A Review of Topical Issues in Pain edited by Louis Gifford P.T.

Barrett L. Dorko, P.T.

For many therapists, it is enough to see and feel things, hear stories and read reports. They measure very carefully the clinical phenomena large enough to reveal itself to external devices, and they are satisfied with the obvious. This has never been enough for me.

Paracelsus, the German physician/mystic from the 16th century said: “The physician should speak of that which is invisible. What is visible should belong to his knowledge, and he should recognize illnesses, just as anyone who is not a physician can recognize them from their symptoms. But this is far from making him a physician; he becomes a physician only when he knows that which is unnamed, invisible, and immaterial, yet has its effect.” Although Paracelsus believed in a lot of strange stuff (as did most people in that time), he was on to something here, and I feel it bears repeating to the therapy community.

There are two books edited by Louis Gifford, a physiotherapist in England that are faithful to this insight by Paracelsus, and they reveal a great deal more about the “invisible” elements of painful processes than I had previously imagined we knew.

Topical Issues in Pain volumes 1 and 2 contain a total of 29 essays. These are written by a distinguished group of professionals involved with patients and clinical research. The subjects covered range from the biologic to the psychologic and each examines carefully the processes that color pain, increase it, alter it and make it the most challenging problem we see each day. These are wonderful resources, and I couldn’t recommend them more highly. These books are, in part, an outgrowth of Waddell’s “biopsychosocial” model of assessment and management, and toward that end are comprehensive, complex and organic in their approach to the problem of pain. I find that reading each essay several times is essential-not because they aren’t written clearly, just because I don’t want to miss anything.

An exemplar of what you can find here is found at the beginning of the second volume, written by Gifford himself; The patient in front of us: from genes to environment. In this single essay Gifford convinced me that my own understanding of painful processes and how they might be revealed to my testing was nothing compared to what we now know. He makes a compelling case for the consideration of “gene expression” as fundamental to alterations in sensation and, ultimately, painless function. As Gifford says, “No matter what you do to a patient, from whatever level you focus, changes in gene expression will occur if the patient makes some changes.” Of course, he backs up this statement with extensive references, as do all the authors here.

For information on ordering these volumes go to <http://achesandpainsonline.com>