International Association for the Study of Pain®    IASP Press®

Progress in Pain Research and Management, Vol. 15
Donald D. Price

        1999 · hardbound · 250 pages · ISBN 0-931092-29-9 Price: $69.00 US [IASP members: $50.00 US]

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The author received the 2003 Founders Award of the American Academy of Pain Medicine for distinguished achievement in pain science and medicine. The awards committee cited this book as a major factor in honoring Dr. Price.

A beacon of clarity in understanding the neurobiology of pain, this book illuminates meaning and significance in pain research. Understanding the subjective nature of the pain experience is the task of psychophysics, and Donald Price, one of the most creative scientists in the field of pain research, rigorously and concisely explains how psychophysics informs pain research. He sets the standard for thinking about and measuring the experiential aspects of pain.

Price tackles as valid targets of scientific inquiry the difficult issues surrounding subjective experience. He synthesizes and interprets existing scientific discoveries relating to the psychological mechanisms of pain and its modulation. Improved methods of pain measurement and assessment, together with technological advances such as neural imaging, allow us to address questions that were unanswerable only ten years ago. Recent advances in neurobiology, psychology, neuropharmacology, and systems neuroscience have led to new pharmacological strategies and principles for the treatment of pain. Neurobiological studies of placebo analgesia and hypnotic analgesia address the distinctions between the multiple dimensions of pain experience from both a psychological and a neurophysiological perspective.

This volume will prove indispensable to anyone with a deep interest in the nature of pain and a serious interest in understanding patients. It will appeal to those active in clinical research because it provides a breadth and level of understanding of pain measurement not available in any other single publication.

Table of Contents

The Phenomenon of Pain

The Dimensions of Pain

Psychophysical Aspects of Pain and Their Relationship to Pain Measurement

Primary Afferent and Dorsal Horn Mechanisms of Pain

Brain Processing of Pain

General Mechanisms of Pain Modulation

Placebo Analgesia

Mechanisms of Hypnotic Analgesia

Understanding Pain and Its Mechanisms

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For a non-psychologically minded person even with an interest in pain mechanisms, this is not a title that would impel me to look further. However, this book is compelling reading for all interested in pain mechanisms. 
The book begins with a new definition of pain. It is acknowledged that pain is difficult to define in less than a paragraph, and the reader could form the opinion that the author is yet another person who wants to find a place in medical history. The arguments that support the new definition are difficult to dispute and the remainder of the book only adds to the credibility of the author.
He has managed to combine the neurobiology of pain with the psychological mechanisms that accompany pain. I would have predicted that this would be impossible in a language that I could comprehend, but apart from some new acronyms, the text is easy to follow. The diagrams that accompany the text are well thought out and the references are appropriate. There are chapters on placebo analgesia and mechanisms of hypnotic analgesia which, in a very scientific manner, critically examine the scientific evidence surrounding these somewhat ethereal topics. The book is excellent value and should be a part of any pain anthology.
Anaesthesia and Intensive Care

[It is] rare that a single-authored, non-edited text addresses the integrated and all-encompassing pain experience, without limiting itself to an explication of one of pain’s purported dimensions. This is such a text. Price breaks through the remaining vestiges of dichotomization and gives a picture of the pain experience that is true to its complexity. Perhaps the most astounding feature of this endeavor is that he manages to do it in a manner that is clear, concise, of interest to the most physiologically inclined of pain researchers, as well as accessible to a readership focused on the clinical treatment of pain.
...Price positions pain at the heart of the study of consciousness. He sees it as an important test case for the integration of experiential and natural science methods. According to Price, neuroscience and subjective methodologies are necessary allies in the study of pain. Importantly, these are not just perfunctory closing comments at the end of a book but an important idea that is intricately woven throughout the entire text. Psychological Mechanisms of Pain and Analgesia is a valuable reference for anyone designing either etiologic or pain treatment outcome studies.  
Journal of Nervous and Mental Disease

This book devotes nine chapters to a highly academic exploration of the physiological and psychological characteristics of nociception from the peripheral to the central processes of the pain experience. It is to date the most comprehensive volume in accessible form. It includes PET studies with clearly reproduced pictures of brain slices showing the structures and calculations involved in identifying increasing brain regions recruited to process increasing stimulus intensity.
Pain needs to be comprehended as both a somatosensory and an affective experience, both of which are subserved by different mechanisms. Price shows evidence that nociceptive stimuli activate neural pathways having direct input to areas of the brain responsible for the production of fear arousal, but that there is also a secondary stage of affective evaluation which engages the cortical areas of the brain likely to be involved in emotional reactions and the planning of behavioural responses, thus diverting attentional and motivational resources away from other activities.
The complicated business of measuring such a subjective experience is given a whole chapter ... Other chapters focus on the relative contribution of conditioned responses and expectancy in placebo analgesia and the mechanisms of hypnotic analgesia.
The chapters each stand alone as separate papers on the relevant aspects, and as such tend to be repetitive if approached at a single sitting, especially as Price’s agenda is clearly on emphasizing the importance of the personal meaning of pain. However, the concluding chapter helpfully summarizes the research quoted in the foregoing pages.
This book is dense with experimental data and is by no means an introductory text. However, it is a "must have" for those who are interested in researching the most recent and comprehensive theories of pain and its management. 
British Journal of Anaesthesia

This interesting book attempts to meld what is known about neurophysiological mechanisms with psychophysical and emotional mechanisms of pain. It is well written and illustrated and has a helpful index.
The discussion of placebo analgesia is ... very thorough and serves as a succinct review of a complex topic which is fraught with contradictory research findings. Price makes sense of many of these and offers a good review of the attempts to understand how pain may be modulated by expectation and learning. The attention Price has devoted to mechanisms that lie rostral to the dorsal horns and peripheral nerves is particularly good. His survey of brain imaging during painful events is also a good starting point for reading in this rapidly developing area.
In summary, this is an important book that synthesizes knowledge in many different aspects of pain research and clinical information. I recommend it highly as an important contribution to our understanding of painful phenomena. 
APS Bulletin

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This page was updated on August 17, 2001