Publications
APS Bulletin • Volume 13, Number 2, 2003
Resource Reviews
John D. Loeser, MD, Department Editor
Practical Pain Management, Third Edition
Reviewed by R. Norman Harden, MD
Tollison, C.D., Satterthwaite, J.R., Tollison, J.W., Philadelphia, Lippincott Williams and Wilkins, 2002, 848 pages, $129 (hard cover), ISBN 0-7817-3160-7
This book’s purpose is excellent: to provide a pragmatic and accessible book for clinicians. In some chapters, the authors achieved this goal; in other chapters, they did not. In the aggregate, this textbook is moderately useful to clinicians and, as advertised, should not be considered as a reference for basic science researchers or those who are interested in the fundamental mechanisms of disease.
As in most textbooks, there are excellent sections and chapters, some scholarly and exhaustive reviews, and some weak chapters. The section on cancer pain is superb. Beginning with an excellent review, it delves into clinical issues of radiation therapy, and has a relevant section on the psychological management of cancer pain. The pain and medical-legal issues section is unique, topical, and salient. The chapter headings are a little disorganized, and some of the chapters are not well written. The attempt is important, however, and as a section it is a valiant attempt at collating previously underrepresented concepts and skills. The sections on compliance and psychological impairment are one-of-a-kind and valuable as preliminary attempts to organize these topics. The section on evaluating and rating physical impairment is a comprehensive review.
The foundations section is disappointing and outdated (the most current reference from the suggested reading list for the anatomy section is 1987)! The taxonomy section is narrow, only discusses existing IASP taxonomy, and does not discuss improving or developing taxonomy or other taxonomies such as the International Headache Society’s headache taxonomy. The diagnostic sections feature two very good reviews on evaluation of patients and medical electrodiagnostics. The section on diagnostic and therapeutic injections is informative and a real standout.
The section on therapeutic modalities is highly variable. It begins with a good review of manipulative therapy in the management of pain, but then brushes over the lack of evidence for efficacy and goes on to propose manipulation therapy as a panacea. The rehabilitation section is disappointing; allocating too much space to physical therapy, considerably less to occupational therapy, and none to the many other modalities. This is especially weak for a pain textbook. The neuraxial opioid chapter disregards the lack of randomized controlled trials and evidence, and plunges into what proves to be an excellent review of techniques. The same author writes another good review section on neurostimulation techniques, again ignoring the embarrassing lack of evidence. Carrying on with a lack of randomized controlled trials and support from the literature, there is a readable chapter on neurosurgical options. There is a solid review of cognitive behavioral therapy, and a very brief, well-referenced section on alternative therapies.
The chapter on opioid analgesics is superb. It includes an erudite discussion of the rationale for using opioids and how to use them. The pharmacologic interventions section interestingly begins with an inappropriate chapter on behavioral issues that turns out interesting, but biased. The chapter on non-opioid and adjuvant analgesic is disappointing, providing one-third page for serotonin drugs, and one-third page for anti-epileptic drugs (clearly inadequate). The chapter on non-steroidal anti-inflammatory and COX-2 inhibitors is informative and well written. There is a good scholarly review of anticonvulsants and muscle relaxants.
The chapter on pediatric and geriatric medication considerations is clearly a standout. The chapter on detoxification protocols is a good scholarly review of clinical procedures and the literature. The section on selected pain disorders has a good review of facial pain and cervical spine pain and disc disease. The section on gynecologic pain is outstanding, and may be the most important and useful chapter in the book. The chapter on complex regional pain syndrome is also good. The chapter on phantom pain is interesting and useful. The chapter on post herpetic neuralgia is instructive, exhaustive, and certainly stands out as one of the better chapters.
The chapter on myofascial pain syndrome (MPS) is disappointing, loses focus entirely, and goes on about neuropathic pain from plexus injury, “thoracic outlet syndrome,” and complex regional pain syndrome. MPS is the most common diagnosis treated in pain clinics; the failure to adequately address it is one of the major failings of the book. In the section on selected topics, the pain in primary care chapter represents a good start for collating information in an unusual topic area. The chapter on consultation is also good. The chapter on inpatient treatment addresses a topic that has become a dying art in pain management. The chapter on providing pain management services under the managed care paradigm is also one-of-a-kind and very topical.
All things considered, this textbook has some excellent chapters and can be a helpful reference to the practicing clinician. One of the principal disappointments is the book is poorly organized, with many chapters seemingly misplaced. There is also a good deal of redundancy. This textbook is now in the resident’s office in our clinic; our house staff often refers to it and tells me they find it useful.
Dr. Harden is director of the Pain Center at the Rehabilitation Institute of Chicago.
Review content represents the opinion of the reviewer, not APS.