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Understanding Pain
In Understanding Pain, Fernando Cervero explores the mechanisms and the meaning of pain. You touch something hot and your brain triggers a reflex action that causes you to withdraw your hand, protecting you from injury. That kind of pain, Cervero explains, is actually good for us; it acts as an alarm that warns us of danger and keeps us away from harm.
But, Cervero tells us, not all pain is good for you. There is another kind of pain that is more like a chronic pain that is not related to injury. This is the kind of pain that fills pain clinics and makes life miserable. Cervero describes current research into the mysteries of chronic pain and efforts to develop more effective treatments. Cervero reminds us that pain is the most common reason for people to seek medical attention, but that it remains a biological enigma. It is protective, but not always. Its effects are not only sensory but also emotional. There is no way to measure it objectively, no test that comes back positive for pain; the only way a medical professional can gauge pain is by listening to the patient's description of it. Cervero's account brings us closer to understanding the meaning of pain.
The book is published by MIT Press.
But, Cervero tells us, not all pain is good for you. There is another kind of pain that is more like a chronic pain that is not related to injury. This is the kind of pain that fills pain clinics and makes life miserable. Cervero describes current research into the mysteries of chronic pain and efforts to develop more effective treatments. Cervero reminds us that pain is the most common reason for people to seek medical attention, but that it remains a biological enigma. It is protective, but not always. Its effects are not only sensory but also emotional. There is no way to measure it objectively, no test that comes back positive for pain; the only way a medical professional can gauge pain is by listening to the patient's description of it. Cervero's account brings us closer to understanding the meaning of pain.
The book is published by MIT Press.
168 pages, Hardcover
First published August 20, 2012
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Displaying 1 - 8 of 8 reviews
December 27, 2019
Read this for a neurobio of pain course. Gives the info of a college course in a completely accessible and story-driven manner. I believe understanding pain is extremely useful in any field especially in healthcare so this was very helpful prior to medical school. Highly recommended!!
March 26, 2014
I really liked this book, and thought it was clearly written, and at times funny. But I can't help but wonder... why did the author make such a glaring omission by never acknowledging that sometimes and for some people, pain is NOT negative? If leaving this out was intentional, weird. If unintentional, really weird.
June 11, 2024
۳/۵💉💉💉
به نظرم یه رَنت خیلی خوب در مورد دسترسی به داروهای ضد درد و مخصوصاً اوپیوییدها داشت؛ میگه حالا که مردم کشورهای توسعه یافته خودشون داروهای کم خطر تر ولی گرون تر رُ در دسترس دارن، یه موج راه انداختن که ریشه اوپیوییدها رُ در کل دنیا بخشکونن. غافل از اینکه این داروها بعضاً تنها داروی آنالجزیک در دسترس قشر کم درآمد و مردم کشورهای درحال توسعه هستن. اشاره به همین اخلاقِ نزدیک بینانه ی آمریکایی باعث میشه به کتاب یه ستاره اِرفاقی بدم. 1footnote*
از چپتر هفتم و Visceral Pain مباحث جذابیت پیدا کردن.
اولین جایی از کتاب که یه سوال ساده و خیلی مهم پرسید همینجا بود: چرا زایمان باید با درد و اونم این میزان از درد اتفاق بیافته؟ باعث شرمندگی خودم میدونم که تا حالا اصلا -مخصوصا از منظر بیلوژی تکامل- این سوال حتی به ذهنم هم نرسیده بود.
یه کم بعدتر درباره تاثیر دایمی درد مزمنِ کمر، روی مغز این توضیح رُ داده:
Images of the brains of these patients showed a reduction in the gray matter of the thalamus but also showed a reduction in the gray matter of the prefrontal cortex; the area associated with the emotional and cognitive aspects of the pain experience.
و بعد از این خنجر زدن، یه ضربه مهلک دیگه زد و نوشت که تحقیقات متعاقب نشون داده همین تاثیر با همه دردهای مزمن اتفاق می افته مخصوصا درد های نوروپاتیک، IBS ، فیبرومیلوما و حتی سردردهای مزمن.
مبحث دردهای ارگانیک و دردهای فانکشنال هم خیلی خیلی برای من آموزنده بود. این که راهکار درمانی مخصوصا برای درد فانکشنال عموما به غلط اتخاذ شده و اینکه پِریوالانس دردهای فانکشنال در زنان چهار برابر بیشتر از مردانه خیلی فکرمو مشغول کرد.
به علاوه اواخر کتاب یه بحث جالب درباره تفاوت احساس درد بین زنان و مردان داره که متضاد باور من+عوام هست. اشاره میکنه به «emotional components » در ترجمان شخصی درد که به نظرم مبحث جالبی میاد برای تحقیق و مطالعه بیشتر.2footnote**
به داروهای پین کیلر هم یه مقدار جزیی پرداخته و یه نقد خیلی جالب به این داروها داشت. اما به نظرم میرسه درد رُ به صورت یه عارضه از سندرم نمیدونم که برای من خیلی منطقی نیست. ولی خُب، من در جایگاه نقد ایشون نیستم مسلما.
و یه رنت دیگه هم داره درباره پرهیز از حذف درد از بدن و بدنه جامعه که شخصا نمیدونم درسته یا غلط اما میدونم قشنگه حرفاش.3footnote***
1*
The relationship between the developed and the developing worlds in regard to the availability and distribution of analgesics is complex. A case in point is the availability of opiates, the most effective painkillers, whose use has been promoted very successfully in many developed countries.
This has produced a substantial reduction of pain in these countries, but it also has led to unwanted effects associated with the long-term use of opiates and to addiction and abuse. And that has generated a backlash in developed countries, where strong warnings are heard about the dangers of making these drugs too easily available, and a knock-on effect in the developing world, where, owing to deficiencies in control and enforcement, opiates have become almost unavailable. The regulating authorities should be persuaded that there are clear indications for the proper use of opiates and that they should be available worldwide, under the correct medical management, to reduce pain.
2**
Women may be more used to feeling pain, but their reaction to it is very emotional and their ratings of the unpleasantness of pain are always higher than those of men. And it is the emotional component of pain, more than the simple sensory experience, that makes it particularly unbearable. Pain in women has a very negative affective element that makes its experience very different from and more unpleasant than pain in men.
3***
As we improve our pain treatments and develop new and better analgesic procedures, we get caught in a vicious circle that makes a pain-free world an impossible goal. Society demands more and better analgesia, which leads to increased availability of pain-relief procedures, which in turn reduces the amount of pain around us and increases our expectations of a pain-free life. This produces a lower pain tolerance, and therefore an increased demand for more analgesia, a further reduction in the amount of pain around us, even lower pain tolerance, and so on. The final goal — no pain — gets progressively closer but is never reached…
…Unfortunately, the more pain we remove from the world, the less tolerance we have for the pain that remains, and that creates a vicious circle.
به نظرم یه رَنت خیلی خوب در مورد دسترسی به داروهای ضد درد و مخصوصاً اوپیوییدها داشت؛ میگه حالا که مردم کشورهای توسعه یافته خودشون داروهای کم خطر تر ولی گرون تر رُ در دسترس دارن، یه موج راه انداختن که ریشه اوپیوییدها رُ در کل دنیا بخشکونن. غافل از اینکه این داروها بعضاً تنها داروی آنالجزیک در دسترس قشر کم درآمد و مردم کشورهای درحال توسعه هستن. اشاره به همین اخلاقِ نزدیک بینانه ی آمریکایی باعث میشه به کتاب یه ستاره اِرفاقی بدم. 1footnote*
از چپتر هفتم و Visceral Pain مباحث جذابیت پیدا کردن.
اولین جایی از کتاب که یه سوال ساده و خیلی مهم پرسید همینجا بود: چرا زایمان باید با درد و اونم این میزان از درد اتفاق بیافته؟ باعث شرمندگی خودم میدونم که تا حالا اصلا -مخصوصا از منظر بیلوژی تکامل- این سوال حتی به ذهنم هم نرسیده بود.
یه کم بعدتر درباره تاثیر دایمی درد مزمنِ کمر، روی مغز این توضیح رُ داده:
Images of the brains of these patients showed a reduction in the gray matter of the thalamus but also showed a reduction in the gray matter of the prefrontal cortex; the area associated with the emotional and cognitive aspects of the pain experience.
و بعد از این خنجر زدن، یه ضربه مهلک دیگه زد و نوشت که تحقیقات متعاقب نشون داده همین تاثیر با همه دردهای مزمن اتفاق می افته مخصوصا درد های نوروپاتیک، IBS ، فیبرومیلوما و حتی سردردهای مزمن.
مبحث دردهای ارگانیک و دردهای فانکشنال هم خیلی خیلی برای من آموزنده بود. این که راهکار درمانی مخصوصا برای درد فانکشنال عموما به غلط اتخاذ شده و اینکه پِریوالانس دردهای فانکشنال در زنان چهار برابر بیشتر از مردانه خیلی فکرمو مشغول کرد.
به علاوه اواخر کتاب یه بحث جالب درباره تفاوت احساس درد بین زنان و مردان داره که متضاد باور من+عوام هست. اشاره میکنه به «emotional components » در ترجمان شخصی درد که به نظرم مبحث جالبی میاد برای تحقیق و مطالعه بیشتر.2footnote**
به داروهای پین کیلر هم یه مقدار جزیی پرداخته و یه نقد خیلی جالب به این داروها داشت. اما به نظرم میرسه درد رُ به صورت یه عارضه از سندرم نمیدونم که برای من خیلی منطقی نیست. ولی خُب، من در جایگاه نقد ایشون نیستم مسلما.
و یه رنت دیگه هم داره درباره پرهیز از حذف درد از بدن و بدنه جامعه که شخصا نمیدونم درسته یا غلط اما میدونم قشنگه حرفاش.3footnote***
1*
The relationship between the developed and the developing worlds in regard to the availability and distribution of analgesics is complex. A case in point is the availability of opiates, the most effective painkillers, whose use has been promoted very successfully in many developed countries.
This has produced a substantial reduction of pain in these countries, but it also has led to unwanted effects associated with the long-term use of opiates and to addiction and abuse. And that has generated a backlash in developed countries, where strong warnings are heard about the dangers of making these drugs too easily available, and a knock-on effect in the developing world, where, owing to deficiencies in control and enforcement, opiates have become almost unavailable. The regulating authorities should be persuaded that there are clear indications for the proper use of opiates and that they should be available worldwide, under the correct medical management, to reduce pain.
2**
Women may be more used to feeling pain, but their reaction to it is very emotional and their ratings of the unpleasantness of pain are always higher than those of men. And it is the emotional component of pain, more than the simple sensory experience, that makes it particularly unbearable. Pain in women has a very negative affective element that makes its experience very different from and more unpleasant than pain in men.
3***
As we improve our pain treatments and develop new and better analgesic procedures, we get caught in a vicious circle that makes a pain-free world an impossible goal. Society demands more and better analgesia, which leads to increased availability of pain-relief procedures, which in turn reduces the amount of pain around us and increases our expectations of a pain-free life. This produces a lower pain tolerance, and therefore an increased demand for more analgesia, a further reduction in the amount of pain around us, even lower pain tolerance, and so on. The final goal — no pain — gets progressively closer but is never reached…
…Unfortunately, the more pain we remove from the world, the less tolerance we have for the pain that remains, and that creates a vicious circle.
October 16, 2017
In this book, the author explores how pain works physically, emotionally, and spiritually. This isn’t a self help book about getting rid of pain. Rather, this book attempts to explain what causes pain, how it works, and what we might do in the future to treat pain. I suspect it will be of interest to people like me who live with chronic pain as well as clinicians who treat pain.
March 29, 2022
Some excellent information here, but far too optimistic about the future. Yet it was written at least 10 years ago, perhaps before the advent of the hysterical "opioid epidemic," since which it has become almost impossible for chronic pain sufferers (like myself) to obtain adequate medication.
January 6, 2023
Thought there would be more philosophical commentary, which is probably my mistake.
Lots of science talk if you're into that!
Lots of science talk if you're into that!
July 19, 2025
I read this book three times.
I work in the field of Neuromodulation (peripheral nerve stimulation) for chronic pain. I was seeking a sophisticated approach to the mechanisms of pain. This book is a holy grail.
The book starts with neurophysiology and then goes into the gate control theory of pain. As the book progresses, the author mentions key spinal cord tracts and then arrives into the field of neuroscience. After reading this book, I can say with confidence that pain originates in the brain.
The author even ties in the transorbital lobotomy procedure from the early 1900s. This, in turn, made me read the book "The Lobotomist" by El-Hai.
The author mentions some interesting new brain regions that may be key to modulating pain such as the insular cortex. The insular cortex could be a potential target for Deep Brain Stimulation.
My favorite aspect of the book was how the author broke down pain into three components: emotional, cognitive, and sensory. These three components modulate the pain signal and determine what you are going to feel once the pain signal has initiated propagation.
I work in the field of Neuromodulation (peripheral nerve stimulation) for chronic pain. I was seeking a sophisticated approach to the mechanisms of pain. This book is a holy grail.
The book starts with neurophysiology and then goes into the gate control theory of pain. As the book progresses, the author mentions key spinal cord tracts and then arrives into the field of neuroscience. After reading this book, I can say with confidence that pain originates in the brain.
The author even ties in the transorbital lobotomy procedure from the early 1900s. This, in turn, made me read the book "The Lobotomist" by El-Hai.
The author mentions some interesting new brain regions that may be key to modulating pain such as the insular cortex. The insular cortex could be a potential target for Deep Brain Stimulation.
My favorite aspect of the book was how the author broke down pain into three components: emotional, cognitive, and sensory. These three components modulate the pain signal and determine what you are going to feel once the pain signal has initiated propagation.
August 23, 2016
nice book, i have learned alot.. "pain is in your brain" very comprehensible book for a mediocre reader who is interested in science.. not so many technical jargons as one might expect
Displaying 1 - 8 of 8 reviews