If you’ve been following this blog for a while you’ll know that I tend to read non-fiction books on a variety of different topics. I genuinely enjoy reading non-fiction because I learn a lot of new things about e.g. science, biology, personal struggles of memoir writers etc. What first attracted me to In Pain: A Bioethicist’s Personal Struggle with Opioids was the cover – it’s just so powerful and bang on in showing what the book is mainly about. I just love that! Of course, a reader mustn’t judge a book by its cover but…. it helps when a book has a cool cover you can stare at for hours. Now, for all of you who like short reviews…. well…. this won’t be one BUT I’ll try and make it as on-point as possible.
Let’s begin with what the book is about – In Pain: A Bioethicist’s Personal Struggle with Opioids by Travis Rieder is about [you guessed it] Travis Rieder, who winds up getting in a motorcycle accident which lands him in a hospital having to endure a number of surgeries to fix his foot. While staying in hospital he has to take medication to keep his pain away – the medication is a blessing but after several months of being under their influence he realises that something’s not right. Following his doctor’s order he begins to get off the medication – most of us would think ‘Great, now I’m off the meds and I’ll be able to function better’ but that’s not what happened. Rieder went under opioid withdrawal which caused him a lot of pain and suffering. Rieder and his family try every door to get help but every single one seems to be shut. What most doctors suggest to him is that he should go back to the medication and try to get off them later but having endured what he has Rieder knows that it’s not a good idea to go back, instead what he does is something that’s very brave and something that made him a stronger person. What this painful and exhausting experience sets off in Rieder is the search for answers and loopholes in the American healthcare system. What he does in this book is a result of meticulous research on history of opioids, the production of opioids, the effects of opioids, healthcare system and how it’s failing when it comes to prescribing medication and giving needed information to its users and more.
What I loved a lot in this book was that even before writing about his experience and other things the author writes a note to the reader saying that he asks of the reader to go into his book with an open mind because some people won’t like what he states in the following pages and some might even disagree.What’s most important is that you go into In Pain without any prejudice because while reading the book you’ll see in what way Rieder presents the subject matter he discusses in each chapter.
In Pain: A Bioethicist’s Personal Struggle with Opioids will be out on June 18th 2019. I’ve put links where to pre-order it and add it to your TBR below in the Get the book section.
So, this is my review in short for those of you who don’t like long reviews – if you wish to know more in the following I’ll be discussing the chapter structure and what each chapters deals with. Thanks for reading and please let me know your thoughts on whether you think you’ll add this one to your TBR!
I’ll be getting into more detail about the book below.
In Pain: A Bioethicist’s Personal Struggle with Opioids consists of three parts and an epilogue. When it comes to the beginning of the book we are introduced to Travis and how he ended up in hospital. His accident and his painful journey he’s about to describe to the reader. What I liked is how Rieder doesn’t spoon-feed you his beliefs – as I’ve mentioned before in the review, what Rieder does is asks the reader to go in with an open mind. He’s definitely skilled in writing and describes his situation in a fantastic way which is readable and makes you read on. Moving slowly onto the second chapter, Rieder introduces the reader to Pain 101, basically what pain is and how it’s defined. What caught my attention in this chapter is the pain scale – [I’m describing it in my own words so it might not be completely accurate] the pain scale is a method/scale used by physicians where a physician asks the patient ‘On a scale of 1 to 10, rate your pain’ and the patient provides an answer. Rieder raises a question here how can someone who hasn’t experienced the same amount of pain know anything about the other person’s pain? This is an interesting question because Rieder states the facts – how can someone know other person’s pain and in this case how to treat it? While staying in a hospital Rieder experiences the worst pain of his life and although he went through this torture he did make some use of it because he knew how to differentiate his pain, to be precise, how to rate his pain on the pain scale. He then on goes to discuss pain medicine which deals with how people perceive pain as well as how to turn something that’s completely subjective into something that’s somewhat objective. In the third chapter Rieder presents the history of opium – from its origin to its use and more. What struck my attention the most is the part where he discusses pain as the fifth vital sign. I find this to be very interesting because I haven’t come across this kind of thinking. Rieder says that ‘the basic claim is that pain is not merely a symptom – it is a vital sign akin to heart rate, respiration, temperature, and blood pressure and should be similarly monitored’ [pg. 58). This is something that’s very interesting and important – a physician should definitely check his patients pain levels in order to give her/him adequate treatment. In this chapter, Rieder also discusses how people as well as societies were mislead during the making of opioids, to be precise, in the times when new drugs were being introduced to the public. There are many loopholes when it comes to the whole approving-of-the-drugs. In a chapter called The Opioid Dilemma [chapter 4] Rieder presents us with an example of a doctor-patient visit regarding prescription of an opioid. He describes two cases and weaves through stereotypes as well as prejudice and asks the reader a question ‘How would you react in this case?’. The two cases are about one patient: white, male, well-dressed, tired because of working too hard who asks a doctor for opioids because of back pain and the other patient is black, not well dressed,tired and also seeking opioid medication. He then poses a question of who would you [doctor or the reader of the book] more likely prescribe an opioid to? Will this decision be made by your objective assessment of the person or will your subjective side [prejudice, stereotypes] take hold and make that decision for you? The whole chapter deals with the question How does one treat a drug seeking patient? Do we believe them or not? Based on what does a person prescribe a drug to someone? The fifth chapter is a tough one because it deals with Rieder getting off of opioids and struggling while doing that. Rieder and his wife Sadiye have realised that there’s something they must do in order to fully get him off of opioids. I loved this chapter a lot. When it comes to the sixth chapter Dependence and Addiction, Rieder states many valid points when it comes to the drug patient crisis where a physician who prescribes such drugs must know how to fully deal with them. What most physician don’t do is fully advise their patients either because lack of knowledge or simply because of being over-worked. What’s important to note is that each individual’s brain chemistry is different as well as their reactions to drugs – one might succumb to addiction whilst the other might not. Rieder also discusses how isolation can drive a person towards becoming an addict – where his society for example won’t accept her/him which can cause this reaction. In the seventh chapter What Doctors Owe Patients, Rieder raises a question of how a doctor should react to prescribing of opioids. What doctors need to realise is that patients are experiencing a lot of pain and should react accordingly to that. He gives us an example of two cases where people lost their lives because of not getting the correct opioid treatment and medical treatment. Ninth chapter deals with Rieder’s recovery and here Rieder shares what he went through with physical therapy and overall trying to heal and against all odds show that he can and will walk again without using crutches. He shines a light on how important it is to share one’s story with the world because other people can hear it and will know what to do in these situations if they ever end up in them. In the chapter titled Pain, Drugs, and Doing the Right Thing. Rieder suggests that stopping overprescribing won’t stop the opioid crisis but rather help doctors/clinicians manage pain of their patients more efficiently. Every patient deserves the best care possible. Rieder writes that clinicians need to get more and better educated on pain as well as patient pain because it’s the only way of stopping what’s happening all over America – inadequate care of patients which causes many problems. Tenth chapter deals with the three opioid epidemics which according to Rieder are [in chronological order]: 1. Old Heroin epidemic ; 2. Prescription crisis and 3. Opioid epidemic [which is the current one]. He then begins to discuss each of them but what stood out to me was the part where Rieder talks about overdose and where he says that in order to deal better with overdosing, what needs to be done is the following: creating more facilities which offer help to users. In terms od clean needles, sites where to inject [heroin for example] safely instead of the streets. Rieder says that drug use isn’t bad which is something I find questionable – but he does provide examples of coffee, energy drinks which can also be classified as addictive substances. In the epilogue Rieder discusses many things among which stood out the following: he went to veteran doctors who gave him insights into alternative medicine where one doctor introduced him to acupuncture. This is very interesting and something I enjoyed reading about. What’s hopeful about today is that there is a revised pain scale with more question regarding pain which introduces four different considerations: activity, stress, mood and sleep. I believe that this will provide much better insight to physicians when it comes to the treatment of pain.
In Pain: A Bioethicist’s Personal Struggle with Opioids is a fantastic exploration of opioids, the effect they have on the body, the issues America and its healthcare system face when it comes to prescribing and a personal experience of opioid withdrawal. If you’re a person who enjoys reading about social issues, memoirs and getting more educated then this is the book for you!
I will leave you with this quote from the book that I found interesting: ‘Life hurts – quite a lot for some of us – but not all of those pains require pharmacological intervention’ (pg. 246).
If you’ve come to the end of this review I want to say a huge thank you for taking the time to read it. I really enjoyed reading this book and hope that my review shows that. Thank you again.
I would like to thank the publisher Harper Books for my free advance reader’s copy of this book in exchange for an honest review. Also a special thank you to the author for being amazing and helping clear few things up. All opinions written here are my own and weren’t influenced by the fact that I got it for free from the publisher.
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Travis Rieder was born and raised in Indiana, after which he has slowly and steadily moved eastward. After completing his BA at Hanover College in southern Indiana, he moved to South Carolina to do an MA in philosophy. He then did a PhD in philosophy at Georgetown University before taking a faculty position at Johns Hopkins, where he currently teaches.
Travis’s writing is wide-ranging, but took a sharp turn in 2015 after a motorcycle accident and a traumatic experience with pain and pain management that resulted. Since that experience, he has worked to turn his intimate struggle with opioid painkillers into a research program and a mission to reduce harm from irresponsible prescribing. IN PAIN, published by HarperCollins in June 2019, combines his personal story with fascinating and disturbing facts about the history of pain and opioid use, the American healthcare system, and suggestions for how the tide can be turned on the interlocking epidemics of pain, opioids, and addiction.