Review of: The Phenomenon of Pain by Serge Marchand

Abstract

At first glance, The Phenomenon of Pain appears to be a medical textbook. Its initial chapters deftly cover topics of neuroscience and pain in scholarly detail and scope. A closer look reveals that the author, Professor Serge Marchand, PhD, has a more advanced purpose in mind, namely to demonstrate how neurophysiologists and psychologists might benefit from studying the basic tenets of each other’s specialties so that both can more capably treat pain. Dr Marchand notes, ‘‘This approach is quite logical because even if the treatment is ‘psychological,’ knowledge of the neurophysiological mechanisms can only help the therapist to apply it and measure its effects. Similarly, knowledge of factors other than the physiological ones will help the health professional to monitor the patient’s progress and distinguish the effects directly related to the treatment, pharmacological or otherwise, from those related to other internal or external events that may be affecting the patient’’ [pp. 2–3]. He illustrates this point throughout his book, choosing not to concentrate on any one medical condition in detail, offering instead a more general discussion of pain and its treatment. Following detailed, medical chapters on neurophysiology, neurophysiology of pain, and the history/evolution of pain, Dr Marchand introduces the reader to situations where a psychological or societal frame of reference can provide special forms of data or a context in which individuals in pain can be understood. In his chapter on measuring pain, he cautions that, ‘‘. . .it is important to remember that pain is a perception and that physiological measurements reflect nociceptive activity and not necessarily pain’’ and that the ‘‘patient’s assessment is still the standard measurement!’’ [pp. 131–132]. He also discusses in detail many of the concepts and problems inherent in measuring pain from both a physiological and psychological perspective. Not to be missed are later chapters which explore special populations of pain patients. Dr Marchand poignantly describes how in past times the pain perception capabilities of the very young were sometimes grossly underestimated meaning that young infants suffered through painful procedures or illnesses with little or no pain medication. At the other end of the age spectrum, the elderly are particularly vulnerable to the adverse effects of medications, but still need to have their pain addressed. Problems in treating both age groups are difficulties in communication. Also, extremely important in the book is the material on the differences in pain sensitivity and pain tolerance between males and females and between [and within] various racial and ethnic groups. The Phenomenon of Pain is very impressive in all that it covers. It would benefit, though, from a sequel which considers pain not as a single symptom, but one which frequently exists alongside [or in conjunction with] other similarly troublesome, physiological symptoms, such as fatigue, stiffness, brain fog, etc. In addition, it would be useful to consider the various pain conditions that can coexist or overlap. Consider fibromyalgia syndrome, osteoarthritis and myofascial pain, which are a frequent trio that appears together, particularly as aging occurs. [It would be nice to see myofascial pain discussed in more detail, too, as there have been many new developments in the field recently.] And what of patients who take multiple prescription pain medications for more than one condition? All of