Mailis-Gagnon A, Israelson D. Beyond Pain: Making the Mind Body Connection. Viking Canada (Pearson Canada/Penguin), Toronto, 2003. ISBN 0472030825; 274 pages; $25.00.

In this book, Dr Mailis-Gagnon relates her own experience – indeed journey as a person and as a professional and investigator – in her work with patients with chronic pain. It is written well and interestingly, and is full of case histories, told in a sympathetic and engaging manner, of many pain sufferers she has dealt with over many years. It also describes the unique approach she has evolved in assessment and diagnosis of patients with apparently bizarre complaints. The book is warmly endorsed in the Foward by Dr Oliver Sacks, who had himself once experienced unexplained pain and sensory symptoms. Dr Sacks points out that the function of the central nervous system is far more complex than we might have imagined a few decades ago, and that the concept of ‘plasticity’ may have much relevance to phenomena such as phantom limb pain and neurologically unexplained pain disorders. Dr Mailis-Gagnon has specialized in study of and treatment of patients with complex presentations and poor outcomes, and has evolved a protocol of extensive sensory testing and examinations using intravenous placebo and amytal. While these approaches may seem foreign to the usual practice of doctors, her recommendations for multidisciplinary and cognitive behavioural therapy in rehabilitation for chronic pain patients with psychological comorbidity is based on good evidence, and she is a respected clinician who has often had good results when to everyone else the case seemed hopeless. The strong point of this book is her sense of warmth and good humour and optimism, and profound respect for her patients, no matter what their history or complaint. Her feistiness, that much characterizes her in reality, also comes across with her infectious good humour, and that gives great human interest to the narrative. Another strong point is the biopsychosocial perspective. There is a great variety of fascinating personal stories, even including that of Dr Mailis-Gagnon herself, and most patients will find patients’ stories that would speak to them. Perhaps the greatest endorsement is that in the past two months three patients have come to me with this book in hand and have said that it was reassuring and helpful to read this, and that one or other patient story in it was particularly meaningful. Clinicians involved in treatment of chronic pain, and especially clinicians who see patients with medically unexplained or ‘nonorganic’ symptoms, will find her approach and her concepts on this subject interesting and engaging. It is not a textbook of diagnosis, of theory, or a how-to book, but it will likely appeal to patients who have chronic pain and who are looking for a way to understand that the biopsychosocial perspective is relevant and palatable for them as patients. It will also appeal to clinicians who have struggled with interpreting medically unexplainable complaints in their pain patients.

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