K. H. Simpson Leeds, UK E-mail: [email protected]
Oxford Handbook of Pain Management. P. Brook, J. Connell and T. Pickering (editors). Published by Oxford University Press, Oxford, UK. Pp. 384; illustrated. Price £32.95. ISBN 978-0-19-929814-3. This book is the latest in the ‘Oxford Handbook’ series which has a strong pedigree, beginning in 1985 with the now classic, ‘Clinical Medicine’; a battered copy of the 1st edition still adorns my bookshelf. The remit of this book, boldly printed at the top of the front cover, is to provide ‘a truly biopsychosocial approach to patients in pain’, and the multi-author nature of the project aims to achieve this goal. The book takes a traditional view of the subject, with a two part split into ‘Acute Pain’ and ‘Chronic Pain’ issues, and it is interesting to note that the latter is only 10% larger. The first section details basic physiology and pharmacology and is followed by specific scenarios built around the postoperative period, trauma, obstetrics, paediatrics, and opioid dependence. The format is different from the earlier templates which gave quite detailed diagnostic and management plans, here, instead, describing broader themes. The postoperative
analgesia chapter simply states that, ‘a multi-modal strategy should be employed including paracetamol+NSAIDs and either an opioid, LA block or regional blockade’. There are some details in other chapters, for example, the numbers needed to treat of some non-steroidal anti-inflammatory drugs, but this is not a book to provide prescribing guidance to the junior doctor. The chapter of greatest pharmacological detail is in the cost and relative efficacy of street drugs and a description of the doses of naltrexone used in drug rehabilitation. I have to admit to some disappointment that this difficult subject was primarily focused on the problems of the illicit user. The Chronic Pain section begins with basic history and examination assessments, although the author cannot resist the need to include checks for symptoms that may ‘suggest an underlying treatable pathology’ and signs of a ‘systemic inflammatory arthritis . . . iritis . . . parotid glands . . . splenomegaly’, and I did sigh slightly at this need to look for simple answers, in a book designed to help healthcare staff in managing, and understanding, the pain aspects of a problem. There is coverage of the principle, and some of the rarer, drugs used, and a very detailed section on interventional approaches, although the need for detailed guidance (needle size, angle of insertion, etc.) for a coeliac plexus or facet joint injection in this book is unclear. The section on physical therapies gives considerable coverage to the passive end of the spectrum, whether from the physiotherapist, osteopath, or chiropractor, and the active approach seems curiously underplayed, even in the Pain Management Programme section. There is a short section on the psychologist and their role, which covers the basics of the profession and its importance in treatment. As in the first half of the book, various scenarios are given, covering the basic spectrum of musculoskeletal, neuropathic, visceral, and urogenital chronic pain. These often focus heavily on possible causes, and treatable diagnoses, and seem to have missed a clear opportunity to emphasize both the problem issue of no or non-therapeutic diagnoses, and the importance of the symptomatic, without an ongoing diagnostic, approach. The book is a valiant attempt at a very large subject within the pocket-sized format, and such projects are always a huge compromise between what is left in and what is of specialist interest or simply infrequent enough to be excluded. This is where the intended audience is the final arbiter. The book aims to be for nearly all healthcare staff, from the complementary therapist to the doctor. But in aiming so wide, it is difficult to see for whom it is on target. B. Miller Bolton, UK E-mail: [email protected]
Downloaded from http://bja.oxfordjournals.org/ at University of Nebraka-Lincoln Libraries on April 9, 2015
liver, gynaecological, urological, and reconstructive. The last is particularly good with regard to free tissue transfer. There are excellent chapters on pre-assessment and perioperative fluid management. Part 3 has five chapters that cover critical care issues. These are interesting and very varied. The chapter on interaction between critical care management and tumour spread is up-to-date and fascinating. The final chapter on ethics and the law would make a superb stand-alone article. Part 4 has seven chapters on pain; this was the section I of course enjoyed the most—as would be predicted. It contained some real gems—the chapter on complementary therapies is well written and balanced. The issue of pain in cancer survivors is important and will increase over the next decade, I am sure. Despite the multiple contributors, the authors have done an excellent job in keeping the book easy to read and fluent in style. The layout is good, the tables and figures are clear, and the references up-to-date and balanced. I commend this book to trainees and consultants in adult and paediatric anaesthesia, intensive care, pain medicine, and palliative care and to other involved healthcare professionals, for example, nurse specialists and pharmacists. It is mainly aimed at hospital practice, but some chapters would be of interest to those in primary care and community-based palliative care.