Enhanced descriptions from Syndetics:

Pain is one of medicine's greatest mysteries. When farmer John Mitson caught his hand in a baler, he cut off his trapped hand and carried it to a neighbor. "Sheer survival and logic" was how he described it. "And strangely, I didn't feel any pain." How can this be? We're taught that pain is a warning message to be heeded at all costs, yet it can switch off in the most agonizing circumstances or switch on for no apparent reason. Many scientists, philosophers, and laypeople imagine pain to operate like a rigid, simple signaling system, as if a particular injury generates a fixed amount of pain that simply gets transmitted to the brain; yet this mechanistic model is woefully lacking in the face of the surprising facts about what people and animals do and experience when their bodies are damaged.

Patrick Wall looks at these questions and sets his scientific account in a broad context, interweaving it with a wealth of fascinating and sometimes disturbing historical detail, such as famous characters who derived pleasure from pain, the unexpected reactions of injured people, the role of endorphins, and the power of placebo. He covers cures of pain, ranging from drugs and surgery, through relaxation techniques and exercise, to acupuncture, electrical nerve stimulation, and herbalism.

Pain involves our state of mind, our social mores and beliefs, and our personal experiences and expectations. Stepping beyond the famous neurologic gate-control theory for which he is known, Wall shows that pain is a matter of behavior and its manifestation differs among individuals, situations, and cultures. "The way we deal with pain is an expression of individuality."

Table of contents provided by Syndetics

• Preface
• 1 Private Pain and Public Display
• 2 The Philosophy of Pain
• 3 The Body Detects the Brain Reacts
• 4 The Whole Body
• 5 A "Normal" Pain Response
• 6 Pains with Obvious Causes
• 7 Pain Without a Cause
• 8 How Treatments Work
• 9 The Placebo Response
• 10 Your Pain
• 11 Other People's Pain
• Epilogue
• Index

Reviews provided by Syndetics

Library Journal Review

A British neuroscientist and physiologist who has written several books on pain, Wall provides a broad scientific account of the enigma of the brain and specifically its interpretation and use of pain. His book varies from Frank Vertosick's Why We Hurt (LJ 3/15/00) in that Wall fits facts, relevant data, and bizarre pain cases (abrupt injuries, torture, masochism) into an overall body-brain pain theory. Vertosick is a great storyteller who gives his text a more anthropological context. Divided into 11 sections, Wall's text investigates the philosophy of pain, whole body theories, obvious and mysterious causes of pain, and the placebo response to pain. He also provides practical if obvious advice on personal pain and its treatment. Wall is a sage neuroscientist who challenges younger pain researchers and the "new breed of clinicians" to create a contemporary picture of a "subtle multiplexed reactive system" we call the neurological response to pain. Recommended for academic libraries.DRebecca Cress-Ingebo, Fordham Health Sciences Lib., Wright State Univ., Dayton, OH (c) Copyright 2010. Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.

Publishers Weekly Review

Wall (The Challenge of Pain), a professor of physiology at St. Thomas's Hospital Medical School (London), presents an alternative to the traditional theory of pain. Earlier theorists attributed painful sensations to nerve endings that transmitted a message from the spinal column to the brain. Drawing on the latest neurological research, Wall hypothesizes instead that when nerve endings are stimulated by painful sensations, the message is transmitted, but then, the brain analyzes this data to determine the appropriate motor response. One's response to the stimulus is, in part, based on personal history and expectations. According to Wall, this interconnectedness explains why people experience pain differently, and it also accounts for why a strong belief in the efficacy of a placebo may actually reduce an individual's pain. Although he doesn't examine specific conditionsÄlike cancer and migrainesÄin as much depth as Frank Vertosick does in Why We Hurt: The National History of Pain (Forecasts, May 29), Wall is a sympathetic and thorough writer: he describes the physiology of the nervous system; he explores, philosophically and scientifically, the history of pain and its treatment; and he suggests some improvements to popular medical approaches to pain management, explaining (in detail) the different ways in which pain can be eased. Postoperative patients, for example, deal with their pain better when they are able to regulate their analgesic medication (because control helps them overcome their feelings of physical helplessness). In this generally thoughtful text, Wall offers his belief in the benefit of narcotic medications for cancer patients in pain. B&w illus. (Aug.) (c) Copyright PWxyz, LLC. All rights reserved

CHOICE Review

Wall (physiology, St. Thomas's Hospital Medical School, London) provides a broad, comprehensive overview of the pain experience and offers a very interesting discourse on the complexities involved in understanding pain and its treatment. Chapter topics vary in scope from detailed coverage of the physiology and sensory pathways activated during a pain response, to philosophical debates about the mind-body problem and placebo responses. The chapters are well organized, with an introduction and closing summary, and while they include descriptions of fascinating studies that have led to breakthroughs in the study of pain, the studies are not formally referenced for those interested in greater details of the research. The information on central and peripheral mechanisms involved in pain sensation is well woven in with medical history and clinical cases. This book would be useful to upper-division undergraduates and graduate students entering the pain research arena. It would also interest pain researchers, faculty in academic medicine, medical students, and health professionals who treat pain. C. S. Weisse; Union College (NY)

Booklist Review

Wall, a well-known researcher of the clinical aspects of pain, has a refreshing and direct writing style as well as broad knowledge of his subject. He inveighs against the "mountain of hogwash written about patients inventing their pains." The patient's mood and attitude don't create pain, he holds, though the moods and attitudes of those around a patient well may be influential. Wall clearly describes what is known about types of pain, their causes, their transmission, responses to them, and treatments for them, and so doing, he demolishes a number of myths. As for truths, he says that a standard cause doesn't produce a standard pain, that pain cannot be specifically located in the brain, and that damage in one area can produce a distant pain. He also deals with the mystery of phantom pain. Wall notes some top-drawer pain clinics, but medical schools don't teach students about pain, he avers, and current "evidence-based" medicine can drive student and physician further away from realizing the role of pain for the patient. --William Beatty

Kirkus Book Review

Pain is a universal experience, so everyone has strong beliefs on the subject. Wall (Defeating Pain, not reviewed) delivers an expert's account for the general reader. Aside from sensitive areas like politics and religion, most intelligent people enjoy discovering everything they believe is wrong. Wall overturns many popular beliefs, but he plays no favorites, and he insists that the medical profession must also rethink its ideas. We learned in medical school that pain occurs when nerve signals from injured tissue stimulate the pain center in the brain, but this turns out to be wrong. Frequently injured tissue is pain-free, but normal tissue hurts (no one suffering a backache believes his back is healthy, for example, but 85 percent of painful backs show no evidence of injury--and for headaches, this number approaches 100 percent). Yet these victims suffer genuine pain. No study reveals a single pain center in the brain; half-a-dozen areas become active when something hurts (areas that govern attention, orientation, planning for action, and bodily processes such as blood pressure and heart rate), but nothing hurts until the brain gives it a thorough evaluation. After explaining the mechanism of pain, the author turns to its relief, and, again, surprises come thick and fast. Morphine is a natural herbal remedy. Not only is it derived from a plant, but its action mimics a natural narcotic-like substance produced by the brain to modulate pain. The chapter on placebos is an eye-opener: they are, in fact, powerful remedies with significant side effects. Reacting to placebos, therefore, is not a sign that one is suggestible or weak-minded, but rather that one expects a certain outcome. Every human reacts to placebos, as do dogs and rats. Despite his impressive academic qualifications, Wall (Physiology/St. Thomas's Medical School; Fellow/Royal Society) writes lucidly, using vivid examples, stories from his own life, and a generous dose of personal opinions. Readers may find they know more about pain than those who should be experts--such as their doctors. Copyright ©Kirkus Reviews, used with permission.

Author notes provided by Syndetics

The late Patrick Wall was professor of physiology at St. Thomas's Hospital Medical School, London and a fellow of the Royal Society. His books include Defeating Pain , The Challenge of Pain , Natural Pain Relief , and Textbook of Pain .