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Anesthesiology:
doi: 10.1097/ALN.0000000000000178
Reviews of Educational Material

Pain Comorbidities: Understanding and Treating the Complex Patient.

Kamerlink, Jonathan M.D.; Peeters-Asdourian, Christine M.D.

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Seeing patients with multiple medical problems can be somewhat of a challenging task. We are often faced with the question: Do the patient’s medical problems take precedence over their pain symptoms? Perhaps, prioritizing one problem over another is not the best approach. Rather, we should look at each problem because it intertwines with and directly relates to the others.
The book Pain Comorbidities: Understanding and Treating the Complex Patient provides a complete picture of pain syndromes in patients with moderate to severe medical conditions. This book is published by the International Association for the Study of Pain Press and reflects the multidisciplinary tradition of the International Association for the Study of Pain Press. In addition, the multiculturalism of its numerous authors gives the text a truly diverse flavor.
On the back cover is quotation by Harold Breivik concerning the importance of treating the “whole patient with pain,” which is thoroughly reinforced by the authors. Throughout the book, the authors emphasize the mechanisms of pain and the origin of pain from medical conditions as well as the models dealing with its management. The authors demonstrate to the reader that perhaps a patient’s medical problems should be treated in a holistic matter. For example, in treating a person who has been diagnosed with multiple illnesses, such as hypertension, diabetes, and low back pain, rather than each illness being treated separate and apart from the other illnesses, clinicians should provide treatments that tackle all the problems collectively.
The book contains 24 chapters divided into three sections. In the first section, several contributing authors detail a basic science foundation of pain symptoms, from epidemiology to various animal models of pain. In addition, there are chapters dedicated to genetic and environmental effects on pain syndromes. In the second section, the authors discuss how nonpainful medical conditions are related to painful symptoms, making their points concisely. In the latter part of the second section, psychological conditions that affect pain are also detailed. The third section discusses medical management of various pain symptoms.
Overall, we think that this book is well written and provides the reader with a good basic understanding of the interaction between medical conditions and pain syndromes. The authors provided a clear description of the basic science of pain syndromes with an exhaustive list of resources. We were particularly interested in how medical conditions are linked to pain syndromes. The authors and editors used very succinct language to describe these complex ideas. We would recommend this book to any physician looking to expand their knowledge of pain syndromes. It will be a good primer for medical students, residents, and practitioners not specialized in pain management although in the United States they will be hard pressed to find truly multidisciplinary pain centers. Multidisciplinary pain centers are all but gone in the United States, where most management focuses on invasive therapies.
Our only criticism of this book is that there was no mention of procedural interventions in the treatment section. We believe that a discussion of all nonsurgical and surgical options, including neuromodulation for pain management, would be beneficial to the reader, regardless of whether these patients are candidates.
Jonathan Kamerlink, M.D., Christine Peeters-Asdourian, M.D.
Beth Israel Deaconess Medical Center, Brookline, Massachusetts (J.K.). jonathan.kamerlink@gmail.com

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