Publications
APS Bulletin • Volume 15, Number 3, Summer 2005
Resource Reviews
John D. Loeser, MD, Department Editor
Psychological Methods of Pain Control: Basic Science and Clinical Perspectives
Reviewed by David R. Patterson, PhD ABPP
Donald D. Price and M. Catherine Bushnell (Eds.), Seattle, WA, IASP Press, 2004, 308 pages, $51.00 IASP members, $63.00 nonmembers (hard cover), ISBN 0-931092-52-3.
Over the past few years, there have been sophisticated developments in studies of psychological interventions for pain and the potential underlying mechanisms that explain how they may work. Included among the latter is how to apply advances in psychophysiology and neuroimaging to the study of pain. The authors point out the gap between research that elucidates the multidimensional nature of pain and the psychological interventions that may be capable of treating at least some of the facets of this complex perceptual pheno-menon. There are four parts to the book, each of which contains basic science or clinically oriented chapters on the nature of pain: “General Mechanisms of Pain Modulation” (overview of pain dimensions, physiological and demographic factors, preclinical/animal studies, pain reduction strategies); “Modulation of Pain by Attention, Cognitive Factors and Emotions” (psychophysical and neurophysiological studies, pain and emotions, environmental/ learning factors); “Modulation of Pain by Placebos” (neuromechanisms, clinical studies, changes in expectation and desire); and “Modulation of Pain by Hypnosis” (neuro-phenomenology, mechanisms of action and clinical applications). Chapters tend to switch back and forth between a basic science focus and clinical focus. The authors in this edited text are experts in their respective areas. The quality of writing is generally excellent and is largely consistent across chapters. The content areas of the various chapters certainly represent current thinking in the field. The section on modulation by placebos, however, did not seem to meet the standards of the other chapters. This may be because of my personal proclivity regarding the term placebo. In some respects, I believe that placebo is outmoded and leads readers and investigators to one category of unexplained effects. I prefer to use nonspecific effects to describe reductions in pain not explained by active effects. This one issue does not diminish the contributions of this section, however.
Does the book meet the goals of explaining some of the fundamental principals of how pain can be modulated by psychological factors and applying this to treatment? In the sense that disease pathogen models or genome science can link more basic science with applied medicine, perhaps not. For some psychological treatments, such as those relying on attentional mechanisms, it is far easier to meet this objective. Creativity and innovation aside, this book still alternates between basic science and clinical interventions, but a seamless flow between these two domains seldom occurs. Such an aspiration, however, will prove elusive to any clinician-scientist, particularly when the problem being treated is as complex as pain. Perhaps a more reasonable question might be, “Have the authors done a better job of integrating basic science and psychological interventions than their predecessors?” In my opinion, the answer to this would be yes. This book represents an ambitious, creative effort, and any failure to meet this goal is reflective of limitations inherent in the field rather than of the efforts of the authors. I highly recommend this book as a resource for readers who wish to better understand the underpinning of psychologically based approaches to pain control and to use science to make such interventions more respectable.
David R. Patterson, PhD ABPP, is Professor of Rehabilitation Medicine at the University of Washington, 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