions all the time and how our brains trick us. The important thing to remember is that our brains try to make predictions about everything and the same to be true in regards to how predicting something like a placebo might work is able to change our perception of pain..
- Some soldiers who have been tortured or scarred by war fare can suffer post-traumatic stress disorder when the brain suddenly becomes hyper vigilant in trying to manage pain by just making you aware of it all the time. This is often the result of cortisol constantly flooding the brain and impacting on the amygdala (a small almond shape of the brain that manages our emotional responses such as anxiety). Emotional responses have a massive impact on how we perceive the pain and how it can manifest itself later on in life in our own sense of being and how we deal with pain and fear. It is one of our greatest emotions and powerful
- Back Pain is one of the most common causes of pain in the world and yet many people who have structural abnormalities in the spine often do not have any back pain. Yet many people have back pain who don’t appear to have anything structurally wrong that can be noted.
- There appears to be a difference between people seeking pleasure and avoiding pain but actually the true analogy is people seeking rewards and avoiding punishment. Some of us find pain to be pleasurable, think of people who do marathon runs, or like me, love hot chilli peppers. And somebody who might think a mouldy piece of bread is disgusting when they are fully fed might consider it a pleasure or a reward to those who have been starving for two days.
- It's worth reading the chapter and information around the neurotransmitters opioids and dopamine which both perform important tasks in how we perceive pain. Often a dopamine will release a sort of pleasure in allowing us to seek something but also is released when pain has been removed and released from us so it gives us another additional pleasure hit. These two neurotransmitters are absolutely essential to understanding how the human mind and behaviour work.
- By using the same mechanism where we find pleasure when we have had some form of pain can often be the same reason the people who might feel the severe numbness in the form of depression and find pleasure in self harming or doing other reckless activities. By looking at it that way you can understand why some people self harm as a relief. There is a wealth of evidence that self harm isn't seeking attention but finding pleasure and the same things might be true of people with depression. Self-harming can reduce the pain the person feels.
- People with low self esteem are often much better at managing pain or do not feel as much pain as others. It's almost as if they're immune to the pain. In experiments, these people can put their hands in an ice cold bucket of water for longer periods of time than subjects who have higher self esteem.
- It's also interesting how some people can really feel pain when we might see someone else in pain. Think how we might wince when somebody falls over and hurts themselves. However in psychopathy these people when shown using brain imaging will not really feel another person's pain although they can empathise with their own. However empathy and mirror neurons can often indicate how much we are going to feel another person's pain but it might be just part of our brain chemistry and make up.
- Understanding and emphasising with other people's pain and feeling helps us as a protective measure to look after others and care for others also. Another reason why pain is a protective mechanism. However, just because somebody might feel somebody else's pain and empathise, it does not necessarily mean compassion and sometimes doctors or other professionals will have to be able to distance themselves from someone else to be able to treat them effectively.
- The author also describes the social pain which many have felt, whether it be rejection or hearing cruel words from another person. And now that we live in the age of social media we are all just one heartbeat away from an angry word, isolation and rejection and all of these things can cause hurt and pain. This is another example where pain is a protective measure that helps us to avoid isolation or rejection and deal with emotional issues.
- When animals have had damage or surgery to remove sources of pain in the brain such as on the anterior cingulate cortex (ACC) then hamster mothers will no longer try to keep their pups nearby and baby squirrel monkeys with similar neural damage will no longer cry when separated from their mothers. So pain and brain chemistry can be shown how the importance of the brain can help us care and look after others.
- There is lots of interesting information on the value of social relationships including things in synchronicity like singing. Fascinating information around bias around race even in medical students. And in women where much of the 20th century they were given hysterectomies when they were said to be in pain and that pain was not treated in the same way as it might've been had they been male. The value and role of isolation is as significant as the risk of smoking 15 cigarettes a day. So we need to find ways that we can synchronise and help people socialise and not feel that isolation. The link between isolation and pain is very real. Showing once again the impact of emotions, feelings and expectation
- The book also looks at pain management in babies of which happened to be the prevailing thinking as recently as 1985, everybody thought the babies do not feel pain. However studies show that when given fentanyl during operations, that these babies made better outcomes than when babies were not given pain management and that babies are often treated without medication when in trauma early on in life will go on to develop later issues around pain suppression. Another interesting fact is regarding the role of touch which is an effective approach that can dampen and manage pain in babies.
- The mind manifestation can change physical response and that's not just in tears when sad but also on the flight and flight response where the whole body will alter into a completely different physiological response. This includes changes to a blood system, our eyes dilate, and we have the ability to reduce the amount of blood that might be released if we are bleeding.
- Although we no longer live in a world where as many of us are harmed by physical threats and warfare as in the past, we are nowadays much more taken by mental exhaustion and physical stress which will drip, drip, drip, slowly and cause more pain and result in increased pain as well.
- A reason we should try to maintain a healthy weight isn't just because increased weight adds to stress on our bones and muscles but also because it increases diseases within our fat cells.
- Sleep also plays a part in managing pain and should be looked at in all circumstances and lack of sleep can impact even on managing pain physically as well as drugs and lack of sleep
- It's worth considering that pain is like a thorny weed growing in a garden - it feeds on the soil and causes tissue damage but to grow, it also needs more watering, which can be increased through stress, lack of sleep, poor diet, smoking and this can cause the thorny weed to grow stronger.
- Persistent pain once it occurs due to an actual physical injury, the brain then becomes overly sensitive to new forms of pain occurring and if something twinges and it stops actually manifesting through response to pain and begins to manifest pain that isn't real and just triggers off something like a sensory alarm going off - similar to how some people respond who might have had their house broken into and things stolen. They just become too sensitive to the threat of it occurring again.
- The brain contains 86 - 100 billion nerves and possibly as many as 10,000 billion connections but we can rewire our brains. The more we use certain brain receptors and how they communicate with one another through neurotransmitters then the body begins to remember the feeling of new pain rather than actual physical pain.
- It's important to state that pain is very real, but the brain can become hypersensitive to pain received and that persistent pain continues can be something that remains in the head. Some people have had amputations but can have something that's called phantom limb syndrome. Even though they have an arm or leg that has been removed, they can still feel pain in that part of the body which shows that pain is created in the brain. Three-quarters of all amputees can experience phantom pain syndrome. Simple psychological programs can reduce the pain by creating an illusion where they see an imagined arm that they believe is real and scratch it or rub it and the pain can be reduced or even disappears.
- The author then talked about the value of simple, repetitive movements that can release serotonin through such simple approaches carrying out art and craft activities or knitting in particular which can help people reduce the feeling of pain. Through small repetitive movements, pain can become much more manageable in how we deal with percieve pain.
- Pain needs to be treated using the whole person. Not only sleep deprivation but also social isolation can impact on how pain is managed and felt and using more movement, social interaction, better sleep, and actions like knitting can dramatically improve the pain that someone feels and reduce the expectation being created in the brain. By taking it out of our mind we can better manage pain
- The book ends with a number of approaches to manage pain. It begins with motion to improve emotion - the power of gentle movement whether it be taking a walk or some exercise such as knitting can help manage and reduce pain.
- Another approach is to breathe correctly, which can stimulate the vagus nerve. To do this, breathe through the nose for 5 seconds, pause for 1 second and breath out for slightly longer (7 seconds). And when breathing, breathe through the nose and use your diaphragm and not your chest and lungs to breathe slowly and steadily this has a massive impact on the vagus nerve and relaxing and reducing
- Another approach is to accept the pain we feel by becoming a non-judgmental observer - instead of trying to control or defeat it. This can be done through mindfulness. This might sound like madness but I have tried it and have felt it works.
- Drug therapy and surgery are often only effective in only 30% of cases and we need to stop managing pain by dealing with surgery or pills and look at a more holistic approach to managing pain when we think and how the placebo and other effects could really have a dramatic effect on how we deal with pain.
- This was a remarkable book which has changed how I feel about and respond to pain. I would highly recommend it.
January 23, 2023
“The Painful Truth” is a book produced by Monty Lyman in response to an incorrect interpretation of the point, and reality of, pain and why we feel pain that is held by the majority of the population. Whilst most of us believe that pain is produced in response to an injury and is an indicator of its severity, Lyman believes, backed by strong scientific evidence, that this is incorrect, and that pain is actually our protector, serving as a warning, not an indicator. His masterpiece, “The Painful Truth”, is his way of making this clear to his readers, guiding them whilst encouraging scientific thinking and packing his audience with a plethora of real-life examples.
Lyman starts with an embarking of the classic medical ideas and how models of pain have changed over the last few centuries. This includes a mention of Descartes’ “bell ringer” mechanism of pain which refers to how a stimulus acts as a bell which rings a response of pain in the body. However, now the psycho-socio model of pain is what is accepted, the essence of which says that pain is caused by a numerate range of factors which are psychological and social, as suggested by the name. Lyman extensively criticises Descartes’ model which is the one which is widely believed by the general public to be the true one, mostly because they are unaware of the current model. The author argues that pain is generated by the brain to protect, and pain and extent of injury are, in reality, poorly related. So feeling lots of pain doesn’t actually mean that the injury associated with it is as major as it seems.
Lyman then fascinates his readers through a discussion of various case studies of people whose feelings of pain are warped. He talks about someone infected with congenital analgesia, which is the inability to feel pain, and moves on to talk about causes such as the malfunctioning Na-V1.7 channel which is a microscopic structure formed from proteins responsible for activating nerves that transmit pain signals. The writer’s structure of detailing the pain defect and how it is caused, as well as the impact in this specific chapter is a very effective and informative one, keeping readers aware and making it easier for them to follow. The cases are very interesting too, with a special story about someone who is almost “permanently high”, due to a mutation in a gene they have known as FAAH-OUT preventing them to produce an enzyme that breaks down cannabis-related chemicals released by the brain during times of bliss.
The author then goes on to detail how pain can be relieved but in ways we would not expect, and crucially talks about why these ways work. Hypnosis is an interesting therapy that Lyman believes can be extremely effective, when combined with modern virtual reality (VR) related therapies. This is because it actually helps lead to increased connectivity in the brain to the prefrontal cortex and insula, which are parts of the brain associated with feelings, and this in turn leads to increased mind-body control. Lyman writes about many studies that prove the effectiveness of hypnosis-VR treatment as well as many other therapies mentioned in the book, which helps to convince readers of the validity of his words.
The science of pain and its reality has been linked to real-life situations and practices masterfully in “The Painful Truth”, and one of the areas that the author focuses on is that of medical trials, especially concerning the use of placebos. An interesting concept is that of the “Open-label placebo” which involves actually telling the patient that whatever they are taking is a placebo instead of the real drug. Fascinatingly, this has been found to be effective in pain relief, often actually being as successful as a placebo given in the usual context blind to the patient. This time, there is actually no ethical issues. Ethics is an idea that is commonly brought up in this book, which good ethical practice being central to medicine and how humans conduct medical practices.
After much further depth discussion about the science behind pain, Lyman ends with detail on how pain brings negativity to society and the damage that not dealing with it in a healthy way can bring. This is through the mention of the “Persistent pain crisis” regarding how one in five of us suffer from long chronic pain and how our habits are not helping with this. Lyman talks about how drugs have often had negative, not positive influences, with a criticism of the opioid group of drugs and how it actually increases pain in the long term, through slow release of inflammatory chemicals, albeit being an extremely effective short term pain reliever. Insomnia too, something which many, especially the young, are suffering from, is also a pain aggravator. However, Lyman ends his book with a speck of hope. He reminds his readers that the brain is a fascinating organ, capable of changing dynamically, a property known as neuroplasticity. If we start doing good habits, then our brain will adapt to the better lifestyle and become stronger along with us.
What does Monty Lyman and pain have in common? They are both protectors. Lyman has extremely successfully, in making this book, functioned as a guardian to many in society who eventually will read his words. As he has made clear multiple times in his masterpiece, knowledge is power.
Lyman starts with an embarking of the classic medical ideas and how models of pain have changed over the last few centuries. This includes a mention of Descartes’ “bell ringer” mechanism of pain which refers to how a stimulus acts as a bell which rings a response of pain in the body. However, now the psycho-socio model of pain is what is accepted, the essence of which says that pain is caused by a numerate range of factors which are psychological and social, as suggested by the name. Lyman extensively criticises Descartes’ model which is the one which is widely believed by the general public to be the true one, mostly because they are unaware of the current model. The author argues that pain is generated by the brain to protect, and pain and extent of injury are, in reality, poorly related. So feeling lots of pain doesn’t actually mean that the injury associated with it is as major as it seems.
Lyman then fascinates his readers through a discussion of various case studies of people whose feelings of pain are warped. He talks about someone infected with congenital analgesia, which is the inability to feel pain, and moves on to talk about causes such as the malfunctioning Na-V1.7 channel which is a microscopic structure formed from proteins responsible for activating nerves that transmit pain signals. The writer’s structure of detailing the pain defect and how it is caused, as well as the impact in this specific chapter is a very effective and informative one, keeping readers aware and making it easier for them to follow. The cases are very interesting too, with a special story about someone who is almost “permanently high”, due to a mutation in a gene they have known as FAAH-OUT preventing them to produce an enzyme that breaks down cannabis-related chemicals released by the brain during times of bliss.
The author then goes on to detail how pain can be relieved but in ways we would not expect, and crucially talks about why these ways work. Hypnosis is an interesting therapy that Lyman believes can be extremely effective, when combined with modern virtual reality (VR) related therapies. This is because it actually helps lead to increased connectivity in the brain to the prefrontal cortex and insula, which are parts of the brain associated with feelings, and this in turn leads to increased mind-body control. Lyman writes about many studies that prove the effectiveness of hypnosis-VR treatment as well as many other therapies mentioned in the book, which helps to convince readers of the validity of his words.
The science of pain and its reality has been linked to real-life situations and practices masterfully in “The Painful Truth”, and one of the areas that the author focuses on is that of medical trials, especially concerning the use of placebos. An interesting concept is that of the “Open-label placebo” which involves actually telling the patient that whatever they are taking is a placebo instead of the real drug. Fascinatingly, this has been found to be effective in pain relief, often actually being as successful as a placebo given in the usual context blind to the patient. This time, there is actually no ethical issues. Ethics is an idea that is commonly brought up in this book, which good ethical practice being central to medicine and how humans conduct medical practices.
After much further depth discussion about the science behind pain, Lyman ends with detail on how pain brings negativity to society and the damage that not dealing with it in a healthy way can bring. This is through the mention of the “Persistent pain crisis” regarding how one in five of us suffer from long chronic pain and how our habits are not helping with this. Lyman talks about how drugs have often had negative, not positive influences, with a criticism of the opioid group of drugs and how it actually increases pain in the long term, through slow release of inflammatory chemicals, albeit being an extremely effective short term pain reliever. Insomnia too, something which many, especially the young, are suffering from, is also a pain aggravator. However, Lyman ends his book with a speck of hope. He reminds his readers that the brain is a fascinating organ, capable of changing dynamically, a property known as neuroplasticity. If we start doing good habits, then our brain will adapt to the better lifestyle and become stronger along with us.
What does Monty Lyman and pain have in common? They are both protectors. Lyman has extremely successfully, in making this book, functioned as a guardian to many in society who eventually will read his words. As he has made clear multiple times in his masterpiece, knowledge is power.
This entire review has been hidden because of spoilers.
November 3, 2022
A book about pain, and why it isn't what we think.
The conventional wisdom is that pain is caused by damage, but it's more subtle than that. Pain is a signal that can be triggered by damage, but can also be caused in response to less physical causes such as fear and a memory of past damage – and can be suppressed by activity or positive thinking, at least to a degree. This is awkward ground, as Lyman recognises: it's close to saying that "it's all in the mind", which is both literally true and deeply offensive to those suffering persistent pain. But it also offers hope that enormously dangerous pharmaceuticals can – sometimes – be replaced or complemented with cognitive therapies that might be effective.
Everyone has had the experience of being deeply engaged in some activity, incurring damage, and not noticing until afterwards. Soldiers frequently report it: they also sometimes feel significantly less pain from their injuries than civilians, because an injury that takes you off the battlefield makes you safer than you were. The signals get mixed, and the pain felt changes accordingly.
There's much to like in this book, not least a very thorough treatment of placebos. It does sometimes get lost in reporting yet another clinical trial, or yet another insight into neurochemistry. It sometimes feels a little too long and too well-referenced for a popular science take on the issues.
The conventional wisdom is that pain is caused by damage, but it's more subtle than that. Pain is a signal that can be triggered by damage, but can also be caused in response to less physical causes such as fear and a memory of past damage – and can be suppressed by activity or positive thinking, at least to a degree. This is awkward ground, as Lyman recognises: it's close to saying that "it's all in the mind", which is both literally true and deeply offensive to those suffering persistent pain. But it also offers hope that enormously dangerous pharmaceuticals can – sometimes – be replaced or complemented with cognitive therapies that might be effective.
Everyone has had the experience of being deeply engaged in some activity, incurring damage, and not noticing until afterwards. Soldiers frequently report it: they also sometimes feel significantly less pain from their injuries than civilians, because an injury that takes you off the battlefield makes you safer than you were. The signals get mixed, and the pain felt changes accordingly.
There's much to like in this book, not least a very thorough treatment of placebos. It does sometimes get lost in reporting yet another clinical trial, or yet another insight into neurochemistry. It sometimes feels a little too long and too well-referenced for a popular science take on the issues.
March 18, 2025
Am fost convinsă, la începutul cărții, că voi da peste o pledoarie pentru pseudo-știință și abordări de tipul NMG.
Scepticismul meu a fost neîntemeiat. Cartea s-a dovedit a fi exact opusul. Fără a susține renunțarea la tratamentele convenționale, autorul subliniază că durerea nu este altceva decât un mecanism de protecție al corpului nostru.
Că deși medicamentația este soluția pentru multe afecțiuni, corpul nostru este echipat cu o serie de mecanisme analgezice și antiinflamatoare naturale, pe care le putem stimula prin alimentație, odihnă și, mai ales, mișcare. Că opioidele reprezintă o epidemie la fel de înfricoșătoare ca durerea cronică în sine (și că eficiența lor pe termen lung în ceea ce privește managementul durerii este discutabilă). Că mintea noastră, prin efecte ca placebo și nocebo, ne influențează radical percepția cu privire la durere și suferință.
Este concisă, foarte bine argumentată, ușor de parcurs și, în ciuda titlului, nu vine cu soluții mesianice.
Scepticismul meu a fost neîntemeiat. Cartea s-a dovedit a fi exact opusul. Fără a susține renunțarea la tratamentele convenționale, autorul subliniază că durerea nu este altceva decât un mecanism de protecție al corpului nostru.
Că deși medicamentația este soluția pentru multe afecțiuni, corpul nostru este echipat cu o serie de mecanisme analgezice și antiinflamatoare naturale, pe care le putem stimula prin alimentație, odihnă și, mai ales, mișcare. Că opioidele reprezintă o epidemie la fel de înfricoșătoare ca durerea cronică în sine (și că eficiența lor pe termen lung în ceea ce privește managementul durerii este discutabilă). Că mintea noastră, prin efecte ca placebo și nocebo, ne influențează radical percepția cu privire la durere și suferință.
Este concisă, foarte bine argumentată, ușor de parcurs și, în ciuda titlului, nu vine cu soluții mesianice.
May 23, 2022
After 2 years+ in chronic pain with a rude physio who had no sympathy or understanding of chronic pain, this book was the perfect read. Covering what healthcare professionals should and shouldn’t say to those suffering in pain was really reassuring and lifted a dark and tainted cloud for me. It’s helpful to understand what it really means when nurses and doctors say to you “it’s all in your head” as there’s more to it than that and more often than not that statement alone can come across unhelpful and be mentally damaging. This book explained pain to me in a way I wish someone did 2 years ago. I think anyone working with people in pain should read this.
Whilst I would have liked more tips on how to move forward with chronic pain this book was an educational piece and a must read.
Whilst I would have liked more tips on how to move forward with chronic pain this book was an educational piece and a must read.
June 2, 2023
��有证据都表明不运动的危害比运动更大。此外运动在止痛方面不但成本低廉、安全又有效，还能顺带促进身心健康。“锻炼和运动几乎比一切药物和饮食都更能促进人体所有系统的平衡（体内平衡）。人在锻炼中强化体质、活动关节、代谢废物，并打开大脑里的天然止痛剂药柜，短时间内，运动就能直接降低痛感。4它具有消炎作用，能改善睡眠，促进心理健康，并且一这点与运动会让人很累的传统认知相反一能够消乏醒脑。6最重要的是，运动能训练大脑停止持续产生痛觉
健康的呼吸应该是缓慢、深沉的，而且需动用我们的横膈膜（我们肺部底部的帐篷状肌肉）。但在压力持续来袭的时代，大多数人的呼吸都太浅太急了，原始的战逃反应让交感神经系统为了增加体内氧气而督促人类进行短促的呼吸，短期来说，这没什么不好，但长期来看这会破坏二氧化碳和氧气的平衡，而且低效率运动胸肌也会浪费体内能量。对此解决方案也很简单，那就是去慢慢深呼吸。深呼吸是一种放松反应，能刺激交感神经，激活副交感神经系统帮助我们休息、消化。有很多指南都在以不同的方式教我们如何正确呼吸，但关键环节都大同小异。首先，在一个让你放松的环境中坐下或躺下，然后闭上眼、合上嘴。用鼻子缓慢而深深地吸气5秒，腹部向外扩张，停留1秒后，再轻轻呼气7秒。吸气时，全身在动的部位只有腹部。一开始你可能会觉得有点儿难，但它的技巧并不难掌握。重点是要将深呼吸保持为一种习惯，大概每天做3到5组，每组10~15次。许多研究都表明这样的呼吸训练能够对抗压力、止痛消炎。19，20
引自 12 疼痛革命
健康的呼吸应该是缓慢、深沉的，而且需动用我们的横膈膜（我们肺部底部的帐篷状肌肉）。但在压力持续来袭的时代，大多数人的呼吸都太浅太急了，原始的战逃反应让交感神经系统为了增加体内氧气而督促人类进行短促的呼吸，短期来说，这没什么不好，但长期来看这会破坏二氧化碳和氧气的平衡，而且低效率运动胸肌也会浪费体内能量。对此解决方案也很简单，那就是去慢慢深呼吸。深呼吸是一种放松反应，能刺激交感神经，激活副交感神经系统帮助我们休息、消化。有很多指南都在以不同的方式教我们如何正确呼吸，但关键环节都大同小异。首先，在一个让你放松的环境中坐下或躺下，然后闭上眼、合上嘴。用鼻子缓慢而深深地吸气5秒，腹部向外扩张，停留1秒后，再轻轻呼气7秒。吸气时，全身在动的部位只有腹部。一开始你可能会觉得有点儿难，但它的技巧并不难掌握。重点是要将深呼吸保持为一种习惯，大概每天做3到5组，每组10~15次。许多研究都表明这样的呼吸训练能够对抗压力、止痛消炎。19，20
引自 12 疼痛革命
June 16, 2025
A great book that discusses the latest revolutionary developments in pain research. Pain is a much more complex mind-body concept than traditional biomedical theories of pain as centrally representing tissue damage allows for. Pain is more than such a representation and when the damage that accompany the acute pain is gone, starts to live its own life in the brain and the body. I will not even try to go into details here, but will say that the book, though not a self-help book at all, describes a number of different and astonishing new approaches to deal with acute and especially permanent or chronic pain. Lots of references to specific theories, research and methods to deal with pain.
October 10, 2024
3.5
The book explores the idea that pain is more complicated than we often think. Pain isn’t just physical—it also has emotional and psychological components. This idea is interesting because we can start to think about how our emotions and mind play a part in how we experience it.
That said, I found some parts of the book a bit slow and boring. Certain sections felt too detailed or scientific, which made it harder for me to stay interested.
Overall, it offers a new way to think about pain and it’s a good read for anyone who wants to understand pain from a broader perspective.
The book explores the idea that pain is more complicated than we often think. Pain isn’t just physical—it also has emotional and psychological components. This idea is interesting because we can start to think about how our emotions and mind play a part in how we experience it.
That said, I found some parts of the book a bit slow and boring. Certain sections felt too detailed or scientific, which made it harder for me to stay interested.
Overall, it offers a new way to think about pain and it’s a good read for anyone who wants to understand pain from a broader perspective.
August 21, 2023
As a hospital worker who treats multiple patients suffering from persistent pain this book was extremely enlightening. Written really eloquently, every chapter opened up whole new worlds of understanding and knowledge regarding chronic/ persistent pain. I highly recommend this book to everyone, especially anyone who treats people in pain whether it be physical or emotional. Am passing on the concepts and ideas to colleagues in the hopes of easing pain globally.
January 1, 2025
This is a well written and accurate account of the current understanding of pain science, and its implications for managing persistent pain. I am welding this as a medical pain specialist, but I think the book is easy to understand by people outside the profession. The content is important, whether or not you are living with pain - pain is a universal human experience, and this helps us to understand it.
November 7, 2022
Forget everything you thought you knew about pain. Lyman presents a holistic approach to understanding and dealing with pain which is not just linked to the severity of the painful stimulus itself. Detailed and expertly written, accessible for those who have no medical background, this book is a stepping stone for taking charge and being in control of your own pain.
October 17, 2022
It's a good book that covers stuff I feel like everyone should know about pain. I was hoping for something mindblowing or groundbreaking, but I've known most of this for a while as someone who has written a lot about pain myself. But that's also reassuring and it was a good reminder and refresher.
December 29, 2022
A really interesting look at the latest research in pain, and the philosophical, psychological, and (surprisingly small) medical basis of it. Easy to digest, succinct, and packed full of further reading.
April 19, 2023
Enlightening and fascinating truth about pain! There are no boring facts about neurology, only succinct, interesting science following each experimental example. Lyman has made the subject full of mystery and many possibilities. I definitely learnt a lot from this amazing book!
June 3, 2022
Wow, just wow! Eye opening and wonderful read. Spread the knowledge about pain science!
August 31, 2022
What an amazing book. Completely eye-opening and quite easy to read too!
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