A book about pain, and why it isn’t what we think.

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.

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.

There’s much to like in this book, not least a very thorough treatment of placebos. It does sometimes get lost in reporting yet another clinical trial, or yet another insight into neurochemistry. It sometimes feels a little too long and too well-referenced for a popular science take on the issues.

3/5. Finished Thursday 3 November, 2022.

(Originally published on Goodreads.)