Pain is a condition that affects us all at one point or another. It is an adaptive response to avoid further injury and, following an injury, the pain in a body region is present to promote behaviors that guard the area to allow for the healing process to repair the injury. For that reason, the same cells that fix the problems are the ones that result in inflammation and increased sensitivity. Unfortunately, for some individuals, pain from an injury can last much longer than the normal healing time or arise for no clear reason whatsoever. For those chronic pain sufferers, an understanding of the mechanisms of chronic pain can aid in development of treatments to alleviate this burden.

Pain is one of the most common reasons that people visit their primary care physician and the most common reason people seek treatment in the emergency room. Pain can be debilitating and, when it is not alleviated by over-the-counter medications, can significantly impact a person’s mental and physical health. As such, pain is something that is physicians see on a daily basis. In 2018 Shipton and colleagues completed a systematic review of pain medicine teaching in 383 medical schools in New Zealand, Australia, the United States, Canada, the United Kingdom and Europe. What they showed was eye-opening. Most schools had no dedicated teaching related specifically to pain and the median hours of pain content ranged from 11-20 during the entire medical school training period. This represented 0.2% of the curricula, even though approximately 40% of the questions on the licensing examinations were related to pain. As a consequence, up to 95% of medical students found the time dedicated to pain medicine to be insufficient (Shipton et al., 2018). Subsequently this group also found that there is a need to develop tools to properly assess pain medicine learning in medical students (Shipton, Steketee, Bate, & Visser, 2019). The reasons for the lack of training are numerous. In some cases, pain is seen as a symptom of another disease that gets priority within the curricula (i.e., cancer). In other cases, pain medicine has not had a prominent place in medical teaching and inertia prevents dramatic changes. Sometimes, as is often the case expressed to pain researchers, the instructors do not have the necessary background or resources to adequately address this specific content area.

The “Dynamics of Pain” textbook was designed with students and instructors in mind and written by experts in the field of pain research (read their bios in each chapter). The book will take you through the various aspects of pain medicine from basic anatomy and intracellular machinery to clinical conditions and novel treatments. The intention of the textbook is to fill the gap in medical knowledge related to pain and provide a resource for those interested in the field on a personal or professional level. It is my hope that this book helps students learn more about the exciting field of pain and that instructors can use this book to teach or supplement their classes. At this time, there is pain research being conducted at all levels across the world as the population ages and opioids lose favor as pain-relievers. As such, the title “Dynamics of Pain” was chosen to illustrate that the field is in a state of constant progress and advancement. To illustrate that point, as this text was being prepared, the International Association for the Study of Pain (IASP) released a revised definition of pain as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.” The infographic below gives some more context and clarification.

The new IASP definition of pain. Source: (Raja et al., 2020)

All of the authors (myself included) have devoted our careers to the study of pain and pain mechanisms. We hope that the content of this textbook gives you the information needed to advance your academic and/or professional career and that you enjoy learning about pain as much as we enjoy talking about it!

Cheers,

Robert E Sorge, PhD

 References

• Raja, S. N., Carr, D. B., Cohen, M., Finnerup, N. B., Flor, H., Gibson, S., . . . Vader, K. (2020). The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. doi:10.1097/j.pain.0000000000001939
• Shipton, E. E., Bate, F., Garrick, R., Steketee, C., Shipton, E. A., & Visser, E. J. (2018). Systematic Review of Pain Medicine Content, Teaching, and Assessment in Medical School Curricula Internationally. Pain Ther, 7(2), 139-161. doi:10.1007/s40122-018-0103-z
• Shipton, E. E., Steketee, C., Bate, F., & Visser, E. J. (2019). Exploring assessment of medical students' competencies in pain medicine-A review. Pain Rep, 4(1), e704. doi:10.1097/PR9.0000000000000704