The Pain Detective by Hillel Finestone The Pain Detective by Hillel Finestone The Pain Detective by Hillel Finestone

Quest for healing

An Ottawa doctor offers advice to chronic pain sufferers with his new book The Pain Detective

For three years, Ann ( not her real name) had been suffering from persistent lower back pain that grew worse when she was active. An X-ray revealed a problem with two vertebrae in her lower back, but it was not severe enough to cause the pain she was experiencing.

The 28-year-old mother of two always seemed tense, and rebuffed her doctor when he asked her personal questions, saying it was irrelevant to her pain. Although she eventually took her doctor's recommendation and sought help from mental health professionals, she said they were of no help.

However, she did report that her pain had decreased by 90 per cent. How had this happened? Ann was sure it was because she had ended her relationship with her brooding and difficult live-in boyfriend.

Ann was not cured, the damage in her lower spine was real, but the pain was now manageable.

This is one of many fascinating stories in Dr. Hillel Finestone's new book The Pain Detective. The Ottawa pain specialist delves into the approach he takes to diagnose persistent, unexplained chronic pain.

Patients are sent to Finestone by other doctors who have been unable to determine what is causing their pain. He is like a detective, sifting through the physical evidence and emotional accounts of patients, trying to find the culprit. He looks for clues in the patient's social life, relationships, stresses, work situation, ergonomics, sleeping patterns and body.

He cautions anyone reading his book that he doesn't have a cure-all solution to chronic pain. Every case is different.

"I have one rule," he says. "If someone says they have all the answers, the most important thing to do is to run away. No one has all the answers."

A first step to healing is to understand pain and how it works in the body and in the mind, Finestone says.

The first chapter carefully explains the process the brain undergoes to receive and interpret pain signals sent from the central nervous system. It is like a series of minuscule electric wires running from every point on your body, to the spinal cord and into the brain. If, for example, the wire connecting a patient's big toe is pinched somewhere, the brain can be tricked into believing the pain is in the toe, although it could be elsewhere. A doctor could examine the toe and find nothing. The patient, still answer.

In Finestone's more holistic approach, he tries to find if there is a problem with the central nervous system, but in pain, has no then he goes further by asking his patients many personal questions.

Stress, one of the biggest factors in pain, increases in the brain the levels of a chemical called cortisol, which is needed to mount an effective stress response and is also an anti-inflammatory. But too much can create a situation where it stops functioning as an antiinflammatory.

Finestone feels his biggest contribution to his field has been to prove the relationship between mind and body is complex and the two are interdependent. For many people, this proof has validated their feelings of pain.

It's not always possible to put Finestone's multi-faceted approach into practice because many of the health-care practitioners he recommends are not fully covered by health insurance, including chiropractors, physiotherapists and psychologists. Finestone says few people have sufficient insurance coverage to afford the help they need.

"Society has to be ready too," he says, noting the persistent stigma around seeking help for mental health.

First appeared here: The Ottawa Citizen