M onty Lyman is a British doctor and The Painful Truth is his second book, released in 2021. It provides excellent explanations of persistent pain and the research around it. It has already changed how I consult patients presenting with pain in general practice. Another approach is to accept the pain we feel by becoming a non-judgmental observer - instead of trying to control or defeat it. This can be done through mindfulness. This might sound like madness but I have tried it and have felt it works. Although we no longer live in a world where as many of us are harmed by physical threats and warfare as in the past, we are nowadays much more taken by mental exhaustion and physical stress which will drip, drip, drip, slowly and cause more pain and result in increased pain as well. The painful truth by Monty Lytham looks at how so many of us suffer pain without truly understanding what it is and how it impacts on us. The best way to look at pain is as something that is a protective mechanism to help us deal with things that we may not be aware of going on inside the body. These are some of my takeaway ideas from this wonderful book:

Even if we know, deep down, that pain isn’t a measure of tissue damage, many of us act (and many health professionals treat their patients) as though pain is produced in the body and detected by the brain. Pain is a conscious translation of our unconscious brain’s decision that the body is in danger. V. S. Ramachandran, the eminent Indian–American neuroscientist, puts it well: ‘Pain is an opinion on the organism’s state of health rather than a mere reflective response to injury.’ In most cases of persistent pain, the brain has become overprotective and is no longer detecting tissue damage. durerea nu este detectată de creier, ci este un produs al său, creat de un tipar de activitate care implică mai multe regiuni ale creierului ( se activează mai multe zone care au legătură cu senzorialul, emoționalul, cognitivul). Acest tipar se numește neurosemnătură The author then goes on to detail how pain can be relieved but in ways we would not expect, and crucially talks about why these ways work. Hypnosis is an interesting therapy that Lyman believes can be extremely effective, when combined with modern virtual reality (VR) related therapies. This is because it actually helps lead to increased connectivity in the brain to the prefrontal cortex and insula, which are parts of the brain associated with feelings, and this in turn leads to increased mind-body control. Lyman writes about many studies that prove the effectiveness of hypnosis-VR treatment as well as many other therapies mentioned in the book, which helps to convince readers of the validity of his words.

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When animals have had damage or surgery to remove sources of pain in the brain such as on the anterior cingulate cortex (ACC) then hamster mothers will no longer try to keep their pups nearby and baby squirrel monkeys with similar neural damage will no longer cry when separated from their mothers. So pain and brain chemistry can be shown how the importance of the brain can help us care and look after others.

The conventional wisdom is that pain is caused by damage, but it's more subtle than that. Pain is a signal that can be triggered by damage, but can also be caused in response to less physical causes such as fear and a memory of past damage – and can be suppressed by activity or positive thinking, at least to a degree. This is awkward ground, as Lyman recognises: it's close to saying that "it's all in the mind", which is both literally true and deeply offensive to those suffering persistent pain. But it also offers hope that enormously dangerous pharmaceuticals can – sometimes – be replaced or complemented with cognitive therapies that might be effective. The brain contains a chemistry set that can manage and feel pain, full of neurotransmitters such as dopamine, opioids and cortisol which as this book explains, is a protective mechanism. All pain manifests itself in the brain, and the brain can change the physical behaviour of your body. Think fight or flight, where fear response can cause eyes to dilate, veins to contract (so we might bleed less if cut), the heart to beat faster so that we can either fight or run faster than without it. Sadness can manifest itself with the physical manifestation of wet tears from our eyes. The placebo effect which could be nothing more than a sugar pill can change the way our mind perceives and works on the mindbody connection. This is such an important factor in how our body can respond to pain as well as healing in certain conditions. The placebo can change and alter the chemistry in our brain with neurotransmitters like dopamine and opioids in our brain and allows us to release these neurotransmitters which can then influence and reduce the impact and effects of pain. Exploring cutting-edge research that encompasses everything from phantom aches to persistent pain, as well as interviews with survivors of torture and those who have never felt pain, Dr Lyman not only provides hope for reducing and managing pain but takes us to a deeper understanding of what it means to be human.Everyone has had the experience of being deeply engaged in some activity, incurring damage, and not noticing until afterwards. Soldiers frequently report it: they also sometimes feel significantly less pain from their injuries than civilians, because an injury that takes you off the battlefield makes you safer than you were. The signals get mixed, and the pain felt changes accordingly.

Monty Lyman is a superb storyteller... I loved this book so much. ― Rachel Clarke, bestselling author of DEAR LIFE Pain is necessary for life. But pain can also be life-ruining. Persistent pain pandemic is widespread and growing, and the medical profession is poorly equipped for it. Persistent pain is also perplexing: there is overwhelming evidence that in most cases the pain persists well after an injury has healed. Although certain cases of persistent pain are caused by a persistent injury in the tissues, in the majority of cases pain itself has become the disease. Lyman explains how pain is a ‘guardian angel’ and a protector — it tries to stop harm coming to the body. But it is not always a reliable indicator of damage. In most cases of persistent pain, the brain has become overprotective and is no longer detecting tissue damage. The Painful Truth helped me to understand that pain is a protector but that in persistent pain, the sensation of pain has become overprotective. The brain becomes rewired to ‘feel’ pain more often that it needs to. But there is the possibility that it can also be re-wired. I found it helpful that Lyman suggests that doctors should view persistent pain as a neurological condition rather than either a sign of tissue damage or of depression. I think this book is helpful reading for all working in general practice.The book sets out how pain is interpreted within the meaning we apply to it. For instance, we can all recall situations where we are able to cope with pain if there is a clear goal or reward to work towards, for example, childbirth or training for a marathon. Where there is a high feeling or threat or danger, pain will be increased. cuvintele negative și mediul tensionat afectează creierul, starea psihică și pe cea fizică. Cuvintele pot răni la propriu ! The book also looks at pain management in babies of which happened to be the prevailing thinking as recently as 1985, everybody thought the babies do not feel pain. However studies show that when given fentanyl during operations, that these babies made better outcomes than when babies were not given pain management and that babies are often treated without medication when in trauma early on in life will go on to develop later issues around pain suppression. Another interesting fact is regarding the role of touch which is an effective approach that can dampen and manage pain in babies.