The manual includes useful diagrams, clinical photographs, supplementary reading material and an index. The management of chronic pain can be one of the most difficult tasks in medical practice. Attention should be directed to the underlying factors which exacerbate the pain or decrease tolerance to it. Many doctors are fearful of creating addicts and provide too little analgesia even for patients with terminal conditions. The irrational prescribing of patient opioid analgesics administered by injection for chronic low grade benign pain is equally difficult to defend.
Oral administration is always preferred to parenteral routes for the management of chronic pain.
Simple analgesics such as aspirin or paracetamol should be tried first. If this does not provide adequate relief, combinations of either aspirin or paracetamol with codeine should be tried next. If more potent analgesia is required, orally absorbed, long-acting opioids such as oxycodone should be prescribed. Morphine can be given orally with satisfactory results, but the dose required might be 3-6 times the parenteral dose because of variable absorption and hepatic metabolism. It is important to appreciate that the very satisfactory analgesia produced by opioids in acute pain is not necessarily achieved by opioids when used for other pharmacological treatments.