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on February 1, 2014
Judy Foreman has done a brilliant job of shedding light on one of the biggest problems in American medical care. The under-treatment of chronic pain in adults is an embarrassment to the medical profession, from inadequate education of medical students about any aspect of pain to a prevailing view that people requiring opioids for chronic pain are guilty until proven innocent. Sadly, even oncologists receive almost no training in pain management.

The book is encyclopedic in scope, covering many research efforts, patient stories, and interviews from the nation’s leading pain experts. I can’t even imagine how much research was done to compile such a vast amount of information. This book is a gift to patients who have suffered unnecessarily AND to doctors who need more education and should be more sympathetic to people suffering with this prevalent and highly debilitating condition. When all is said and done, we are all but one major car accident away from a life of chronic pain. Judy Foreman gets a gold star for writing a book that should be required reading for all physicians.

Gail Gazelle, MD, FACP
Assistant Clinical Professor, Harvard Medical School
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on February 9, 2014
Judy Foreman's new book, A Nation in Pain, doesn't waste any time diving in to the shocking statistics and research related to chronic pain and the severity of the problems surrounding it. It is a mandatory reading for Chronic Pain patients, Medical professionals, and society at large - who is so often misinformed by the media and general lack of education surrounding these issues. This book covers everything from the basic definition of chronic pain --- to opioid wars --- to ideas on how to make real improvements in our nation's response to chronic pain.

Some early facts in this book that i found to be highly interesting:
1). "[the government] spends only about 1% of its vast budget on pain research, despite the fact that chronic pain....is a bigger problem than heart disease, cancer, and diabetes COMBINED. ...Federal spending on chronic pain is actually going down."
2). Judy Foreman discussed the problem of doctors not being educated to treat or work with patients with chronic pain. She cites, "Across all the years of medical training, students got an average of 13 to 41 hours of pain education. Veterinary students got more than twice that - 87 hours on average."
3). "Out of 238 million American adults, 100 million live in chronic pain. And yet the press has paid more attention to the abusers of pain medications than the astoundingly widespread condition they are intended to treat. Ethnically, the failure to manage pain better IS TANTAMOUNT TO TORTURE."

I fully believe that we will be better as a country due to this book, the more people that read it the better. It is rare that any book fills me with this level of inspiration for positive change. I know i will read this book many times, and buy it for those who are important to me. Ms. Foreman's research appears to be ignited by her own personal experience, fueling her passion for this subject. I am further impressed as I emailed her with some of my questions and comments and she responded within 24 hours! If you are interested in improving our country and preventing the unnecessary torture of our citizens, i highly recommend you read this book!
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on January 31, 2014
The reason I am buying is that both my wife and I have pain issues. The following is from a very reliable web site I subscribe to that gave this review. Another reason I am buying the book. After reading I will adjust the stars rating based on my feelings about the book.

The following review was written by SB. Leavitt, MA, PhD at Pain Topics News & Research.
Of nearly 240 million adults in the United States, more than 4 in 10, or about 100 million, live with chronic pain of some sort. Yet, the professional and popular news media focus more on abuses of pain medications than the dreaded conditions the drugs are intended to treat. Meanwhile, the suffering of untreated or mistreated patients with pain is largely overlooked.
In her new book — A Nation in Pain: Healing Our Biggest Health Problem — author Judy Foreman provides a deeply researched account of today’s chronic pain crisis and reasons behind it, and she discusses some solutions that could be within reach. Far more than just a symptom, Foreman explains, chronic pain can be a disease in its own right, and the failure to manage pain better in the U.S. and other countries worldwide may be tantamount to torture.
A great many (perhaps, too many) books have been written on the subject of pain; all are well-intentioned and often they are self-published. While some of the books are of interest, most appear to be riddled with personal opinion, biased perspectives, and/or misinformation rather than being guided by facts and solid evidence. As a journalist and investigative health reporter, Foreman has done a noteworthy job of crafting easy-to-read text that also is excellently documented with enough citations of her evidentiary sources to satisfy even the most skeptical readers — which is quite rare for a book intended for both lay and professional audiences, as is A Nation in Pain.
The 464 page book, published by Oxford University Press, is ambitious in scope, covering in a mere 14 chapters subjects ranging from the nature of pain to genetic, age, gender, immune system, and mind-body influences. Foreman also examines various traditional, newly discovered, and alternative therapies for chronic pain.
She says that her research for A Nation in Pain spanned 5 years, during which time Foreman consulted a library of books and hundreds of scientific papers on pain. She also interviewed nearly 200 scientists and physicians, as well as countless patients, a few lawyers, and a handful of government officials. [Full disclosure: This writer was one of those persons consulted, and we can attest to the depth and relentless probing of her inquiries.]
A most appealing approach of the book is that it is simultaneously a textbook providing research insights and hard evidence, an investigative report replete with stories of affected patients and their families, and a personal memoir relating Foreman’s own experiences with chronic pain and its treatment. Certainly, this juggling was no easy task, but the genre makes for fast-paced, informative reading while captivating even a casual reader.
Overall, Foreman suggests that there is an appalling mismatch between what people in pain need and what healthcare providers know about pain and its treatment — chronic pain in particular. She found that physicians in the U.S. typically receive only about 9 hours of education specifically on pain during 4 years of medical school — even veterinarians are better educated on pain management.
Systematic failure is equally evident at the federal government level; for example, in 2012 the U.S. National Institutes of Health spent only about 1% of its vast $30.8 billion budget on pain research, Foreman states, despite the fact that chronic pain was (and still is) a bigger problem than heart disease, cancer, and diabetes combined. At the same time, chronic pain in the U.S. conservatively costs as much as $650 billion per year in direct medical costs and lost productivity. Shamefully, there is no National Institute of Pain; yet, there are other Institutes addressing diverse health conditions that are important, but affect far fewer citizens and with less burden on the economy.
One of the more startling chapters in A Nation in Pain discusses the mismanagement of pain in pediatrics. Among other revelations, Foreman discloses how as recently as the mid-1980s in the U.S. healthcare professionals believed that young children, especially newborns and infants, seldom needed medication for pain relief and tolerated discomfort well. She recounts the particularly disturbing story of a newborn boy who was subjected to open-heart surgery without anesthesia — a practice that apparently was commonplace at the time, but somewhat of a dark secret known only among medical insiders. In general, management of pain in children of all ages has been deficient worldwide, as Foreman reveals in an examination of the research evidence.
Foreman devotes 2 chapters to the destructive "Opioid Wars," which have led to a misguided demonization of prescription opioid analgesics. Her discussion of this highly controversial topic is among the most fairly-balanced and evidence-based that we have seen. She observes that there are 2 separate public health “emergencies,” sometimes called “epidemics”: (a) undertreated pain influenced by some degree of limited access to opioids, and (b) the abuse of opioid analgesics for illegal or nonmedical purposes. She stresses, “whether the term ‘epidemic’ truly applies here is debatable.”
Foreman recognizes that there are many sides to the ongoing debate and relatively little hard evidence one way or the other. As she states, “The complex truth is that opioids, especially opioids for long-term use in chronic non-cancer pain, are probably both under-prescribed for some patients and overprescribed for others.” Opioids are not a solution for all patients or all types of severe pain, she acknowledges, and at best the pain relief they afford is only partial. She accordingly emphasizes:
“Opioids, in other words, may be necessary, but they are rarely sufficient. What I am saying is that government drug policy seems to be lopsided, politicized, stacked against legitimate pain patients, and fueled by public hysteria over abuse of prescription pain relievers. That hysteria, in turn, is fueled by often-misleading media coverage.”
Those few sentences say a great deal about what has gone awry with concerns about opioid analgesics today. In support of those statements, Foreman laces her discussion with references to relevant research studies, while also distinguishing between good- versus poor-quality evidence — an objectively analytical perspective that is missing in most other books and articles on the subject.
As Foreman observes, the controversy over prescription analgesics is a “highly emotional struggle in which much of the ‘debate’ is driven not by scientific facts but by dueling anecdotes of horror.” She aptly denounces a misguided popular press, prejudiced bureaucrats, and a small cadre of fear-mongering medical professionals for trying to foist a negatively slanted view of opioid pain relievers on the public as well as on the healthcare community at large. In balance, Foreman also tells how over-exuberant marketing by drug manufacturers has contributed to problematic analgesic prescribing and use.
Throughout the book various therapeutic approaches for managing chronic pain are discussed, including new developments still in preclinical or clinical trial stages. Additionally, a whole chapter is devoted to marijuana (“The Weed America Loves to Hate”) and another focuses on exercise (“The Real Magic Bullet”). A range of CAM (Complementary & Alternative Medicine) therapies also are covered, with balanced discussions of pro and con research evidence for each.
Challenges of effective chronic-pain management are complex, with many obstacles to overcome on the path to finding practical solutions. As the diverse stories of patients with pain in the book demonstrate, pain often cannot be extinguished altogether; yet, it almost always can be better managed and patients can live more fulfilling lives. Foreman offers some suggestions for action — such as expanded pain education in medical schools, reforms of federal policies across the board, and increased funding for pain research — but it would require a separate book to do justice to such proposals. Meanwhile, for healthcare providers, researchers, policy makers, and patients and their loved ones, A Nation in Pain is highly recommended reading.
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on January 10, 2014
Ms Foreman, a pain sufferer, does an excellent job of detailing the problems of how pain is treated in America. She provides a biopsychosocial explanation of what pain is including the genetic, neurological, hormonal,immunological and psychological aspects of pain. She explains the experimental evidence for several treatments for pain including opioids, marijuana, anti-depressants, injection therapies,diets, supplements, exercise, electrotherapies, hypnosis, massage, acupuncture, reiki, Alexander technique,Rubenfeld synergy, biofeedback, exercise and pemf. This is where this book excels -and few books do as thorough and unbiased a review of pain treatments as this one. She discusses the politics of pain care and the lack of education and research on pain. She explains in detail the undertreatment and mistreatment of women and children in pain and the complexities of treating them. She includes some of the most current research and some new biomedical targets for pain.This would make an excellent text for graduate course in medical, psychology, physical therapy, chiropractic school.
This book falls very short, in my opinion, on offering a vision to improve pain care for she just calls for more of the same research that has failed pain sufferers in the past. As Helen Keller wrote: To see without a vision, is a terrible thing. In addition, she calls for the same people who have failed people in pain to somehow, take it seriously(Government and doctors) and she is slanted toward finding more biomedical treatments and education for pain-despite her showing evidence of inadequate effectiveness of biomedical treatments and biomedical research-and despite nowing doctors aren't interested in obtaining education in pain care. She could have called for adaptive interventions or new types of research-making use of big data or data mining biomedical or patient authored texts or improving public involvement in research on pain- or better public representation at NIH or on medical boards- but she failed to do that. Ms. Foreman, lets you see the problems with treating pain in America but fails to offer a vision to improve parlous pain care in America. I hope Ms. Foreman will consider working on a book that will explore visions to improve pain care.
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on February 2, 2014
Judy Foreman is not only well qualified to write this excellent and complex book about pain, but she writes with a clear, wonderful, style that keeps you reading every page! She shares her life, her pain, and her recovery that is remarkable. She knows the ins and outs of the medical profession and she knows the best in medicine. She is a person to listen to now. We need to stop physicians from thinking that people are "hysterical" because they have pain. Medical schools have to listen to this book and increase the amount of training they give on pain (more than 1%). I treat children every day and see children who have pain. We need to care for them with the best treatment possible. This author advocates for children and for everyone who experience pain. Ms. Foreman also backs up what she says (the Endnotes are impeccable and must have taken hours of research). I loved the statement, "When researchers analyzed the behavior of people with back pain, they found the more fear people had about moving, the more pain they reported during activity." (p. 287). Then she followed this statement up with the Rainville research on low back pain (1993) that had patients with pain in an intensive reconditioning program. She writes, "The people who hung in and completed the exercise program were those who were able to change their beliefs." Their functioning improved. Exercise seems to be one of the best ways to treat pain. I know that Ms. Foreman believes in exercise. So do I! This book has many new ideas, a better way to understand pain, and respect for those in pain. I highly recommend this book! Ann Densmore, Ed.D.
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on February 6, 2014
For decades we Bostonians have turned to Judy to help us understand the thicket of scientific advice out there (starting when she was editor at the Globe). Now she has taken it to a whole new level. Thank you, Judy!
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on February 2, 2014
A Nation in Pain offers an illuminating view of what is known and unknown about this universal fact of life, how our government and medical establishment have utterly failed to address the problem, and what we must do to ease the daily suffering of 100 million people in the United States alone. Foreman, a longtime columnist for The Boston Globe and other publications, writes lucid and powerful prose. In a call to arms, she describes our failure to treat chronic pain as “torture by omission.”
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on March 28, 2014
Everyone that has chronic pain or loves some one with chronic pain should read this book. It is a very informative and shines a light on a very under rated problem in the world. It is amazing to me that doctors know so little about pain and in many cases ignore it. There is pain research going on but on a ver small scale compared to the enormity of the problem. Pain is probably the single biggest heal problem in the world with the smallest amount of research. Under treating pain is a form of torture practiced daily in this country, it is just criminal. Buy the book it is awsome!
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on March 26, 2014
I am so pleased with this book. I have suffered chronic severe pain for 4 years. No one seems to understand it, not even doctors. Judy Foreman writes this book in a way that makes me feel like I have discovered a new medicine. Chronic pain takes over your entire life. Takes me away from friends and activities. Thank you, Judy for writing this book. I wish I could afford to buy one for all my doctors. I was a nurse for 24 years and I BELIEVED my patients when they said they had pain. I was caring and compassionate. My doctors are cold and unfeeling. Insensitive to my pain. Thank you, Judy. I feel like I have found a new friend. God bless you for writing such an informative book.
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on March 14, 2014
It is well written. It is a must read for anyone with chronic pain or who has a family member who suffers with this malady. It is also helpful for those who deal with periodic though not chronic pain. The more you understand about pain you are experiencing the less frightening it is and thus the less severe the discomfort.
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