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A Classic Textbook for the Practice of Clinical Pain Management: Practical Management of Pain

Wallace, Mark S. M.D.

The Clinical Journal of Pain: March 2001 - Volume 17 - Issue 1 - p 101-102
Special Topic Series: Musculoskeletal Pain: Book Reviews
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Program Director; Center for Pain and Palliative Medicine; Department of Anesthesiology; University of California, San Diego; San Diego, California, U.S.A.

Practical Management of Pain, 3rd Edition. Edited by Raj Prithvi. St. Louis: Mosby, 1070 pages

Why another book on pain management? Raj points out that, unlike many of the available books of pain management, this book is intended to provide the clinician with practical aspects and knowledge of pain management. Raj has done an outstanding job of doing more than making a few changes in a previous edition for a new publication. Instead, he has reformatted the book and created a new organizational structure. Before embarking on this third edition, Raj organized an advisory board of recognized international authorities in pain management who advised the editor on what topics should be included in the next edition. Unlike the second edition, the third edition has section editors who were selected based on expertise and experience. Together, Raj, the advisory board, and the section editors have published an outstanding book of pain management. Overall, this edition is more organized and flows much better than its predecessors.

The second edition was divided into five sections (overview, clinical, therapeutic considerations, special situations, and future considerations). The third edition is organized into eight sections: general considerations; basic considerations; clinical considerations; evaluation and investigation; techniques of pain management; outcomes (a new addition); pain management in special situations; and (8) future of pain medicine and needs of pain management. This new format provides a much better basic foundation in pain management before moving to specific clinical syndromes and techniques.

In the third edition, several chapters found in the second edition have been divided to provide a more detailed discussion of certain topics; for example, chapter 2 of the second edition ("Development and Organization of Pain Centers") has been divided into three sections (acute, chronic/cancer, and pediatric). In addition, chapter 3 of the second edition ("Standards of Care and Reimbursement Issues in Pain Management") has been divided into three chapters, which reflect the changing practice of pain medicine and the importance of understanding the business of pain medicine. Finally, chapter 5 of the second edition ("Pain Mechanisms: Anatomy and Physiology") has been divided into two chapters regarding pain pathways and pain mechanisms.

At first glance, in the table of contents, it seems that there is some redundancy among some of the chapters. For example, chapter 13 ("Biopsychosocial Evaluation and Treatment of Chronic Pain") and chapter 28 ("Psychological and Behavioral Assessment") appear to be redundant; however, chapter 13 is more of a description of the biopsychosocial model of pain management rather than a psychological assessment of the patient with chronic pain. In addition, chapter 12 ("Pharmacological Management of Pain") and chapters 31 and 32 ("General Principles of Pharmacological Techniques and Clinical Pharmacokinetics of Analgesic Drugs") seem redundant; however, chapter 12 describes the clinical use of various agents, whereas chapters 31 and 32 focus on the pharmacology of the agents. Only chapters 60 ("Palliative Care") and 71 ("Palliative Medicine") were redundant and could have been combined.

Other differences between the second and third editions include:

1. General Considerations: The topics are broader, geriatric pain has been added, and more specific topics have been eliminated.

2. Evaluation and Investigation: Chapter 6 of the second edition ("History and Physical Examinations of the Pain Patient") has been divided into two chapters, the chapter on thermography in the second edition has been eliminated, and a chapter on differential neural blockade has been added.

3. Techniques of Pain Management: This section has been expanded the most. Nine chapters have been added, which include a perspective on pain management techniques (chapter 30), spinal analgesics (chapter 35), infusion tests and therapies (chapter 50), cryoneurolysis and radiofrequency lesioning (chapter 53), implanted drug delivery systems (chapter 54), alternative pain medicine (chapter 57), radiation therapy and chemotherapy for cancer pain management (chapter 59), palliative care (chapter 60), and radiation safety (chapter 61).

4. Outcomes: This is a new section in the third edition.

5. Special Situations: Two chapters in the second edition ("Preparation and Presentation of Medical Evidence; and Management of Pain In a Major Disaster") have been replaced with two different chapters ("Pain Management in the Emergency Department and Palliative Medicine").

6. Future: This section has been expanded from one chapter in the second edition to three chapters, including standardization of pain medicine practices, preemptive analgesia, and future needs. Finally, the appendix has been expanded considerably.

In summary, the third edition of Practical Management of Pain is a major improvement over the second edition. It is a textbook that should be a part of the library of any physician, nurse, or healthcare provider who practices pain management. A fourth edition will top this book only if we make considerable strides in pain knowledge, diagnosis, and management.

Mark S. Wallace, M.D.

Program Director; Center for Pain and Palliative Medicine; Department of Anesthesiology; University of California, San Diego; San Diego, California, U.S.A.

Copyright © 2001 Wolters Kluwer Health, Inc. All rights reserved.