Drugs for Pain
H. S. Smith (ed)
Hanley and Belfus: Philadelphia, USA, 2003, 528 pp; indexed, illustrated
ISBN: 1-56053-511-3; Price £26.99
This book intrigued me when it arrived on my desk to review. I couldn't remember seeing a book with a similar title before and this was confirmed by the statement on the back cover that 'The material in this text has never before been presented in a single source, and a significant amount of information can be found only in this text'. So far, so good. However, it then went on to say that the text was 'Authoritative, practical and clearly written, Drugs for Pain is sure to become a valued guide for all those who care for patients in pain'. Hmmm.
The book has 44 contributors, excluding the editor, all from the USA. At the outset, I thought that this was rather excessive for a book of only 528 pages and it seemed likely that there would be significant overlap of information. The 39 chapters cover the basic acute pain drugs (such as acetaminophen (paracetamol), aspirin, NSAIDs and opioids) as well as drugs used in chronic pain situations (such as antiepileptics and α-2 agonists). There are also chapters on spinal analgesia and more diverse subjects, such as migraine and bone metastases. The general layout is one of mini-monographs, with chapter lengths varying from two or three pages to around 20. The main chapters on drugs are divided into two, with one chapter labelled 'bench' and the other 'bed side'. However, the implied distinction between 'science' and 'clinical use' is often arbitrary and there is considerable overlap between the two.
Personally, I found the layout of the text rather forbidding with narrow margins and a single column. There are a few illustrations with many of the diagrams rather crude and poorly conceived. The histological illustrations were difficult to see in a matt, grey scale reproduction. Each chapter is followed by a comprehensive list of references but, rather confusingly, the format varies between chapters. Thus, some are arranged alphabetically, some numerically, some with the full reference and some with just an abbreviated list (e.g. Chapter 9). Surely there should have been a consistent approach. Inevitably there are overlaps and repeated information. This is carried to an extreme in Chapters 11 and 12 which both seem to cover opioid tolerance and addiction, but in slightly different ways. The same overlap applies to mechanism of action of opioids, which is covered in at least four different chapters.
Unfortunately, the text contains many inaccurate and misleading statements. For example, 'Morphine is more effective against sharp intermittent pain than dull continual pain' (p. 90), 'Diamorphine is used currently in several European countries as the substitute pharmaceutical preparation to control heroin dependence' (p. 111) and 'Remifentanil is the most potent μ receptor agonist from this (piperidine) series and ... is highly lipophilic (more than fentanyl and sufentanil) and has a greater volume of distribution ...' (p. 114). On p. 138, we read that 'Buprenorphine is unique and may show the most promise of this class of opioids'. Well, for a drug that has been around for nearly 30 yr this seems a bit off the mark.
However, these are relatively minor (if irritating) complaints. The book is a great achievement and has some outstanding chapters. Leonard Bushell's chapter on Synergistic Epidural Analgesia and Wolfgang Ummenhofer's review of Spinal Analgesics are exemplary. It is most certainly a reference book that will find a place in every anaesthetic department library and pain clinic. However, I hope that the next edition (and I am sure there will be one) addresses some of the criticisms above.
D. W. Green