By Dermot Fitzgibbon, M.B.B.Ch., and John Loeser, M.D. Philadelphia, Lippincott Williams & Wilkins, 2010. Pages: 464. Price: $149.00.
Since the beginning of my medical training, there has been an increased emphasis on addressing pain complaints. Most institutions now include pain scores alongside vital signs in flow sheets. Yet the availability of pain management specialists has not kept up with the numbers of patients in need of consultation. With waiting rooms already packed, it may be months until someone can be initially assessed. Because the perception of pain is so multifaceted, patients may suffer unduly. A cancer patient may endure a barrage of treatments with accompanying pain complaints that are just as dynamic. Primary care providers and oncologists are then left to manage the cancer pain. In addition, many pain specialists may not care for many cancer patients. Cancer Pain: Assessment, Diagnosis, and Management is a text that provides a good overview of cancer, psychosocial elements involved with cancer, types of cancer pain, and cancer treatment modalities.
As physicians who spend countless hours caring for patients, we need a book that is concise. With the increased specialization of medicine, a good review of topics once learned and since forgotten is also necessary. This book accomplishes all of that. It is easy to follow and would be good for those who are still in graduate training as well as physicians who are many years removed from managing cancer pain.
This text is organized into two large sections, with the first one addressing assessment and diagnosis. There are 12 chapters in this section. A quick review of the epidemiology of cancer and the physiology of pain begins the book. This is followed by a description of how to assess cancer patients and how to evaluate their pain. An adequate amount of text is also devoted to reviewing different types of cancers, their symptoms, and potential sources of pain complaints. There are also individual chapters dedicated to bone metastases, spinal cord compression, and neuropathic pain. As a pain fellow who cares for cancer patients, I felt the first section was enlightening because my anesthesiology residency left my knowledge of cancer diagnoses rather rusty. This section also provides a good review of basic pain information useful to the pain fellow.
The second section is focused on the management of cancer pain. The 14 chapters in this section concentrate on medical and interventional management. There are individual chapters on nonopioid analgesics, opioids, and adjuvant drugs. The chapters on interventional management are more concise because there is a multitude of possible interventions to cover. The tables provide good summaries of the chapter content and would be good for quick reference. The anatomical diagrams are particularly helpful in explaining procedures, although this book is not meant to take the place of an atlas dedicated to interventional procedures. During the discussion of management modalities, one will notice many first-person references to the University of Washington. I conclude that this serves as a reminder that clinical experiences may be as important as evidence-based research.
Also worth mentioning are the appendices. They are filled with useful patient questionnaires that one could use in practice that are reminiscent of the CAGE questionnaire for detection of alcoholism to which we were introduced in medical school. There are even contracts for opioid and marijuana use. I find that formulating one's own patient self-evaluation on the basis of these appendices could streamline a patient's visit for maximum efficacy in a short amount of time.
This text is well written for any healthcare provider, no matter their area of expertise. For non–pain specialists, it is organized into an easy-to-read format that allows one to reference a type of cancer and then find possible treatments. For the pain physician, the text brings to light elements of cancer and its related pain that are often overlooked. The text provides a better appreciation for cancer pain treatments, whether medical, interventional, or surgical. I would recommend this book to the pain practitioner who does not have a lot of experience with cancer pain and is looking to be better prepared to provide care to a population whose complaints are not centered on arthritic back pain. Cancer patients can thus be more effectively cared for and pointed in the appropriate direction without wasting crucial time.
Roswell Park Cancer Institute, Buffalo, New York. email@example.com.