Pain Management in Hong Kong

Abstract

Edited by Joseph Chuan Shih Yang and Siu Lun Tsui Published by Hong Kong University Press, Hong Kong, 2002 432 pages, $35 (Paperback) In the preface of their book, A Guide to Pain Medicine, editors Joseph Chuan Shih Yang and Siu Lun Tsui lay out their purpose as the provision of “…more concise information in pain medicine for medical professionals…” What is unfortunate is that whether or not they have achieved this goal, most readers of this volume will still not find it to be very useful. The editors have recruited an impressive list of authors—individual specialists associated with the University of Hong Kong, regional institutions and hospitals. Each contributed a chapter or section related to areas of particular interest and/or expertise and an impressive list of references follows each chapter. However, the relevance of those references to the text is often unclear. The editors point out in their preface that “some controversial issues are addressed according to the authors' personal experiences.” What results is more a series of “how I approach this problem” essays rather than well-researched monographs. There is much here that is excellent, however. The discussion of trigeminal neuralgia, for example, is well written, and for readers not versed in the subtleties of gangliolysis, there may even be a sense of the ‘wow’ factor. The chapter on psychological, behavioral and social management is particularly well designed and practical. The short chapter on principles of pain control in traditional Chinese medicine will be a nice introduction for Western readers unfamiliar with these concepts. However, some sections are less commendable. For many physicians whose memory of neuroanatomy and neurophysiology is remote, the “Mechanisms of Pain” chapter, without even a single diagram or table, will be frustrating to decipher. In addition, separating the section on pharmacologic management from that on side effects (not only in different chapters, but separated by 100 pages) does not fit with the way most physicians think about drug therapy. This brings up the question that I frequently asked myself while reading this book: “Just who is the target audience, anyway?” Pain medicine specialists will find the book superficial and incomplete. Western palliative care physicians will also likely object to the repeated warnings about addiction that gave me a sense of paradox—an opiophobic pain medicine text. For a generalist looking to improve his/her knowledge base in the field of pain medicine, reading this volume will inform about methods available, but little about choosing appropriate therapies for individual patients. And certain of the recommendations given do not correspond to standards of care in the US (examples include refractory ischemic cardiac pain, for which opioids are not even mentioned, and acute pancreatitis with recommendations for pain control using NSAIDs while the patient is “NPO”). For physicians in training, the greatest weakness of this volume is that the text is mainly comprised of expert opinion and clinical experience rather than researched evidence. For those interested in a discussion of difficult clinical problems, or for those looking to expand their global perspective on the practice of pain medicine, Yang and Tsui have produced a valuable addition to the literature. But for the purposes of most practitioners and researchers, better choices are available.