Cancer Pain Management.

Abstract

Mayo Graduate School of Medicine, Rochester, Minnesota. obray.jon@mayo.eduCancer Pain Management. By Michael J. Fisch, M.D., and Allen W. Burton, M.D. New York, McGraw-Hill, 2006. Pages: 319. Price: $99.00.Symptomatic treatment is important to patients with cancer, where treatment of pain can become as high a priority for the patient as treatment of the cancer itself. Multiple specialists often contribute to the care of a cancer patient, and their investigations into clinical care can lead to a diverse literature with respect to symptomatic management. It is to this end that the authors have sought to introduce a text where the diverse experience of multiple specialists is collected into one resource dedicated to the relief of suffering secondary to cancer pain.Chapters are focused on specific topics relevant to the treatment of cancer pain, with appropriate supporting references. The target audience is oncology specialists, but the editors note the benefit of the text for nononcology physicians and allied health professionals. The chapters are organized with appropriate titles and subtitles. Numerous figures and tables contribute to a clear, effective presentation. I appreciated the inclusion of chapters such as ethics in cancer pain management as well as skin pain and wound management.The book’s sections include general principles of cancer pain management, management of specific cancer pain syndromes, special issues in cancer pain management, and interventional techniques and other specialized approaches. Appendices address practical clinical subjects. Some chapters are brief and somewhat underdeveloped for most specialists who are engaged in the care of cancer pain patients. But overall, each chapter is well referenced, and when brief, the reader is able to identify a resource for a more in-depth review of the subject.Basic pharmacology is addressed in the first section, with a succinct but useful review of opioids and other analgesics such as nonsteroidal antiinflammatory agents. Tables provide general medical dosing guidelines. Studies addressing cardiovascular morbidity and cyclooxygenase 2–specific inhibitors are presented as well. A dedicated chapter addressing prevention and treatment of opioid side effects is helpful given the frequency of unwanted symptoms with opioid therapy. A chapter dedicated to the basic neurobiology of cancer pain is also included.The section on management of specific cancer pain syndromes includes chapters dedicated to bone pain, neuropathic pain, and wound management. These chapters provide a blend of basic science and clinical information. They are succinct, but well referenced. The chapter dedicated to the management of wounds is clinically beneficial, because this is a common serious complaint for patients. Special issues in cancer pain management are addressed in eight chapters, including a diverse mix of subjects from ethics to complementary and alternative medicine in oncology. A chapter dedicated to pediatric palliative care is included in this section, covering a broad number of topics, from pain assessment to treatment, including pharmacology and interventional techniques.I would have liked more detail included in the interventional technique chapters, specifically dealing with neuraxial infusions and neurolytic nerve blockade. These chapters are best described as an overview of interventional treatment options for cancer patients. As someone who has not trained in radiation oncology, I found the chapter on palliative radiation therapy techniques helpful.After noting the complexity of developing healthcare guidelines in the absence of a mature clinical literature, the editors have included appendices describing guidelines used in cancer care at the M. D. Anderson Cancer Center. These appendices offer practical suggestions in how to approach the application of procedural pain techniques in cancer patients as well as methadone dosing.Overall, this textbook is a good orientation to cancer pain management, which will be valuable to medical students and residents as well as fellows starting advanced training in pain medicine. It will also serve well the nonpain specialist looking to increase knowledge of cancer pain management. For the mature pain specialist, much of the information presented will likely be a review. I will look forward to future editions, which will likely be of increasing value to practicing pain specialists.Mayo Graduate School of Medicine, Rochester, Minnesota. obray.jon@mayo.edu