Publications
APS Bulletin • Volume 15, Number 1, Winter 2005
Resource Reviews
John D. Loeser, MD, Department Editor
The Myth of Chronic Pain
Reviewed by John D. Loeser, MD
Benjamin L. Crue, Durango, CO, 2001, 1,359 pages, $94.00 (2 vols, hard cover), ISBN 0-9748575-0-5. Order from Maria’s Bookshop, 960 Main Avenue, Durango, CO 81301.
The Myth of Chronic Pain is a self-published book, and I have seen no marketing activities on its behalf. This is a shame, for the book is a fascinating tale of a wonderful life that centers upon chronic pain. This is really more than one book, as it has several narratives and a large dose of medicine and medical politics arranged in a semi-chronological fashion.
The first three chapters of volume 1 focus on Crue’s beliefs about chronic pain. Then there are a series of chapters that document his perspectives on the development of pain clinics: the American Pain Society, the International Association for the Study of Pain, and the clinics that Crue directed. Although a lot of material in this book has been published earlier in other formats, there are some fascinating case series that have never been reported elsewhere.
In the second volume, Crue offers his views on psychotherapy and how to run a pain clinic based on psychotherapeutic (Freudian) principles. There are chapters on the medical/legal aspects of chronic pain, disability ascribed to pain, outcomes from the management of chronic pain, and the author’s predictions about the future of pain therapy. Interspersed throughout the book is Crue’s autobiography, including a description of his adoption of the Mormon faith. David Morris composed the forward to the book, and Truman Madsen wrote an afterward. A prodigious list of references and a set of appendices with interesting data and opinions round out this unusual publication.
It is difficult to review a book like this without considering the life and contributions of the author. As a window into Crue’s life, beliefs, and contributions to the world of pain, this book is fascinating. He was there at the beginning of APS, the Western Pain Society, and the pain clinic movement. These historical parts of the book need to be in the Liebeskind Library of Pain, and I hope that they are included in Crue’s interview by John Liebeskind in 1996.
For 30 years, Crue has held a “centralist” view on chronic pain, by which he means Freudian. Very few of the rest of us “peripheralists” in the world of pain have found Freudian concepts and treatment strategies to be useful, although we have centralist viewpoints regarding the causes of chronic pain. Changes occur in the spinal cord and brain that are responsible for the perpetuation of pain behaviors in the absence of ongoing peripheral nociceptive input. I believe that this Freudian view is why Crue and Pinsky never developed a significant following. In 1978 at the first meeting of the APS in San Diego, I organized a one-day CME course. Its centerpiece was a presentation by different psychologists and psychiatrists of their approaches to the treatment of chronic pain patients. Their conceptual frameworks were different, but they shared a caring for and commitment to the patient. They all recognized that it was the patient who had to do the work to change his or her life of pain. Freudian concepts are not required for one to be a centralist.
The Myth of Chronic Pain is packed full of medicine, psychology, history, opinion, research, statements of faith, and autobiographical material. There is much to be learned from it, but the text would have benefited from a professional publisher. Due to limited editing, it makes for difficult reading. One needs to persevere in order to cull numerous pearls of insight into issues of pain. Judicious editing would have made for a shorter, more readable, and better organized book with more appropriate type styles. Despite all this, Crue’s concern for and commitment to chronic pain patients shines like a beacon throughout this book. He has personally helped thousands of sufferers. He has been a major contributor to the founding of organizations that have developed the field of pain management. Long ago he recognized the existential meaning of chronic pain and has thought deeply about it. We are all privileged to read and to know him in The Myth of Chronic Pain.
Dr. Loeser is professor of neurological surgery and anesthesiology at the University of Washington in Seattle.
Reviewer content represents the opinion of the reviewer, not APS.
Please direct your suggestions for future Resource Reviews to John D. Loeser, MD, Department Editor at jdloeser@u.washington.edu.