A Nation in Pain: Healing our Biggest Health Problem

by Judy Foreman

Overview

Out of 238 million American adults, 100 million live in chronic pain. And yet the press has paid more attention to the abuses of pain medications than the astoundingly widespread condition they are intended to treat. Ethically, the failure to manage pain better is tantamount to torture. When chronic pain is inadequately treated, it undermines the body and mind. Indeed, the risk of suicide for people in chronic pain is twice that of other people. Far more than just a symptom, writes author Judy Foreman, chronic pain can be a disease in its own right -- the biggest health problem facing America today. Published in partnership with the International Association for the Study of Pain, A Nation in Pain offers a sweeping, deeply researched account of the chronic pain crisis, from neurobiology to public policy, and presents to practical solutions that are within our grasp today. Drawing on both her personal experience with chronic pain and her background as an award-winning health journalist, she guides us through recent scientific discoveries, including genetic susceptibility to pain; gender disparities in pain conditions and treatments, perhaps linked to estrogen; the problem of undertreated pain in children; the emerging role of the immune system in pain; advances in traditional treatments such as surgery and drugs; and fair-minded assessments of the effectiveness of alternative remedies, including marijuana, acupuncture, massage, and chiropractic care. For many people, the real magic bullet, Foreman writes, is exercise. Though many patients fear it will increase their discomfort, studies show it consistently produces improvement, often dramatic. She also explores the destructive "opioid wars," which have led to a misguided demonization of prescription painkillers. Foreman presents a far-reaching but sensible plan of action, ranging from enhancing pain education in medical schools to reforms of federal policies across the board. For doctors, scientists, policy makers, and especially patients, A Nation in Pain is essential reading.

Product Details

ISBN-13:	9780199389544
Publisher:	Oxford University Press
Publication date:	01/02/2014
Sold by:	Barnes & Noble
Format:	eBook
File size:	2 MB

About the Author

Judy Foreman is a nationally syndicated health columnist who has won more than 50 journalism awards and whose columns have appeared regularly in the Boston Globe, Los Angeles Times, Dallas Morning News and other national and international outlets. She graduated Phi Beta Kappa from Wellesley College, served in the Peace Corps in Brazil for three years, and received a Master's degree from the Harvard Graduate School of Education. From 2000 to 2001, she was a Fellow in Medical Ethics at Harvard Medical School. From 2001 to 2004, she was a Lecturer on Medicine at Harvard Medical School. She has also been the host of a weekly, call-in radio show on Healthtalk.com. In 2014 she was the recipient of the American Pain Society's Kathleen M. Foley Journalist Award.

Table of Contents

1. The Enormity of the Problem 2. What Is Pain, Anyway? 3. The Genetics of Pain 4. Gender and Pain 5. Children in Pain 6. The Mind-Body in Pain 7. Opioid Wars - Part I 8. Opioid Wars - Part II - Proposed Solutions 9. How the Immune System Cranks Up Pain 10. Marijuana - The Weed America Loves to Hate 11. Beyond Opioids - Western Medicine 12. Beyond Opioids - Complementary and Alternative Medicine 13. Exercise - The Real Magic Bullet 14. The Way Forward

Editorial Reviews

★ 12/02/2013
The shadow pain casts and the toll it takes on individuals and society are revealed in this remarkable book by nationally syndicated health columnist Foreman, who chronicles the genetics of pain, types of pain receptors, and the effect of hormones and gender on pain and pain relief. Beginning this journey from personal experience with chronic pain, she discusses how pain can be “catastrophized” (leading to an obsessive focus on the pain) or cause depression. Foreman also describes the difficulties in assessing the pain of others and how this, combined with longstanding prejudices from the house of medicine in particular and society in general, influence the administration—or lack of administration—of pain medications. Foreman effectively juxtaposes her portrayal of a society in pain and a national attempt to limit access to adequate pain therapy. As she notes: “people with chronic pain (often older people with no history of substance abuse) can’t get the opioids they need and could probably use responsibly, while street abusers, often young people, get them all too easily.” Whether or not readers agree that the failure to treat pain is “torture by omission,” this work is thoughtful and thought-provoking reading for the medical community, policymakers, and patients, especially in light of the F.D.A’s recent call for tightening regulations in the administering of pain medications. Agent: Jim Levine, Levine Greenberg. (Feb.)

Publishers Weekly

"The shadow pain casts and the toll it takes on individuals and society are revealed in this remarkable book by nationally syndicated health columnist Foreman, who chronicles the genetics of pain, types of pain receptors, and the effect of hormones and gender on pain and pain relief... this work is thoughtful and thought-provoking reading for the medical community, policymakers, and patients, especially in light of the F.D.A's recent call for tightening regulations in the administering of pain medications." —Publishers Weekly starred review

"Finally, a scientific and empathetic book that sensibly sorts out the problems and possibilities of adequately controlling pain. What a relief!" —Booklist

"Encyclopedic in scope... Foreman's text underscores the fact that pain really is an extraordinarily complex phenomenon that requires more research. If we continue head-in-the-sand policies, we will remain a nation in pain." —Kirkus Reviews

"A Nation in Pain comes to life with people who are dying or who wish they were dying. But Foreman's account goes beyond its emotional appeal and makes some rigorously reported arguments about the failure of the palliative care enterprise in America." —The Weekly Standard

"Judy Foreman has provided a masterful chronicle of the commonest of human miseries — chronic pain. The author delves into neurobiological mechanisms and notes the failure of our educational system to prepare physicians to deliver adequate care, including the perils of ignoring benefits of non-traditional (non-Western) therapies. This is a book for everyone; scientists and sufferers, physicians and their educators." —Joseph B Martin, Lefler Distinguished Professor of Neurobiology and Dean Emeritus, Harvard Medical School

"A Nation in Pain: Healing Our Biggest Health Problem is an extensive and eye opening look into the world of pain from the heart and soul of someone who understands what it is like to live with pain. Judy Foreman explores the anatomy of pain guiding us through treatments both conventional and unconventional and the debate that many of them ignite. I found it refreshing and honest while making a strong point that we need to do a better job at managing chronic pain." —Penney Cowan, Founder, American Chronic Pain Association

"The experience of chronic pain forges new alliances and A Nation in Pain provides insights, knowledge, critiques, questions and comfort for readers — be they individuals impacted by pain, those who care for them and those who might benefit from this thoughtful and comprehensive treatise. I am one of those individuals." —Philip Pizzo, MD, Former Dean, Stanford University School of Medicine, David and Susan Heckerman Professor of Pediatrics and of Microbiology and Immunology

"The great majority of books written on pain in the past decade provide simplistic recipes based on untested remedies. Judy Foreman's new book, A Nation in Pain, attacks the complexity of chronic pain, and thoughtfully provides a realistic approach to optimal pain management. Her research on this topic, including interviews with pain patients and pain scientists, provides a wealth of personal and professional expertise and experience. This book will be a valuable asset to patients, physicians and professional organizations wanting an encyclopedic and unbiased treatise on the very difficult topic of chronic pain." —Don L Goldenberg, M.D., Chief of Rheumatology, Newton-Wellesley Hospital; Professor of Medicine, Tufts University

"This is a book that has been waiting to be written. Tens of millions of Americans suffer from chronic, unrelenting pain, yet until now they've had nowhere to turn to understand how pain arises or what to do about it. Whatever the source of pain — and there can be many — it can come to dominate the sufferer's life and be soul-destroying. Foreman has written a superb analysis of this most distressing of medical conditions. Many people will thank her for it." —Marcia Angell, M.D., Senior Lecturer in Social Medicine at Harvard Medical School and former Editor-in-Chief of The New England Journal of Medicine

"In this book, Judy Foreman, an award-winning health columnist has beautifully narrated the saga of chronic pain—how it happens, how far it can go; why it happens, why it happens to you, and why it happens to you more than the others; and why the suffering is often endless... I would recommend this book for everyone: those in pain, those healing pain, those learning pain, and those policing pain relievers (the drugs and the people who prescribe them)."
—R. Goyal, British Journal of Anaesthesia

From the Publisher

2013-11-18
Encyclopedic in scope, this book on chronic pain also tells the personal story of the author, a Boston-based, nationally syndicated health columnist. When she developed chronic neck pain, Foreman's savvy medical background and reporter's skills were little help. She suffered the same stigmatizing it's-all-in-your-head reaction that many chronic pain patients (especially women) experience. Finally, an MRI scan showed the arthritis, bone spurs and sliding vertebrae of her cervical spine that caused her agony. Foreman spent five years interviewing experts, reviewing the literature and talking to patients to summarize what America is doing about pain. The answer? Not much--despite a 2011 report by the Institute of Medicine of the National Academies of Science revealing that 100 million Americans live in chronic pain. Foreman cites the report, noting also that medical schools barely touch the subject of pain. She then lays out the anatomy and physiology of pain perception. She debunks myths about women's greater tolerance of pain and infants' lack of feelings of pain. She provides an especially solid chapter on mind-body interactions, discussing the placebo effect, the relationship between pain and depression, and alleviation techniques like meditation and cognitive behavioral therapy. Then it's on to treatments. Government, health provider and cultural dictates that inhibit the use of opioids or, in the case of government, even allow research on marijuana, get the drubbings they deserve. (It's important to note, however, that opioids provide limited relief for chronic pain.) As for other approaches (drug and nondrug), Foreman discusses benefits and risks and cites multiple clinical trials, some pro, some con, for each treatment. She also extols the benefits of exercise: There's good evidence that it helps for low back pain, arthritis and fibromyalgia. Foreman's text underscores the fact that pain really is an extraordinarily complex phenomenon that requires more research. If we continue head-in-the-sand policies, we will remain a nation in pain.

Kirkus Reviews