All psychiatrists will see patients in pain at some time and those working in some fields, such as liaison psychiatry, are likely to see many patients in this category. People in pain, particularly if this is chronic, are prone to develop psychiatric illnesses and this book describes how these comorbid conditions interact to affect emotional equilibrium.

The earlier chapters are concerned with neurochemical factors associated with chronic painful states and with assessment. The role of chronic stress in leading to an increase in glucocorticoids, a decrease in glucocorticoid receptor sensitivity and subsequent increase in pro-inflammatory cytokines is well described. Early lifetime stressful experiences can effect changes in how DNA is regulated, so-called epigenetic change. Recent work has shown that osteocalcin, produced by osteoblasts, in inhibiting the activity of post-synaptic parasympathetic neurons, further increases the stress response.

A large part of the book is devoted to describing the associations between pain and psychiatric illnesses, with recommendations for treatment. In some physical illnesses the presence of anxiety, depression and other psychiatric symptoms are precipitants for the medical condition. This applies to temporomandibular joint disorder and irritable bowel syndrome, whereas in most other illnesses the emergence of more serious psychiatric conditions occurs following chronic pain. Consequently, in most illnesses psychiatric symptoms reduce as painful symptoms improve. In fibromyalgia a strong case is made for attention to remedies to improve sleep architecture in alleviating pain.

Unfortunately there is less focus on treatment strategies, although the value of comprehensive pain programmes is highlighted.

The stimulus for writing this book arose when the main author spent time in South America investigating an illness called Jaki, which is widespread among the Quichua Inca people of the Andes. When the Quichua experience pain and stress they will only complain of painful symptoms to a Western doctor. Those familiar with the Quichuan language enable frank disclosure about emotional issues. Dr Incayawar found that over 40% of patients diagnosed with Jaki had somatoform disorders. Doctors seeing the Quichua need to have linguistic skills as well as medical ones.

This book is mainly of value to psychiatrists who see patients in pain regularly. As is the case in virtually all books about chronic pain it poses more questions than answers.