Book review

The Pain Detective: Every Ache Tells a Story By Hillel M. Finestone.

ABC-CLIO Press, 2009. ISBN: 978-0313359934. Hardcover, $48.
Dr Hillel Fine­stone, medical dir­ector of the Stroke Rehabilitation Program in Ottawa, has written a book for people who have come to know pain, and those who are curious about how mind-body interactions influence it. The book has wide applicability in Canada, where it has been estimated that 35% of Canadians experience chronic pain.[1] 

The book is organized into 12 chapters, each on a distinct subtype of chronic pain. Topics covered include a wide range of life and pain issues: musculoskeletal pain, stress, wound healing, chronic fatigue, fibromyalgia, alcoholism, shame, post­traumatic stress, fear, abuse, and life balance. 

Also included is a pain explanation and treatment diagram that Dr Finestone uses in his practice to enhance patient comprehension. The book concludes with a philosophical reflection on the interaction between belief systems, mind-body education, disability insurers, and the legal system. It concludes on a hope-filled note.

Overall, I feel the book is quite well done and meets a legitimate need for both patients and physicians in British Columbia. As many patients do not understand the role of psychological states in their pain, this book will provide them with empowering knowledge. And because the book is structured as cloaked case studies of Finestone’s actual patients, many patients will find solace via companionship with the book’s patients. 

The book should also likely be accessible to BC doctors’ patients, as it is written at approximately a grade 7 level (based on a chapter sent to me by the author [grade level calculated via Microsoft Word 2009, Washington, USA]). I also believe that employment of the pain explanation and treatment diagram included as an appendix in the book could benefit patients greatly, as research routinely indicates that patients do not comprehend what physicians tell them about diagnosis and treatment.[2]

Lacking from the book is a definition of pain itself. I would have preferred to see a pain definition according to a leading authority such as the International Association for the Study of Pain (“an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”).[3] 

Also disappointing for me is the auth­or’s use of litotes (such as “not uncommon” when the author really means to say “common”). These deficiencies aside, Dr Finestone has written an ex­cellent book recommended to chronic pain patients and physicians alike with few reservations. 
—Jeremy Daniels
University of British Columbia Medical School

References

1.  Toth C, Lander J, Wiebe S. The prevalence and impact of chronic pain with neuropathic pain symptoms in the general population. Pain Med 2009;10:918-929. 
2.  Engel KG, Heisler M, Smith DM, et al. Patient comprehension of emergency department care and instructions: are patients aware of when they do not understand? Ann Emerg Med 2009;53:454-461.
3. International Association for the Study of Pain. Definitions. www.iasp-pain.org/AM/Template.cfm?Section=Pain_Definitions&Template=/CM/HTMLDisplay.cfm&ContentID=1728#Pain (accessed 23 December 2009).