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A Nation in Pain: Healing Our Biggest Health Problem

A Nation in Pain: Healing Our Biggest Health Problem
Foreman J
Get more information on this book at Oxford University Press or

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Comment on Discussion:
May 14 2014

Kathleen Foley, Memorial Sloan-Kettering Cancer Center

I am pleased to add to Howard's remarks.

Judy Foreman’s new book A Nation in Pain is a tour de force. Full of important facts about the public health crisis in chronic pain, this comprehensive text uniquely presents the challenges of America’s pain epidemic.

 As a skilled and accomplished health and science writer, and a person experienced in chronic pain, Ms. Foreman takes on the topic with the perspective of both a sleuth investigator and enthralled observer trying to make sense of what we know and what we need to know to move the science of pain and the care of patients in pain forward.   

The book begins with her startling observation as she began research on the topic of pain, “I found that there is an appalling mismatch between what people in pain need and what doctors know.”

How true this is and her book’s publication follows the 2011 Institute of Medicine ‘s Report  Relieving Pain in America. Commissioned by Congress, this first ever review of the state of pain care in the United States provides the evidence base for Foreman’s call to action. More than 40 percent of the American population (over 100,000,000 Americans) live with chronic pain, and pain costs between $560 to $650 billion a year in direct medical costs and lost wages.  

This encyclopedic review focuses on educating the public, health care professionals and policymakers on the science of pain and the barriers facing patients in pain as they seek medical advice and care.

Through the 14 chapters, which are referenced in detail, the reader is taken on a journey that begins with clarifying what pain is and how it is transmitted from the site of injury to the brain, and how transmitters, receptors and neurons in multiple sites and along anatomically-defined pathways contribute to this hard wiring of pain sensation.

This section needs to be read by every healthcare professional, especially medical students, to help teach themselves and patients about pain sensation and perception. It makes complex pain anatomy and molecular pharmacology understandable, providing a useful framework to grasp the potential for new scientific advances that might inform treatment approaches.

Details about the genetics of pain, imaging pain in the brain, and the mind–body connection and pain are skillfully described and referenced, again serving to emphasize the complexity, variability and plasticity in the nervous system as it responds to painful events  in a complex emotional and social environment. 

In describing how we perceive and respond to pain, Foreman cites the relevant scientific literature by leading pain neuroscientists, to exemplify the sophistication and specificity of pain sensory processing as it assesses and expresses this complex human behavior. 

 At times, the reader can almost experience a David and Goliath feel to the book as one witnesses how this writer is trying to review and describe pain, and make it understandable to an audience who may have experienced the phenomenon, and have their own perspectives and questions on what pain is. But she succeeds in making the topic of pain intelligible, clear and fascinating.

Three chapters focused on the “opioid wars” and marijuana are excellent summaries of the current controversies in the use of opioid drugs and marijuana in chronic pain. They provide not only the evidence base for these agents in selected patients, but also describe in a balanced fashion, the political, ethical, and social controversies associated with drug use and the potential for addiction.   

Foreman’s last chapter offers “A Way Forward” and provides a suggested roadmap for the cultural transformation called for in the IOM Report. She strongly endorses the need for more education of healthcare professionals and for more research, but she also calls on chronic pain patients to consider approaches that might enable them to better live with their pain and to learn self management approaches, to facilitate their adaptation.  

For both patients in pain and for professionals trying to care for such patients, the book is optimistic and hopeful, emphasizing the innovative research opportunities for new approaches to better understand the human experience of pain. The pain community is indebted to Ms. Foreman’s leadership on mastering this complex field and bringing attention to the possibilities and potential, while also calling out the challenges and barriers. This is a landmark publication that helps to make pain accessible and   understandable and needs to be read widely by the public, policy makers and the profession. 

Comment on Discussion:
May 15 2014

Neil Andrews, IASP

I think it is worth a mention here that Judy Foreman recently received the 2014 Kathleen Foley Journalist Award from the American Pain Society. The honor, presented at the APS annual meeting in Tampa earlier this month, recognizes excellence in reporting pain-related topics. See more about the award at the APS website