Clinical Pain Management: Cancer Pain

Abstract

Cancer pain is one in a series of four books entitled Clinical Pain Management. Other books in the series are Acute Pain, Chronic Pain, and Practical Applications and Procedures. The book is divided into three sections: Basic Considerations in Cancer Pain Management; Clinical Management—Therapies; and Clinical Management—Special Situations. The first section is the best part of the book. It consists of nine chapters and is well constructed, covering: cancer pain syndromes; epidemiology; clinical pharmacology; history and examination; psychological evaluation; the role of nursing; teamworking; palliative care; and ethical issues. These chapters are generally well written and give a good overview of cancer pain management principles. They are well focused towards patients with cancer pain, and provide a good basis for the next two sections. The second and third sections are entitled ‘Clinical Management Therapies’ and ‘The Clinical Management of Special Situations’. The chapters in these sections cover the principles of oral analgesia; when the WHO ladder appears to fail; opioid switching and rotation; management of side-effects; non-opioid analgesics; adjunct therapies; nerve blocks; stimulation-induced analgesia; radiotherapy; neurosurgical modalities; complementary therapies; management of bone pain; control of symptoms other than pain; painful procedures; paediatric pain; elderly cancer; AIDS; substance abuse; and pain in advanced non-malignant disease. Unfortunately these two sections are less effective than the first. The quality of the chapters is variable, and whilst all the chapters are well referenced, some read more like a list of therapeutic options rather than providing help to the clinician trying to manage a patient with a particular clinical problem. Indeed, a couple of chapters are written in such a way as to make the reader wonder about the author's own clinical experience in the area. The distinction between the two sections seems both arbitrary and unnecessary, and there is a lot of repetition of topics within the chapters, particularly those covering drugs. For example, chapters 10 and 14 largely repeat what has been mentioned earlier in chapter three, and the WHO ladder on analgesic uses is repeated regularly throughout the book. It is hardly surprising then, that this part of the book lacks cohesion, and feels like a series of reviews that have been put together in a somewhat haphazard way. Furthermore, some of the chapters in this part of the book stray away from the management of cancer pain into the area of chronic non-malignant pain, and a lot of the studies quoted do not relate to cancer pain management. The chapter on the management of bone pain is very good, but begs the question ‘why were more of this style of chapter not commissioned for the book?’. After reading the first section, the final two sections are disappointing. I cannot help but feel that if the editors had taken a different approach to these sections, choosing to concentrate on the management of particularly cancer pain problems, then the book would be far more useful as a reference guide. Overall, this book is therefore a bit of a patchwork. The editors have brought together a wide range of international contributors from a variety of different countries, but unfortunately it does not really work. It becomes clear when reading each chapter where each author comes from and the North American chapters in particular, seem irrelevant to the United Kingdom. The first section provides a good introduction to the subject, but the second and third sections do not keep up this standard. There is a lot of repetition between chapters. In the Introduction to this series, the editors state that Clinical Pain Management ‘is not intended to replace the classic textbook by Melzack and Wall instead it represents a complimentary work addressing the practical clinical aspects immediately relevant to those who work on the factory floor of clinical pain management’. It does not succeed. Although this book is very well referenced and may therefore be worth buying for a department, I would not recommend it to individual doctors in training or to other professionals involved in cancer care.