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American Pain Society
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John D. Loeser, MD, Department Editor
Reviewed by Corrie T.M. Anderson, MD
G. Allen Finley & Patrick J. McGrath (eds.), IASP Press, Seattle, 2001, 183 pages, $50 IASP members ($70 IASP nonmembers) (hard cover), ISBN 0-931092-39-6
Acute and Procedure Pain in Infants and Children attempts to “cover the topic (pediatric pain) from basic science to the bedside and even beyond to the community.” This multiauthored book, edited by two renowned experts in the field of pediatric pain management, does an excellent job of attaining its goal. “From the bench to the bedside and then to the community,” could have been a good subtitle for this book. Although eight of the 15 authors are from Canada, this book does not have a narrow perspective. There are nine well-organized chapters. Eight of the chapters are absolutely required reading for anyone providing health care to children. Only the first chapter, “Hyperalgesia and Allodynia in Infants,” makes for arduous reading. Those readers not familiar with the advanced neurophysiological and biochemical techniques used in the experiments cited will find this chapter a bit ponderous. The lead author has written a much better chapter on the same subject in “Pain in Infants, Children, and Adolescents,” edited by Schechter, Berde, and Yaster (1993).
Chapter two, “Postoperative Pain Management,” is very practical and useful. It reviews many of the current pharmacological therapies for postoperative pain management. If the guidelines laid out in this chapter are followed, most pediatric pain patients will be more comfortable. There is an excellent discussion of nonsteroidal antiinflammatory drugs (NSAIDS) with an emphasis on the data for high-dose (appropriate) acetaminophen. Missing from this chapter is a discussion of the risks of continuous infusion of opiates in the PCA pump. Also, there was little mentioned of the use of ketamine and clonidine as adjuncts for therapy.
The third chapter, “Local and Regional Analgesia,” is extensive and well written. The discussion of continuous infusion of local anesthetics and their pharmacokinetics was clearly presented and can serve as a template for hospital policy and practice guidelines. One of the references on Amethocaine (Smith and Nephew) was missing from this chapter.
Concisely written, chapter four presents an overview of the pharmacological management of procedural pain with a good discussion of the differences between European and North American practices for procedural pain management. The section on organizing a sedation service highlighted the safety, political, and economic problems with its development.
The editors should have placed chapter five earlier in the book. This chapter on psychological and integrative interventions helped crystallize some of the most important concepts forming the basis of good care for the pediatric pain patient. The discussion of cognitive and behavioral interventions and the importance of personality on pain perception were detailed and gave insights that many practitioners may not have considered.
With so many children participating in athletic endeavors, the chapter, “Injury and Pain in the Adolescent Athlete,” is a nice addition to the book. The presentation in the chapter on catastrophizing was excellent and applicable to more than just the athlete with an injury. This subset of patients, although few in number, requires a great expenditure of time and energy. Information in this chapter will help the practitioner deal with this patient population.
The remaining chapters, “The Politics of Pain” and “Towards a Pain-Free Hospital,” present the reader with information beneficial to making the case for the establishment of pediatric pain services to hospital administrators, insurance companies, and donors. The authors of the two chapters help to frame arguments for good pain management by presenting accumulating evidence demonstrating the utility and impact of proper pain management on healing and healthcare economics.
Missing from the book is a clear discussion of complementary and alternative medicine techniques, such as massage and acupuncture. Practiced in many settings around the world, these therapies are an important addition to our current, more invasive medical techniques. Effective options for pain management, other than expensive pumps and computers, should be available for all children.
With the ongoing challenge of balancing effective pain management with patient safety and the reality of economic constraints, this book will be very helpful to many healthcare professionals caring for children who may experience pain.
Corrie Anderson is a professor of anesthesiology at the University of Washington and director of the Pain Management Program at Children’s Hospital and Regional Medical Center in Seattle.
