Clinical Pain Management: Practical Applications and Procedures

Abstract

Clinical Pain Management is a new book with four separate volumes (and editors): Acute Pain, Chronic Pain, Cancer Pain, and finally Practical Applications and Procedures, the latter of which is being reviewed here. The series editors indicate that the first volumes cover three major clinical disciplines of pain relief (acute, chronic and cancer pain), and that these are accompanied by this fourth complementary volume, which addresses practical aspects of management and research into pain problems. I am sure that Practical Applications and Procedures will find its true role as a complementary volume to the other parts of Clinical Pain Management, but the editors of this volume indicate that it could also be used as a stand-alone text. The aim of this volume therefore seems to be to cover pain assessment, therapies, including those provided by different healthcare professionals, and with reference to practical procedures utilized in the treatment of acute, chronic and cancer pain. It can be seen from the above that Practical Applications and Procedures is a considerable text in itself. It is separated into 11 different parts: Principles of measurement and diagnosis; Pharmacological therapies; Psychological techniques; Physical therapy and rehabilitation protocols; Interventions; Stimulation analgesia; Patient-controlled analgesia; Epidural and spinal analgesia'protocols and charts; Paediatric techniques; Clinical trials; and Other issues (the expert medical report). It is immediately obvious to anyone practising in pain medicine that there is a considerable advantage in having all these different topics within one volume. The reviewer also presumes that the editors have referred to this (the fourth volume) in the preceding three (acute, chronic and cancer pain volumes). If this is the case, then this text could be an extremely useful educational tool in the pain medicine clinic. The editors have introduced a few special features ‘to aid the readers’ understanding and navigation of the text’. These include a cross-referencing system between the different volumes (which I feel would be extremely useful), evidence scoring, and reference annotation. These are very good ideas, but at some points the use of the evidence scoring and the reference annotation does seem a little confusing. For example, in some chapters the evidence scoring (1, 2 or 3 asterisks) is used to support a general statement, whereas in other chapters it is used to support a specific reference within the text. The reference annotation is intended to signify key primary papers (a closed black diamond) or major review articles (a black circle) in the reference list. However, in some chapters almost every single reference given in the reference list is either given a black diamond or a circle, whereas in other chapters the annotation is used much more sparingly. In addition, in some chapters the use of dot points is employed (sometimes just for different points, or sometimes for specific ‘key’ points). Together with the black circles for the reference list, in some places the use of dot points appears rather excessive. Nevertheless, in other places the ‘special features’ the editors have introduced do seem to work. Given these comments, the layout of the text is, in general, very clear, with high quality line diagrams used to good effect to describe practical procedures. Each of the 11 parts of the book tends to comprise a number of separate chapters, ranging from ten in part five, ‘interventions’, to only one chapter in part 11, ‘Other issues’. Anyone seeking to learn a new technique, whether it be for pain assessment, an intervention such as a nerve block, or to design a new clinical trial, will find this a very useful book indeed. It may be that an experienced reader would find that their own practice varies from that stated as based on evidence in this textbook, but they would still appreciate, I believe, the reasoned approach to the different items discussed. As the series editors have noted, the requirement for more evidence in pain medicine is urgently required, and the section on clinical trials (part 10) is especially welcome. Perhaps this volume will encourage the production of new evidence for subsequent editions of the book. I am sure that Practical Applications and Procedures represents a useful addition to the pain medicine literature, especially in combination with the other three volumes of ‘Clinical Pain Management’. ErratumBritish Journal of AnaesthesiaVol. 91Issue 1PreviewBJA90711 Full-Text PDF Open Archive