Clinicians' Guide to Pain T. W. I. LOVEL and W. U. HASSAN, Arnold: London, 1999, 191 pp.; indexed; illustrated. ISBN: 0 340 74097 3. Price £29.99
Pain is a common symptom and this book is aimed at those dealing with cancer pain and rheumatic pain, such as family physicians. It is also targeted at those who are doctors in training and allied health professionals, such as physiotherapists, occupational therapists and nurses. Does it fulfil this scope and in particular does it fulfil this with regard to anaesthetic trainees?
Chapter 1 sets out a comprehensive scene for the management of cancer pain and explains that good management involves taking into account more than that physically addressed. Chapter 2 describes the transmission of pain. This is obviously difficult. Many new advances have been made in pain transmission over the last few years and it is difficult to set a framework. Diagrams may have been helpful. The next chapter on ‘The opioid analgesic drugs’ is rather confused. The general headings are not maintained. For example, fentanyl and pethidine (demerol) have a separate heading, whereas all the other opioids are discussed together. There are many opioids used in the management of cancer pain and I think that all deserve a proper mention. I liked the boxed inserts relating to certain topics. However, I fail to see why there should be two on fentanyl, especially as there is no explanation of the cost of this drug. I was somewhat surprised to find no mention of subcutaneous drugs in this section. For an up-to-date book, there should have been perhaps some mention of the use of naloxone to treat constipation. The chapter on nerve blocks is rather short and this perhaps reflects the practice of the individual. This could be enlarged considerably to include data on the efficacy of nerve blocks in this condition. Neuropathic pain could be enhanced to include the use of gabapentin. Chapter 11 ‘Other pains and treatments’ is a little ad hoc– although I thought the boxed ‘pain syndromes caused by invasion of skull’ reproduced from Twycross was excellent. There is nothing about the use of physiotherapy and occupational therapy in the management of the cancer patient with pain, which was disappointing, especially as the book is aimed at this sector.
The second part of the book deals with rheumatic pain. There is some repetition of the second chapter in the tenth chapter of the book and one wishes that the authors could have liased more. The authors raise the old questions as to why should opioids be given sparingly in the patient with arthritis and why should opioids not be suitable for rheumatoid pain. Unfortunately, even in a good chapter on rheumatoid arthritis, there is no logical answer on this topic and it is not discussed. The classification of NSAIDs has not included work done on Cox-2 drugs and so this interesting area has not been included in the topic. Osteoarthritis has a good section on management that emphasizes the functional ability of the patient with pain. Low back pain is probably the commonest condition that we treat in the Pain Management Clinic and advice is simple and straightforward. It is regretted that Pain Management Programmes are not discussed here. Osteoporosis, Paget's disease, ankylosing spondylitis and fibromyalgia are all good chapters from which I learned much. Illustrations would have been helpful to see the contours of the spine. Reflex sympathetic dystrophy is a condition that has yet to be fully explained. The recently suggested schema with an emphasis on self-management by the patient is vital and I would have liked more of the view that physiotherapy is fundamental. Chapter 19 on intra-articular and para-articular blocks is good. This is obviously an area in which the author feels at home.
For a primary health care clinician, this book will give him or her new insights into some of the diseases that palliative medicine and rheumatic diseases encompass. In general, the chapters are well referenced and the book reads well. For the anaesthetist in pain management, I think the chapters on Rheumatic Pain are quite good and that a basic knowledge of this area can be gained. However, the chapters on Cancer Pain are too superficial and more in-depth reading is necessary for the anaesthetist in training.