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American Pain Society
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John D. Loeser, MD, Department Editor
Reviewed by John D. Loeser, MD
E. Salerno & J.S. Willans, Mosby, St. Louis, 1996, $29.95, 585 pages, ISBN 0-8151-7924-3
This spiral-bound, pocket-sized volume is a comprehensive text aimed at nurses who are involved in the management of patients with all types of pain. It properly emphasizes the importance of not just the biology of the patient, but also his or her family, past experiences, culture, belief systems, religion, fears, and knowledge. The chapter by Bozeman is particularly effective in this regard. Other chapters address issues such as preventing pain mismanagement, pharmacologic and nonpharmacologic approaches to pain management, the team approach, and alternative approaches (meaning healthcare strategies whose specific modes of action are not explicable by contemporary knowledge of anatomy and physiology). The second half of the volume is devoted to practical discussions of different clinical problems, such as acute pain, cancer pain, pain in children, pain in the elderly, pain in AIDS/HIV patients, and pain due to invasive treatment strategies. The final 30 pages feature appendices containing a glossary, a trade name list, and a tabulation of adverse drug reactions.
This is a useful book. It is obviously intended to be kept in a pocket or bag, even though many of the chapters are of general interest and do not provide specific management guidelines. Some chapters, however, are more devoted to bedside decision making. Certain things about the book puzzled me. For example, although many chapters specifically said that they were aimed at nursing practice, nowhere in the title, foreword, preface, or table of contents is this specified. Secondly, the glossary contains proprietary definitions of terms that are in widespread use and that have been carefully defined by a multidisciplinary and multinational committee of the International Association for the Study of Pain (almost 20 years ago) and published widely (and generally accepted). Allodynia cannot be meaningfully redefined as “Strange or abnormal sensation.” It will not help the interdisciplinary or multidisciplinary management of pain to have nurses using their own definitions of terms. Thirdly, I am uncomfortable about the inclusion of alternative approaches to pain management as if they had the same coherence and therapeutic value as pharmacological, physical, or surgical treatments. I think that most rational people would choose an opiate over craniosacral therapy if they had a broken leg or a painful malignancy. Those who would prescribe the latter are depriving patients of more effective treatment strategies.
John Loeser is professor of neurological surgery and anesthesiology and director of the Multidisciplinary Pain Center at the University of Washington, Seattle.
