Why We Hurt: The Natural History of Pain [Hardcover]

Frank T. Vertosick Jr. (Author)

Book Description

Publication Date: June 3, 2000

As much as we detest pain, it remains curiously indispensable. Medical science still struggles to conquer pain, yet those who feel no pain at all live in great peril. Dr. Frank Vertosick, a practicing neurosurgeon, explores this paradox, using pain as a lens to give insight into how our bodies function. C. S. Lewis called pain God's megaphone: it gets our attention and warns us of danger. Using stories of patients in pain, Dr. Vertosick explains how pain evolved and why it functions the way it does. Beginning with his own battle against severe migraines, he goes on to explain other common pain syndromes-back pain, angina, cancer pain, arthritis, childbirth, and carpal tunnel syndrome. A fine writer and empathic physician, Dr. Vertosick combines the scientific beauty of the bestselling How We Die with the superb storytelling of Oliver Sacks. He gives us a mixture of medicine, history, anthropology, drama, inspiration, and practical advice. For people in pain, as Dr. Vertosick explains so well, knowledge is often the first, and best, analgesic.

Editorial Reviews

Amazon.com Review

If you've been paying attention, you've noticed by now that pain and suffering infiltrate nearly every part of life. Whether it's an executive nursing a quiet ulcer in the boardroom or a wailing child holding a skinned knee on the playground, this uniquely unpleasant signal must be important; if it weren't, we could more easily ignore it. Neurosurgeon Frank T. Vertosick Jr. explains the evolutionary, physiological, and psychological reasons for pain in Why We Hurt: The Natural History of Pain. Not a paean to despair, the book helps to ease suffering through understanding and learning just how far we've come in the short history of palliative practice. Vertosick's long experience working with sufferers of hideously intractable pain, and his own long battle with migraine, provides depth and illustrative stories that draw the reader into what might otherwise be dry medicalese.

It's heartening to see more surgeons like Dr. Vertosick coming to accept the often-strong psychological basis of pain and appropriate nonsurgical, nonpharmacologic treatments for it. Certainly, as in the case of the woman whose trigeminal nerve was eroded by a circulatory tangle, cutting and suturing have their appropriate place. And the author found several years ago that simple acetaminophen was all he needed to stave off his headaches. His gentle explanations and usually uplifting stories help us prepare for our own episodes of suffering. Though it might seem like small comfort, learning Why We Hurt can be as powerful as the strongest narcotic, with no side effects. --Rob Lightner

From Publishers Weekly

This accessible and compassionate exploration of physical pain should be of great interest since, at one time or another, almost everyone has experienced severe or recurrent pain. As a neurosurgeon, Vertosick (When the Air Hits Your Brain) has treated patients with migraines, back problems, neuralgia, rheumatoid arthritis, angina and cancer. Drawing on case histories from his practice and on scientific research, he surveys the experience and the processes of pain, as well as the idea of it. He gives a brief, clearly stated history of painful conditions, explains how and why pain strikes and describes the various ways medical intervention can ease or eradicate pain. He also reflects on his wife's labor pains; details the history of anesthesia (a medical invention that he rates as "high among the greatest achievements of our age"); and tells a series of stories about how he and his patients have dealt with their pain. He recounts, for example, how he worked with Anne, a patient whose ruptured disc prevented her from walking on one of her legs. First he tried physical therapy, steroids and narcotic medications to alleviate her pain. Then, when all these treatments failed, he performed the back surgery that enabled her to recover. Combining personal narrative with scientific explanation, Vertosick, who describes himself as "a bit of a wimp" who dislikes seeing patients in pain, displays an enormous dedication to relieving suffering. (June)
Copyright 2000 Reed Business Information, Inc.

See all Editorial Reviews

Product Details

• Hardcover: 292 pages
• Publisher: Houghton Mifflin Harcourt; 1 edition (June 3, 2000)
• Language: English
• ISBN-10: 0151003777
• ISBN-13: 978-0151003778
• Product Dimensions: 9.1 x 5.9 x 1.3 inches
• Shipping Weight: 1.4 pounds
• Average Customer Review: 3.8 out of 5 stars  See all reviews (9 customer reviews)
• Amazon Best Sellers Rank: #1,970,800 in Books (See Top 100 in Books)

More About the Author

Discover books, learn about writers, read author blogs, and more.

Customer Reviews

Most Helpful Customer Reviews

59 of 66 people found the following review helpful:

3.0 out of 5 stars Good read, but not always right, July 22, 2000

By 

William C. Tom - See all my reviews

This review is from: Why We Hurt: The Natural History of Pain (Hardcover)

Dr. Vertosick has written a fine collection of vignettes of patients suffering from chronic pain, from his perspective as a practicing neurosurgeon. Detracting from his storytelling skills, however, are the errors of fact and intepretation which appear throughout the book.

Most egregious is the confusion of nitrous oxide for nitric oxide, the molecule used ubiquitously in our bodies for vascular regulation and neurotransmission. This is not simply a spelling error, since Dr. Vertosick goes ahead and mistakenly identifies the subject of the 1998 Nobel prize (nitric oxide) as "laughing gas" (nitrous oxide). Despite the similarity in nomenclature, the two gases are completely different in their physiological roles and effects.

Perhaps in an effort to justify the grandiose title, many appeals to evolutionary theory are made. These efforts are stretches at best, and wrong at times. For example, the speculation that the malaise produced by the flu may be adaptive to humans by limiting viral spread through social contact ignores the fact that the individual, not the group, is the most important locus of Darwinian selection. A more likely adaptive explanation for the clinical symptoms of the flu is that inactivity and fever allow the infected body to concentrate its physiological resources against the invaders.

In a discussion on how nitroglycerin relieves the crushing chest pain (and myocardial ischemia) of angina, the explanation was given that the body's arteries dilate, thus making it easier for the suffering heart to pump blood forward. In fact. the major effect of nitroglycerin is to dilate the veins, providing the heart with lesser volumes of blood to pump.

While lauding the pain relief given to his laboring wife by epidural analgesia, Dr. Vertosick reports that the epidural prolonged the birth process. Although there is a correlation between the use of an epidural and longer labor, the current medical literature attributes this to the likelihood that women with complicated- and longer - labor are more likely to request an epidural, not that an epidural prolongs the childebirth process.

Finally, and this probably falls in the "nitpicking" category, the bacterium causing leprosy belongs to the same genus as that causing tuberculosis, not the same species as claimed in the book.

I did not read the book with an intention to find errors, but there are mistakes which jump out at the biomedically literate reader. I would still recommend the book as a good introduction to the problem of chronic pain, written with sympathy and clinical insights. However, it is disturbing that a book written by a physician would contain so many factual errors of a biological or medical nature. I wish the author - or his editors - would clean up the text for a second edition.

38 of 44 people found the following review helpful:

1.0 out of 5 stars lfootemd, August 26, 2000

By 

Leslie Arden Foote - See all my reviews

This review is from: Why We Hurt: The Natural History of Pain (Hardcover)

After reading the introduction I had great hopes of gaining some unique perspectives on pain from a teleologic standpoint. Unfortunately reading further only led to crushing disappointment.

This is a book on pain that comes from a very narrow focus. Each chapter, opened with a clinical vignette, attempts to educate the reader as to the presumed cause of pain and then the treatment options. Written from the perspective of a neurosurgeon, it's no surprise where this all goes. Unfortunately not everything in the realm of pain is going to take on the appearance of a nail which the author enjoys using his hammer on at the conclusion of each chapter.

Chronic pain is an elusive character and seldom conforms to our needs for a "structural" answer. The author has sadly limited his overview of pain to those situations where a "surgical answer" is awaiting. Those varieties of pain that so often elude us in Medicine, such as Fibromyalgia, are not even addressed. What's more distressing is that the emotional component of pain is given virtually no space in the book, and indeed is ignored. The Vignette on the malingerer is a case in point. The author's idea of therapy was to announce to the patient that "nothing's wrong" and go home. As much as malingering is a nuisance in any clinical setting, there still is pain--you just won't find it on an xray.

As a primary care physician I am concerned about the tone of this book. Many patients in my practice are in chronic pain SINCE they underwent one of these fancy neurosurgical proceedures. It's clear to any of us that see patients in the aftermath of surgery that Medicine does not possess all the answers since it finds it distasteful to deal with the psychosomatic components of pain. The author only reinforces that viewpoint.

In addition to the errors that the first reviewer noted I would like to add that acupuncture does not "treat the imagination" as the author smugly suggests. If a placebo effect were the only explanation than how does that explain the effects observed in veterenary settings?

This is a book that may produce false hope in individuals with chronic pain.

10 of 12 people found the following review helpful:

5.0 out of 5 stars A terrible instrument, March 22, 2002

By 

E. A. Lovitt "starmoth" (Gladwin, MI USA) - See all my reviews
(HALL OF FAME REVIEWER)    (TOP 100 REVIEWER)    (REAL NAME)   

Amazon Verified Purchase

This review is from: Why We Hurt: The Natural History of Pain (Paperback)

C.S. Lewis said in his book, "The Problem of Pain": "Pain as God's megaphone is a terrible instrument." It gets our attention and warns us of danger. Unfortunately, some doctors don't listen to that same megaphone when treating their patients.

According to a recent "New York Times" article, "More than a third of seriously ill patients who requested that doctors ease their discomfort instead of prolonging their lives appear to have had their wishes overlooked, a new study [published in the "Journal of the American Geriatrics Society"] reports".

"Why We Hurt" claims that, "three of four cancer patients will die in poorly controlled pain, and the percentage climbs higher still for those succumbing to malignancies with a talent for invading bones and nerves, including cancers of the breast, prostate, rectum, pancreas, and cervix."

This must be disquieting information for people who are suffering from terminal illnesses like cancer or AIDS, especially since doctors already tend to undermedicate for pain---think of all of the criminal and civil lawsuits pending for over-prescription of OxyContin, and it is easy to understand why some doctors avoid the heavy-duty painkillers or their prolonged usage.

Dr. Vertosick has treated some nightmarish pain problems during his career as a neurosurgeon. This book contains many case histories of patients in agony, connected by the overarching theme of why it is necessary to feel pain. Each story explains why we are connected in such a hurtful way to our inner and outer worlds.

According to Dr. Vertosick, "when stripped of pain's discipline, we neglect our bodies until they become battered beyond recognition....The hands and feet of longtime diabetics and paralytics...become deformed and covered with pressure sores. Patients with trigeminal neuralgia who have their corneas rendered numb by alcohol nerve blocks will ultimately go blind from unchecked corneal scarring."

There is also the sad story of Jimmy, the boy who was born without the ability to feel pain.

"Why We Hurt" is a book that both teaches and fascinates. I learned that neurosurgery can help at least some people (including cancer patients) who suffer from intractable pain. There are only a couple of areas where I found Dr. Vertosick to be overly optimistic. One concerns the efficacy of back surgery. Read this book, and then read the prologue to Dr. Jerome Groopman's "Second Opinions" for an example of where back surgery (spinal fusion) worsened the patient's condition. My own neurologist has told me that 60% of patients who underwent back surgery felt that it didn't do any good.

The question of whether newborn babies feel pain is another gray area where this author tends toward optimism. He feels that they are not yet fully connected to sensations of pain. However, I've read research to the contrary: newborn infants who have been operated on without anesthesia not only feel pain, they remember it.

These two small quibbles aside, please read this book. You may someday have to make choices on pain control, and this is a good place to start learning what those choices may entail, and (if it's any comfort) why it is `natural,' i.e. in accordance with human evolution, that you feel the way you do.