Drugs for Pain. By Howard S. Smith, M.D. Philadelphia, Hanley and Belfus, 2003. Pages: 550. ISBN: 1560535113. Price:$39.95.

Until the publication of Howard Smith’s Drugs for Pain , pain medicine specialists have had to rely on multiple references when trying to keep up with the enormous range of pharmacologic treatment options and drug interactions involved in treating acute, chronic, and cancer pain patients. In addition to the complexity of managing patients with nonsteroidal antiinflammatory drugs, cyclooxygenase-2 inhibitors, and opioids, the practitioner must be familiar with an array of anticonvulsants, antidepressants, muscle relaxants, sodium channel blockers, calcium antagonists, glutamate receptor antagonists, adrenergic agonists and antagonists, bisphosphonates, and topical agents. This requires a reference library of multiple textbooks plus a continuously updated collection of review articles. Smith has compiled an up-to-date collection of reviews on the entire range of pain medicine covering basic pharmacology, clinical treatment options, and drug interactions.

Drugs for Pain  is not organized in the typical textbook format but instead is essentially a collection of review articles. Because of this construction, there is some overlap of material between chapters, and there are some minor difficulties locating certain topics. This problem is minimized by the presence of an extensive index and is a small price to pay for the currency of the material. Unlike most textbooks, it contains very recent references on each topic, some published less than a year before the book’s introduction.

I was impressed by the extensive and understandable basic science sections of the book. The basic pharmacology material is valuable to researchers who need an overview of a particular topic, for practitioners looking for more understanding of the basis for their treatment options, and, especially, for pain medicine fellows studying for sub-specialty board examinations. The text includes a particularly good discussion of the arachidonic acid cascade and the influence of cyclooxygenase-1 and -2 inhibition on various components of arachidonic acid metabolism. There is an extensive and very contemporary discussion of peripheral mechanisms of pain and a good review of the current and future pharmacologic possibilities for influencing them, including discussions of both systemic and topical agents with peripheral actions. Although one chapter discusses the clinical use of N-methyl-D-aspartate antagonists, the basic science of central sensitization is not discussed in detail.

The discussion of opioid analgesics is covered fairly well. A very current discussion of receptor subtypes and mechanistic differences between weak and strong opioids, and a basic discussion of tolerance and addiction, are covered briefly in three different chapters. Opioid side effects are covered well. Spinal opioid administration is covered superficially, along with spinal administration of other drug classes, in a separate section. A good discussion of basic and clinical pharmacology of receptor α2agonists concentrates mainly on systemic rather than spinal administration.

The book provides both basic science and clinical discussions of the use of antidepressants and anticonvulsants for pain management. These chapters are not very extensive, but they provide the reader with a very good introduction. Both chapters provide useful information on drug interactions; plus, a separate chapter on drug interactions concentrates mainly on the cytochrome P-450 system. Other topics covered include acute pain management, headache, and bone pain.

Although Drugs for Pain  does not answer every pharmacologic question that comes up in pain medicine practice, it serves as a good initial source for many topics. The text provides an excellent initial discussion of many pharmacologic issues as well as extensive and, at this time, current reading lists. I hope that it will be updated often.