Explain Pain.

Explain Pain

Butler DS, Moseley GL. Adelaide City West, South Australia, 5000, Australia, Noigroup Publications (distributed by OPTP), 2003, spiralbound, 129 pp, illus, ISBN: 0-9750910-0-X, $49.

The specific purposes of Explain Pain are to help health care professionals explain pain to their patients, to outline modern models of pain management, and to help people with pain understand their pain so they can make the best possible choices about pain management. This is a very broad intended audience, and the book may be too complex for some patients and yet too basic for most health care professionals. Because the intended audience is so diverse, this book is not specifically tailored to meet the needs of any one specific patient population. The book is a useful basic review of pain physiology, although it does not offer clinicians much new information on how to manage a patient's pain. The manual is easy to read for those well versed with pain, and it provides many metaphors that clinicians can use to explain the pain phenomenon to their patients.

The information is accurate and very current, with literature referenced from as late as 2003. There are more than 100 references listed at the end of the book. These references, although useful for the health care professionals, are primarily from medical journals and may be too complex for patients without a health care education. There is, however, a list of 6 books that are suggested for further reading for a general audience. This manual is otherwise tailored to educated patients who have questions concerning their pain and their pain management.

I found the book to be a little difficult to read because of the authors' colorful writing styles and because of the numerous metaphors that are intended to clarify some of the difficult concepts. These metaphors instead become a bit confusing at times. For example, the patient may have questions concerning the "orchestra playing the pain tune" or "living adaptable force transducers (LAFT)." Unless the clinician is aware of the authors' metaphors, patients might not be able to understand that LAFT is the authors' term for the intervertebral disk and that "orchestra playing the pain tune" refers to how the brain works to produce pain. The authors also describe the synapse as a "post office" and later refer to the synapse as the "post office" without mentioning the actual word "synapse." For the educated person with a background in pain physiology, words such as the "post office" metaphor might be a bit confusing.

There are 6 sections in this book with a summary at the end of each chapter. The first section explains how pain is really a normal process. The authors provide "amazing pain stories" to help clarify key points and discuss age, sex, culture, and pain. The second section is devoted to how pain is our danger alarm system and how the pain messages are propagated inside the body. Section 3 describes damaged and deconditioned structures and continues to supply basic information on anatomy. Section 4 is mainly directed at describing how the spinal cord, our thoughts, the parasympathetic system, the sympathetic system, the endocrine system, and the immune system are related Io our pain perception. Section 5 provides some helpful guidelines on how readers can choose a health care practitioner to help them manage their pain. In addition, the authors provide helpful information for patients with pain (eg, 5 current pain models, how movement is associated with pain, and a section on coping with pain). The final section is focused on helping the reader to "understand pain so that you don't fear it." Here the reader learns that hurt does not necessarily mean damage and harm. It concludes with a portion of the chapter devoted to pacing and graded movement exposure. This portion of the book contains some pain management strategy principles that will be helpful for patients who are experiencing pain.

The book has many entertaining cartoons that help provide humor and to illustrate difficult principles. The diagrams are cartoonish oversimplifications and most are probably unnecessary. The diagrams for the pacing and graded exposure section, however, are helpful and effectively illustrate the authors' points. The numerous cases that are presented also are helpful and provide the reader with a chance to apply the newly learned information to pain scenarios.

This book is related to the practice of physical therapy as it deals with pain and pain management strategies. The information is too basic for the practicing clinician and not written specifically for this audience. I would recommend this book as a supplement for curious patients who are well educated and are eager to learn more about their pain.

Ricardo A Fernandez, PT, OCS Northwestern University Feinberg School of Medicine Chicago, Ill

Mr Fernandez is Assistant Professor/Clinician in the Department of Physical Therapy and Human Movement Sciences and specializes in rehabilitation of patients with shoulder and knee dysfunctions.