Pain Management for Primary Care Clinicians

Lipman AG, ed. 372 pages. Bethesda, MD: American Society of Health-System Pharmacists; 2004. $70.00. ISBN: 1585281026. Order at www.ashp.org. Field of medicine: Pain management. Format: Hardcover book. Audience: Primary care physicians, house officers in primary care specialties, and any specialist seeking to understand the pharmacologic, psychological, and rehabilitative approaches to treating pain. Purpose: To provide information needed to identify, assess, and manage the most common types of pain in the primary care setting. Content: The book has 22 chapters, extensive references, and 2 appendixes. There is a succinct comprehensive review of the neurophysiology of pain transmission and modulation. Chapters on management of acute and malignant pain present cookbook descriptions of opioid analgesics, routes of administration, doses, and adverse effects. The book also reviews nonopioid analgesics. Chapters address pediatric and geriatric populations, patients with headache, and patients with arthritis. Legal concerns, such as the perceived (generally unwarranted) risks of prescribing opioids and the danger of failing to appropriately prescribe for pain, are discussed. The final chapter coaches the reader in the proper evaluation of statistics in clinical studies of pain management. Highlights: The book examines the biopsychosocial aspects of pain, especially chronic nonmalignant pain, in depth and emphasizes the important role of an interdisciplinary pain management program. The effectiveness of biofeedback and other relaxation techniques in patients with cancer or headache, children, and elderly patients is highlighted. The chapter on pharmacokinetics of opioids does a splendid job of clarifying a confusing subject and addresses specific drugs and routes of administration. Appendix 2 provides a comprehensive listing of pain-related journals, professional societies, Web sites, and other useful references for the clinician or patient. Limitations: The illustrations for the pathophysiology chapter did not copy well in gray tones, especially Figure 2-8. Figure 11-3 is supposed to illustrate trigger points but doesn't. Figure 13-1 illustrates a synovial joint but is mislabeled. The review of several drug studies for rheumatoid arthritis is intended for the specialist. The most glaring mistake was the omission of Table 5-2, an opioid equianalgesic conversion table. The publisher should provide it as a sheet that can be pasted to an inside cover. The references contain numerous misspellings of authors' names. Related readings: Turk and Gatchel's Psychological Approaches to Pain Management: A Practitioner's Handbook, 2nd edition (Guilford Pr, 2002), presents an excellent overview of the psychological techniques effective in treating chronic pain. Wall and Melzack's Textbook of Pain, 4th edition (Churchill Livingstone, 1999), reviews every aspect of pain patient assessment and treatment. Reviewer: E. Richard Blonsky, MD, Northwestern University Feinberg School of Medicine, Chicago, Illinois.