Back to the Not-So-Basics: The Pharmacology of Pain

Abstract

chapter on pain evaluation includes a list of selfreport pain scales, objective and behavioral measures of pain, and their strengths and weaknesses. Three remaining chapters address opioids, adjuvants, and an analysis of each step in the World Health Organization analgesic ladder. The next seven chapters address common symptoms such as gastrointestinal, neurological and psychological symptoms, feeding and hydration, dyspnea, and skin symptoms. Pathophysiology, etiology, and management are discussed in practical terms, with helpful tables and management algorithms. The chapters on nausea/vomiting and dyspnea are remarkably practical; the former includes a flow chart outlining ‘‘a rational approach to antiemesis’’. After the chapter on pediatric palliative emergencies, the next several chapters cover specific diseases commonly seen in pediatric palliative care. There is a general overview of malignant diseases, and more in-depth coverage of the most common pediatric malignancies, along with a general discussion on management of cancer-related symptoms. Specific nonmalignantdiseases areoutlined inmoredetail, including clinical features andmanagement strategies. The concluding chapters provide a worthwhile practical overview of the clinical issues surrounding death, the major religious issues related to death, funeral practices, bereavement, coping and communication skills, education, and training. As with many pediatric books, a pediatric formulary is included, with recommended dose ranges based on the child’s weight, and notes pertinent to each drug. Each chapter is primarily presented in outline form, with several current references provided at the end. This makes the handbook easy to read and understand. On the other hand, the descriptions of palliative care services for children refer exclusively to services in the United Kingdom and could be less relevant to readers from other countries. In addition, the formulary includes several medications that are unavailable in the United States. As the authors point out in the preface of this book,most children with life-limiting conditions will be cared for not by pediatric palliative medicine specialists but by general pediatric or subspecialist teams. Hospice teams, medical students, pediatric residents, pediatricians, and oncology fellows will appreciate this practical introduction to pediatric palliative medicine. The handbook also will benefit adult palliative care fellows who are rotating through their pediatric palliative training. The authors have succeeded in producing a handbook that provides basic concepts and information for the professional without specialty training in pediatric palliative medicine. The handbook can serve as a framework for those professionals endeavoring to provide good palliative care for children.