A Nation In Pain

From neurobiology to public policy, examines the chronic pain crisis, which is a major national health concern, discussing the latest scientific discoveries and advances in treatments and providing a sensible plan of action.

Chronic pain costs the nation up to $635 billion each year in medical treatment and lost productivity. The 2010 Patient Protection and Affordable Care Act required the Department of Health and Human Services (HHS) to enlist the Institute of Medicine (IOM) in examining pain as a public health problem. In this report, the IOM offers a blueprint for action in transforming prevention, care, education, and research, with the goal of providing relief for people with pain in America. To reach the vast multitude of people with various types of pain, the nation must adopt a population-level prevention and management strategy. The IOM recommends that HHS develop a comprehensive plan with specific goals, actions, and timeframes. Better data are needed to help shape efforts, especially on the groups of people currently underdiagnosed and undertreated, and the IOM encourages federal and state agencies and private organizations to accelerate the collection of data on pain incidence, prevalence, and treatments. Because pain varies from patient to patient, healthcare providers should increasingly aim at tailoring pain care to each person's experience, and self-management of pain should be promoted. In addition, because there are major gaps in knowledge about pain across health care and society alike, the IOM recommends that federal agencies and other stakeholders redesign education programs to bridge these gaps. Pain is a major driver for visits to physicians, a major reason for taking medications, a major cause of disability, and a key factor in quality of life and productivity. Given the burden of pain in human lives, dollars, and social consequences, relieving pain should be a national priority.

INSTANT NEW YORK TIMES and LOS ANGELES TIMES BESTSELLER “Brilliant . . . riveting, scary, cogent, and cleverly argued.”—Beth Macy, author of Dopesick, as heard on Fresh Air This book is about pleasure. It’s also about pain. Most important, it’s about how to find the delicate balance between the two, and why now more than ever finding balance is essential. We’re living in a time of unprecedented access to high-reward, high-dopamine stimuli: drugs, food, news, gambling, shopping, gaming, texting, sexting, Facebooking, Instagramming, YouTubing, tweeting . . . The increased numbers, variety, and potency is staggering. The smartphone is the modern-day hypodermic needle, delivering digital dopamine 24/7 for a wired generation. As such we’ve all become vulnerable to compulsive overconsumption. In Dopamine Nation, Dr. Anna Lembke, psychiatrist and author, explores the exciting new scientific discoveries that explain why the relentless pursuit of pleasure leads to pain . . . and what to do about it. Condensing complex neuroscience into easy-to-understand metaphors, Lembke illustrates how finding contentment and connectedness means keeping dopamine in check. The lived experiences of her patients are the gripping fabric of her narrative. Their riveting stories of suffering and redemption give us all hope for managing our consumption and transforming our lives. In essence, Dopamine Nation shows that the secret to finding balance is combining the science of desire with the wisdom of recovery.

Drug overdose, driven largely by overdose related to the use of opioids, is now the leading cause of unintentional injury death in the United States. The ongoing opioid crisis lies at the intersection of two public health challenges: reducing the burden of suffering from pain and containing the rising toll of the harms that can arise from the use of opioid medications. Chronic pain and opioid use disorder both represent complex human conditions affecting millions of Americans and causing untold disability and loss of function. In the context of the growing opioid problem, the U.S. Food and Drug Administration (FDA) launched an Opioids Action Plan in early 2016. As part of this plan, the FDA asked the National Academies of Sciences, Engineering, and Medicine to convene a committee to update the state of the science on pain research, care, and education and to identify actions the FDA and others can take to respond to the opioid epidemic, with a particular focus on informing FDA's development of a formal method for incorporating individual and societal considerations into its risk-benefit framework for opioid approval and monitoring.

“Harry has written a powerful book . . . . The United States of Opioids is a call to action and tangible steps that we can all take. Harry delivers insights into the challenges facing our health system―doctors, hospitals, and addiction treatment providers―but also offers steps that we can all take as parents and with everyone else in our lives”--Lisa Marie Presley

Rubble Nation tells the story of post-quake Haiti through interviews with Haitian citizens and aid managers. Each interview adds a layer to our understanding of the suffering of the people and of the heroic efforts to ameliorate that suffering. The narrative is set in the context of the country's history and the Haitian government's effort to repair and rebuild their nation. The photographs capture images not only of individuals struggling to survive, but also of the innate dignity and generosity that arises in the midst of the struggle.

Out of 238 million American adults, 100 million live in chronic pain. And yet the press has paid more attention to the abuses of pain medications than the astoundingly widespread condition they are intended to treat. Ethically, the failure to manage pain better is tantamount to torture. When chronic pain is inadequately treated, it undermines the body and mind. Indeed, the risk of suicide for people in chronic pain is twice that of other people. Far more than just a symptom, writes author Judy Foreman, chronic pain can be a disease in its own right -- the biggest health problem facing America today. Published in partnership with the International Association for the Study of Pain, A Nation in Pain offers a sweeping, deeply researched account of the chronic pain crisis, from neurobiology to public policy, and presents to practical solutions that are within our grasp today. Drawing on both her personal experience with chronic pain and her background as an award-winning health journalist, she guides us through recent scientific discoveries, including genetic susceptibility to pain; gender disparities in pain conditions and treatments, perhaps linked to estrogen; the problem of undertreated pain in children; the emerging role of the immune system in pain; advances in traditional treatments such as surgery and drugs; and fair-minded assessments of the effectiveness of alternative remedies, including marijuana, acupuncture, massage, and chiropractic care. For many people, the real magic bullet, Foreman writes, is exercise. Though many patients fear it will increase their discomfort, studies show it consistently produces improvement, often dramatic. She also explores the destructive "opioid wars," which have led to a misguided demonization of prescription painkillers. Foreman presents a far-reaching but sensible plan of action, ranging from enhancing pain education in medical schools to reforms of federal policies across the board. For doctors, scientists, policy makers, and especially patients, A Nation in Pain is essential reading.

Dr. John E. Sarno's groundbreaking research on TMS (Tension Myoneural Syndrome) reveals how stress and other psychological factors can cause back pain-and how you can be pain free without drugs, exercise, or surgery. Dr. Sarno's program has helped thousands of patients find relief from chronic back conditions. In this New York Times bestseller, Dr. Sarno teaches you how to identify stress and other psychological factors that cause back pain and demonstrates how to heal yourself--without drugs, surgery or exercise. Find out: Why self-motivated and successful people are prone to Tension Myoneural Syndrome (TMS) How anxiety and repressed anger trigger muscle spasms How people condition themselves to accept back pain as inevitable With case histories and the results of in-depth mind-body research, Dr. Sarno reveals how you can recognize the emotional roots of your TMS and sever the connections between mental and physical pain...and start recovering from back pain today.