Because I live in the Montréal area, and speak both English and French, I’ll sometimes play with words using both languages. This is a perfect opportunity to do just that. The word for ‘fog’ in French is ‘brouillard’, pronounced like ‘brew-yard’ with an almost-silent ‘d’ at the end.
A book was just published, in French, for people affected by pain; patients, caregivers, and the public. I’d been looking forward to reading it for two reasons. First off, because I have a neuro-inflammatory and autoimmune system disease that causes chronic pain. This book includes a small section on this rare disease.
Second, because the author is a local; he’s a family physician who has also worked in hospital emergency medicine here in Montréal. It’s common in Québec for family doctors to also work in emergency departments – don’t be surprised if you require emergent medical care here and find yourself being treated by a family physician.
The author-physician’s name is Gaétan Brouillard; he writes in French, so that’s the language of the book that I borrowed from my local library. The title of this work is “La douleur repensée : ce n’est pas parce qu’on a mal qu’on doit nécessairement souffrir”(1).
In this post, I’ll provide my own rough translations of French excerpts from this book, and will show them in italics, to avoid confusion. My translation of the title is: Rethinking pain; we don’t necessarily have to suffer because we’re in pain.
Does it sounds interesting so far, for someone who lives with a chronic pain condition? Well, after reading this book, here’s my one-line summary; my two-language play on words:
Instead of dispersing the fog surrounding chronic pain, Dr. Brouillard (i.e. Dr. Fog!) has added more fog.
As you’ve probably guessed, I wasn’t overly impressed by this work. I’m not one to judge a book by its cover, and it takes quite a lot for me to have truly negative feelings towards any of them. This one, though, provided several reasons for my negative view.
To be clear, these are my opinions rather than journalistic reporting; I haven’t sought comments from either the author or the publisher. If you’d like to know what I found issue with in this volume, keep reading!
First, although I didn’t do any scientific calculation (e.g. counting paragraphs or words), it seemed to me that about half the book was spent talking about Dr. Brouillard himself. I felt that I was reading about him, rather than about pain. That would have been fine had it been presented as an autobiographical work, but it was disconcerting in a book on chronic pain.
Worse than that, to me, was an ethical aspect of this book. It’s geared towards patients and the public, rather than to healthcare professionals. This means that readers are likely to view him as an expert in this field, and to feel that the information he provides – as a physician – is trustworthy. This is played upon quite often, as the book includes numerous examples of patients who were ‘cured’ by Dr. Brouillard. This isn’t in itself objectionable in this type of book. The manner in which the cases are described, though, seems like infomercials for the specific services that he offers.
If Dr. Brouillard was providing the services described in the book under any of the Canadian patchwork of provincial, territorial, and federal health insurance plans, I might find this infomercial-style writing less offensive. But Dr. Brouillard’s website(2) states that he charges a medical consultation fee of $7 per minute, with a minimum fee of $210 for a patient’s first appointment. Additional charges(2) would then be incurred for certain techniques or medical products [my translation, as there’s no English version of his website].
This means that this work is, in my view, a book-length advertisement for Dr. Brouillard’s services – which aren’t covered by public health insurance plans. To me, this is advertising disguised as unbiased medical information from a purportedly trustworthy source.
As an example, one of the treatments described – and recommended – for pain in this book is prolotherapy. The author refers to it as “simple and effective [page 120; “simple et efficace”] for sprains, arthritis, back pain, acute and chronic tendonitis, bursitis, partially torn tendons, tennis elbow, sciatica, pulled ligaments, etc. He also states that this treatment is expensive (page 121; “qui est dispendieuse”].
In 2014 however, the Canadian Agency for Drugs and Technologies in Health (CADTH) noted that there was only weak (limited quality) evidence for prolotherapy in several of the conditions for which Dr. Brouillard’s book recommends it:
Evidence from studies of limited quality suggests that dextrose prolotherapy for the management of musculoskeletal pain including low back pain, tendinopathy, and osteoarthritis may provide pain relief and improve physical function compared with saline injection control, exercise alone, or before prolotherapy treatment.”(3)
Third, some readers might view the individual patients’ success stories in this book as ‘proof’ that a treatment being proposed is effective. Having worked as part of an epidemiology and biostatistics team myself, many years ago, I take a dimmer view of this; I see it as anecdata being presented as actual data.
If I were to take an unkinder view, I could liken this to the type of sales pitch one would expect from a snake-oil salesman; a sham. Bearing in mind, of course, that the book makes treatment recommendations for specific medical conditions (in the Appendix).
Another issue I had with this book is that it seems to veer back and forth between describing chronic pain and acute pain, without making it clear to readers which type of pain is being discussed.
Because the underlying mechanisms and treatments differ significantly between acute and chronic pain, this could be confusing for patients. I’ve repeatedly read, in scientific pain publications, that it’s important not to conflate acute and chronic pain – yet this book does just that.
The author also pulls into these already-confusing discussions some purported preventative ‘treatments’; giving an example of having ‘saved’ someone from hip replacement surgery in favour of a different surgical approach which is generally less effective.
The fifth and final issue that I’ll write about, with this book, is its Appendix. This section covers, in alphabetical order, a number of individual pain conditions – along with proposed treatments. The concept seems to be that even if a reader only peruses the portion of this book relating to a specific [pain] disease or condition, they will be exposed to its overarching infomercial aspect.
To not be entirely negative, as it’s not in my nature, the book does touch on some useful information for patients. The importance of a multidisciplinary approach to the management of chronic pain is mentioned, as are the practices of gratitude, meditation, self-compassion, and visualization (in the last chapter; Chapter 8).
The author also notes that any depression that results from – or contributes to – chronic pain must be treated as part of the patient’s pain management plan (in Chapter 7).
And the one-page portion of the Appendix specific to my disease, Complex Regional Pain Syndrome (CRPS, formerly known as RSD or Reflex Sympathetic Dystrophy), was appropriate. The – very brief – description of CRPS states that it’s a pathological condition which is not well understood and which causes different types of pain.(1)
It also notes that in CRPS the problem is with neighbouring nerves, which respond in an erratic and completely dysfunctional manner. Sometimes the peripheral nervous system reacts violently…
[page 214: “une condition pathologique mal comprise associant diverses douleurs”; and “Le problème se situe au niveau de nerfs avoisinants qui répondent de façon désordonnée et complètement dysfonctionnelle. Souvent, le système nerveux sympathique réagit de façon violente…”]
And those are the only positive comments I could think of, in terms of this book. Again, this is only my opinion – feel free to read the book yourself, and make your own decision!
References
(1) Brouillard, Gaétan. “La douleur repensée : ce n’est pas parce qu’on a mal qu’on doit nécessairement souffrir”. Published by “Les Éditions de l’Homme”, a division of “Groupe Sogides inc.”, part of Québecor Média inc. Sep 2017 (original French version). ISBN: 9782761947251. Website (in French only):
http://www.editions-homme.com/douleur-repensee/gaetan-brouillard/livre/9782761947251
(2)
Brouillard, Gaétan (assumed author; it’s his website). “Pour tous rendez-vous
avec le Dr. Brouillard, lisez ce blogue afin de connaitre vos options selon
votre situation”. 2017. Online. Accessed
17 Oct 2017. Web:
https://www.drbrouillard.com/clinique-du-dr-brouillard/
(3)
Canadian Agency for Drugs and Technologies in Health (CADTH). “Prolotherapy for
the Management of Musculoskeletal Pain: A Review of the Clinical Effectiveness”;
Report in Brief. 04 Nov 2014 (update). Online. Accessed 17 Oct 2017. Web:
https://www.cadth.ca/prolotherapy-management-musculoskeletal-pain-review-clinical-effectiveness