Book Review

Navigating the winding road of chronic pain by putting coping and resilience in the driver’s seat

The smart brain pain syndrome: The primer for teens & young adults in pain

Weston G, Zeltzer LK, Zeltzer PM (2021). Shylisca Press, 115 pp. ISBN 978-1737428311 (Hardcover: $27.95 USD). Link

Reviewed by Robert C. Gibler

printable version (PDF)

Despite decades of research and advances in clinical care, educating young people about chronic pain in a non-stigmatizing manner remains a challenge for scientists and practitioners alike. Indeed, studies have shown that young adults diagnosed with a chronic pain condition in childhood often believe the information they received about pain and how to best manage it was unclear, leading to longstanding feelings of being misunderstood by healthcare professionals (Daffin et al., 2021). In their 115-page primer on chronic pain, Georgia Weston, LCSW, and Drs. Lonnie and Paul Zeltzer heard this message loud and clear. The smart brain pain syndrome: The primer for teens and young adults in pain underscores the importance of helping teens and emerging adults with chronic pain understand their diagnoses through the lens of a brain and nervous system that are safe and working properly, but may not always be communicating well with one another.

Rooted in science and evidence-based behavioral pain management strategies, The smart brain pain syndrome masterfully translates traditionally dense, complicated information about pain neuroscience into digestible, patient-centered language. Through engaging analogies, real-world examples and beautiful illustrations, the book clarifies common misconceptions about chronic pain and teaches readers how and why strategies for managing pain work. The authors emphasize that characteristics that make a person inquisitive, creative, and open to learning may also play a role in the maintenance of chronic pain. Perhaps more importantly, however, the authors instill hope in readers that these same innate gifts can foster resilience and place youth on a path toward recovery. Readers and clinicians alike will walk away with a clearer understanding about how and why pain becomes chronic, learn why the brain and body do not always communicate in a language the other can understand, and discover a compelling, data-driven rationale that supports the benefits of actively coping with pain - instead of waiting around and hoping it gets better on its own.

A key strength of the book is emphasis on educating readers about the complex ways in which pain is processed in the body and the brain, and the justification for putting functioning and valued living in the proverbial “driver’s seat.” Introducing the gate control theory of pain using the analogy of a highway system, the authors highlight the role of the autonomic nervous system and the involvement of the brain’s natural fear-based protective processes (termed the smart brain) in maintaining neuronal pain signaling (i.e. letting the “bad traffic” through). Fortunately, the authors also outline why forming new neuronal connections with regular participation in multimodal treatment approaches such as distraction, relaxation, and purposeful engagement in valued activities despite pain can teach readers’ brains learn to let the “good traffic” through, which over time can override unhelpful pain signals.

The final two chapters of the book focus on what young people can do to manage their chronic pain and draw on their own unique gifts and strengths to do so. It is clear from the warm and gentle tone of the writing that the authors heavily draw on their extensive clinical experience and own stories working with patients who feel stuck or trapped by pain and fear that there are no solutions that will provide relief. Although distraction and cognitive behavioral coping skills are emphasized throughout the book, the book also helpfully incorporates principles of acceptance and commitment therapy (ACT) and a discussion of mindfulness-based techniques, which may be more palatable to teens and young adults who have lived with pain for long periods of time without significant symptom reduction. The book concludes with a toolkit that encourages readers to capitalize and expand on resources and talents they already have – and techniques they can use on their own – to discover how they can best manage pain as a part of their daily lives. These skills include breathing and relaxation exercises, mindfulness, visual and performing arts, poetry, exercise, and several complementary and integrative approaches.

Despite the positive, patient-centered language and tone throughout the book, the authors do not leave their readers with unrealistic expectations regarding a timeline during which they should expect pain to improve. Instead, they encourage readers to adopt a curious and educated stance about their pain and, with this knowledge in tow, experiment with several mind-body strategies to determine what works best for them. The authors acknowledge that this can be challenging, and they do not neglect to mention how psychologists and therapists can be helpful in this regard. For example, given that mindfulness and cognitive behavioral coping skills are cultivated through practice and experience, setting goals and monitoring progress with the support of an expert may be needed for individuals seeking to make these skills an integral component of their pain coping plan. Furthermore, while the book incorporates a useful set of mind-body strategies, it does not cover the full range of cognitive behavioral pain coping approaches. Although the role of thinking patterns in the pain experience are addressed in the book, teens and young adults often benefit from input from psychologists or therapists to identify and challenge their own automatic thoughts, thinking traps, and core beliefs in order to promote optimal coping with their symptoms.

Overall, the book is beautifully written, and it is filled to the brim with colorful illustrations and detailed information grounded in research evidence and clinical expertise. Teens and young adults with mild-to-moderate degrees of pain-related functional disability will benefit most from this excellent educational primer, and certain elements of the book such as the coping toolkit could be seamlessly integrated into pain-focused therapy to improve motivation for treatment or facilitate specific goal setting. Psychologists, physicians, and other providers who work with young people with chronic pain conditions will benefit from this book through exposure to new metaphors and explanations for communicating about the pain experience in a way that makes their patients feel seen and heard.

Tapping into youth’s innate resilience and strengths can pave the road to a brighter future in which pain is not the central focus of their lives. This is especially important to do for patients who are transitioning into adulthood, as the messages they receive in childhood about pain and how to best manage it can set the stage for their optimal adjustment and long-term coping.

Cite as: Gibler RC. Navigating the winding road of chronic pain by putting coping and resilience in the driver’s seat. Book review: The smart brain pain syndrome: The primer for teens & young adults in pain. Pediatric Pain Letter 2022;24(1):8-9. ppl.childpain.org 

Reference

Daffin M, Lynch-Milder MK, Gibler RC, Murray C, Green CM, Kashikar-Zuck S. A qualitative study of risk and resilience in young adult women with a history of juvenile-onset fibromyalgia. Pediatr Rheumatol Online J 2021;19:128. PubMed Abstract