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John D. Loeser, MD, Department Editor
Reviewed by John D. Loeser, MD
James N. Dillard, New York, Bantam Books, 2002, 439 pages, $24.95 (hard cover), ISBN 0-553-80183-X
This book is for intelligent laypeople who need to know about chronic pain and its many treatments. The author clearly has the right concepts about chronic pain. The first six chapters provide a good introduction to a biopsychosocial conceptualization with a heavy dose of cognitive/behavioral principles. The reader is then introduced (in a totally non-critical way) to Rolfing, Feldenkrais, chiropractic, pilates, Alexander, Heller, acupuncture, traction, and massage as treatment modalities. The book’s implication is the scientific underpinnings of these therapies, as well as their demonstrated clinical effects, are on the same footing as removing a disc for a patient with sciatica or treating a tic douloureux patient with anticonvulsants.
I guess I am not able to be politically correct on these issues. All healthcare providers should be able to demonstrate what they do has some effect on the natural history of a treated disease above and beyond the non-specific treatment effects of the doctor-patient relationship. Yes, health care is a social convention that has never been based on science. As biomedicine is driven more into outcomes-based strategies (primarily because of its costs), it is ironic to see alternative medicine foisted upon the public without the demand for outcomes studies just because it is so much cheaper.
Having vented on this matter, I’ll return to the review of the book. The second half is devoted to specific types of chronic pain, with recommendations for both allopathic and alternative treatment strategies. What is the evidence in support of specific dietary supplements for specific painful conditions? Why is one alternative treatment better than another? By now, all of us should recognize the importance of seeing patients as human beings and not just collections of nerves and pathologies. Pain is, as Bill Fordyce said years ago, “transdermal.” The whole patient as he or she interacts with his or her environment is the proper subject of pain management. The author does a good job of emphasizing this critical point throughout the book. The book concludes with appendices featuring exercises, acupressure points, recommendations for dealing with insurance companies, and a list of resources for chronic pain patients. The required reading level and the length of the text will make it a difficult source for those without a college education. If you have a patient who wants to combine traditional medicine with alternative techniques, at least this book does not make exaggerated claims for the efficacy of either treatment. It does not promise things that cannot reasonably be achieved. It is probably the most comprehensive book of its type I have seen in the past decade, and should be part of your patient library.
Dr. Loeser is professor of neurological surgery and anesthesiology at the University of Washington in Seattle.
Review content represents the opinion of the reviewer, not APS.
