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Despite the proliferation of pain clinics and various pain-oriented
therapies, there is an absence of data supporting any substantial
change in the statistics regarding the incidence, development and
persistence of pain. As renowned pain clinician and scientist
Daniel M. Doleys argues, there may be a need for a fundamental
shift in the way we view pain. In this thoughtful work, Doleys
presents the evolving concept and complex nature of pain with the
intention of promoting a broadening of the existing paradigm within
which pain is viewed and understood. Combining neuroscience,
psychology, and philosophy of science, this book reviews the
history of pain and outlines the current concepts and theories
regarding the mechanisms involved in the experience of pain.
Experimental and clinical research in a broad array of areas
including neonatal pain, empathy and pain, psychogenic pain, and
genetics and pain is summarized. The notion of pain as a disease
process rather than a symptom is highlighted. Although there is a
continued interest in activation of the peripheral nociceptive
system as a determining factor in the experience of pain, the
growing appreciation for the brain as the intimate 'pain generator'
is emphasized. The definition of consciousness and conscious
awareness and a theory as to how it relates to nociceptive
processing is discussed. Finally, the author describes the
potential benefit of incorporating some of the concepts from
systems and quantum theory into our thinking about pain. The area
of pain research and treatment seems on the precipice of change.
This work intends to provide a glimpse of what these changes might
be in the context of where pain research and therapy has come from,
where it currently is, and where it might be headed.
Part of the What Do I Do Now? Pain Medicine series, Psychological
and Psychiatric Issues in Patients with Chronic Pain presents a
variety of succinct case studies and "curb-side" consults on the
complexity of chronic pain and its successful management. Chapters
present models for understanding issues related to chronic pain
within a psycho-social context, including cases on specific
psychological or psychiatric issues, as well as broad
considerations such as selecting among behavioral therapies options
and the use of complementary therapies and non-opioid analgesics.
Recognizing that most clinicians do not always have the time or
resources to conduct the type of psychological assessment that each
case may require, chapters focus on the key elements of each
diagnosis, covering background information, assessment approach,
treatment recommendations, and key points to remember.
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