The last thing I expected to post on PainOnline is a book review of a fiction novel. This book, however, has obvious reasons for catching the attention of anyone with central pain. This review was submitted by an anonymous PainOnline visitor and offers a perspective from someone with central pain.

A new novel by Andrew Vachss, 'Pain Management,' although couched as a detective thriller, is really a 'Trojan Horse' with a social message, as many of Vachss works have been termed. He has indicated that his purpose in writing his books is to make people angry over the government's sociopathic/stupid/sadistic attitude about intractable pain.

In real life Vachss is a lawyer, but writes about issues he cares about to reach a larger jury, the reading public. Although this work is violent, we know that nothing matches the violence of unremitting pain on the human soul. Therefore, although some may take issue with the violent content, no one can deny the humanity in 'Pain Management.' Without giving away anything, the plot centers around a group of patients with multiple sclerosis, whose doctors have ignorantly and indifferently denied that MS patients can have pain or need medication. The real motive behind this neglect, however, is not the doctors, but the federal regulators who threaten to revoke the medical license of anyone caught dispensing narcotics which might lead to addiction, even if the patients are dying. At this point, you are wondering where the fiction comes in.

The MS patients feel that the war on drugs was lost long ago, but to compensate for its failure, the government drug czars are making them POW's of the lost war, by pretending to perform an important public service by intimidating doctors into withholding drugs. Vachss does not spare the nurses either. One man comments that in his withering need, during his most desperate, humble requests for pain meds, he can see in the nurses their love of the sense of power as they say 'No.'

Vachss is stunningly accurate in his description of central pain when he describes the 'nerve burn.' If those of you with severe central pain can read page 234 without getting angry or page 237 without crying, you are stronger than most with the condition.

Vachss takes on those who administer not medication, but pious speeches to those in intractable pain. The book has to be rated R for language and theme, but the most obscene thing in the book is the simple recounting of the treatment central pain patients receive at the hands of those professionals whose sworn task is to relieve their suffering.

His tale is not far fetched at all. Not one of you who has written here has told a story of immediate diagnosis and adequate care, such as might be dispensed for diabetes. Instead you tell stories worse than those recounted by Vachss. You make us weep for you, and so does Vachss.

A deep thanks to Vachss is in order for finally giving voice to central pain and telling it like it is. It is impossible to write about torture, but Vachss takes it on and there is poetry in his handling of the truth. No extremism is needed on his part. He need merely describe the way things really are in pain management and the shock value follows automatically.