Practical Pain Management (2003)

Practical Pain Management C. D. Tollison, J. R. Satterthwaite, and J. W. Tollison, eds. Philadelphia, Pennsylvania: Lippincott Williams & Wilkins, 2002. ISBN 0-7817-3160-7. 829 pp, $129.00 Anesthesiologists have been the leaders in the evolution of the specialty of pain medicine. There has been tremendous growth in both the scientific and clinical aspects of this practice. Of necessity, the integration of specialists from many fields has matured, and the contemporary pain medicine specialist must manifest broad-based patient care because the physical experience of “pain” is only a “tip of the iceberg” indicator of all the related problems the patient encounters with acute and chronic pain. This third edition of Tollinson et al.’s book represents a thorough revision of the previous editions. Most of the information is up-to-date, including that covering the vital topics of the anatomy and neurobiology of pain, as well as the ever-common pharmacologic and neuraxial therapies. Adequate emphasis has been placed on physical therapy and occupational therapy treatments. These are important modalities not only in the initial management of the patient, but as pain is decreased, because they contribute mightily to the all-important rehabilitation of the patient. Overemphasis is not given to the invasive therapies that seem to be so popular. Rather, the editors have achieved an admirable balance in the topical coverage of intellectual material of value to the practitioner for the management of pain. Only four chapters are devoted to the workup of patients with pain problems, although evaluation comments are a part of most of the chapters in the selective pain disorders section. Modern-day areas of special interest include cancer pain management and compassionate end-of-life care, physician compliance with standards of patient evaluation and documentation, management tips for a variety of practice models, and medicolegal issues. Chapters devoted to selective pain disorders help the reader gain access to focused information on common topics of interest. Over half of the 54 chapters are authored by acknowledged authorities in the field of pain medicine (and all but one are from the United States). The use of tables, figures, and diagrams is effective. These features of the book are not merely duplications of the text, but rather supportive of and contributory to the dialogue. The use of headings and subheadings enhances the organization of the material. Perhaps because this is the 3rd edition, some of the references are dated. The index is generally helpful, but some ordinary topics such as spinal cord injury pain, poststroke pain, spinal stenosis, Munchausen syndrome, bursitis, and superior hypogastric plexus and ganglion implar blocks are not listed. Who will benefit the most from this text? The book will not be as appealing to the hardcore pain medicine practitioner looking for expanded, detailed information, as it will be enlightening to the multitude of clinicians from pain-related disciplines who are seeking basic information on a wide array of topics. It is not a how-to book, so the details of procedures (which would be of great interest to anesthesiologists) will need to be found elsewhere. Rather, it is truly a practical guide to the management of patients with acute and chronic pain problems. It is appropriately holistic in its scope, yet the most common types of pain seen and treated by anesthesiologists in routine practice such as low back pain, cancer pain, CRPS (complex regional pain syndrome, the new name for reflex sympathetic dystrophy [RSD]) are adequately covered. Overall, it endorses the modern concept of pain as a biopsychosocial disease, such that essential patient evaluation and diversified pain management must be sought to result in the best clinical outcome.