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John D. Loeser, MD, Department Editor
Reviewed by Joseph Barber, PhD
B. N. Eimer & A. Freeman, John Wiley & Sons, New York, 1998, 517 pages, $55 (hardcover), ISBN 0-471-15708-2
This volume promises a comprehensive, practical guide to the psychological treatment of patients in pain and is logically organized around three sections: "Pain Assessment and Treatment Planning," "Cognitive-Behavioral Pain Management," and "Hypno-Behavioral Pain Management." The authors have coined the term "pain management psychotherapy," which seems an apt referent for the clinical interventions psychologists have fashioned from pain and disability research over the past 20 years. The assessment section is very thorough, offering an encyclopedic range of evaluation tools. The authors have helpfully included appendices that illustrate their own patient information form and several of the more widely used pain assessment forms.
Eimer and Freeman's exploration of the interaction between a patient's pain syndrome and psychological factors is also one of the ways the authors effectively support their assertion that an adequate psychological assessment is required for effective psychological treatment of patients in pain. In my experience, psychologists are sometimes tempted to begin treatment of a patient's suffering without an adequate assessment, so I believe the authors have made a major contribution by their extensive review of this key facet of pain management.
The authors' reliability plummets, surprisingly, because of their treatment of cognitive-behavioral strategies. The section itself is thorough and clear, but the content is decidedly checkered. To my astonishment, the chapter on "reprocessing pain beliefs" includes a detailed explanation and recommendation of eye movement desensitization and reprocessing (EMDR) therapy, a pseudoscientific procedure that is wholly without empirical support and whose theoretical rationale (that the patient's eye movements facilitate the brain's processing of the clinician's therapeutic suggestions) is thoroughly dubious (Rosen, 1992; Singer & Lalich, 1996). The inclusion of this section is a major flaw in the book.
The section on "hypno-behavioral strategies" is also a major disappointment. To be fair, this is a difficult field to explore. The domain of hypnosis is filled with more than its share of crank theories and insupportable methods, so a casual reader might easily be led astray. Nonetheless, the authors' handling of this domain does not reflect a contemporary understanding of hypnotic phenomena and processes and seems to be guided by clinicians whose writings are not necessarily informed by science. I was surprised, for instance, by their choice of recommended readings for further study since, contrary to the authors' contention, these references are anything but scholarly. In addition, the authors seem to endorse some unsupportable beliefs. For example, they appear to suggest that hypnotic methods are a reliable means for recalling repressed memories (page 308, although they subsequently suggest caution on page 311), and they explore in detail methods for "uncovering" a patient's "unconscious" attitudes about pain (pages 308-311). These are not trivial errors, because readers who take these beliefs seriously are at risk for creating harm (e.g., by unwittingly collaborating with a patient to create confabulations that are subsequently believed by both the clinician and the patient). Given the demonstrated effectiveness of hypnotic analgesia techniques, it is puzzling why the authors go to such lengths to describe more dubious methods (e.g., "hypno-projective techniques" on pages 311-314). Rather than focusing on the experimental and clinical evidence for the effectiveness of relatively simple methods for reducing suffering, the authors focus instead on the completely unsupported assertions about the emotional roots of suffering and the corollary methods for relieving suffering.
The authors' credulous acceptance of these unsupported claims grows worse as the chapter goes on and undertakes a detailed explication of "ideomotor exploratory strategy," a method that is far more likely to produce confirmatory bias than to reveal the truth about a patient. This book is a troubling addition to the literature because it offers quite a useful education on psychological assessment of pain patients, yet its choice of treatments is highly dubious. An inexperienced clinician is vulnerable to being seriously misled. Unfortunately, the promise of this book is not kept.
Joseph Barber is a clinical associate professor in the departments of anesthesiology and rehabilitation medicine at the University of Washington School of Medicine in Seattle.
Reviewer content represents the opinion of the reviewer, not APS.
Please direct your suggestions for future Resource Reviews to John D. Loeser, MD, Department Editor, at jdloeser@u.washington.edu
