A brief summary:
Ch. 1. Introduction. Argues for biopsychosocial approach to pain management, in contrast to traditional "pain is signal of tissue damage" approach, and for role of psychiatrist in interdisciplinary pain medicine.
Ch. 2. First part reviews the anatomy and physiology of pain sensation. Second part distinguishes acute from chronic pain, and simple from complex pain.
Ch. 3. Discusses comprehensive evaluation of the pain patient, including psychological factors, and the use of pain scales and other psychological assessment instruments.
Ch. 4. Discusses the common psychiatric comorbidities, and the interactive nature of the comorbidity (e.g., pain increases anxiety, and anxiety can increase focus on the pain). Includes discussion of substance abuse, and addiction vs pseudoaddiction (med seeking because of inadequate pain treatment).
Ch. 5. Pharmacology of Pain: covers opiates, NSAIDs, antidepressants, anticonvulsants, antispasmodics, and others (including antihistamines, alpha2 agonists, and NMDA antagonists. The chapter's coverage of off-label and sometimes little known uses, such as the antihistamines, is quite good. Also mentions important side effects and cautions, such as toxicity of cyclobenzaprine in overdose.
Ch. 6. Psychotherapy. This chapter is a brief review of the basics of psychoanalytic, cognitive/behavioral, supportive, group, and family therapy, with additional coverage of biofeedback, relaxation training, and hypnosis.
Ch. 7. Special Techniques: Acupuncture, TENS, spinal injections and nerve blocks, and the psychiatrist's role in these interventions.
Ch. 8. Common Pain Disorders: Headache (of various types), back pain, myofascial pain, arthritis, neuropathic pain, complex regional pain disorders.
Ch. 9. Special Populations: Pediatrics, geriatrics, pregnancy, cultural issues, substance abuse, terminally ill patients.
Ch. 10. Forensic Issues: Diversion, misuse, patient contracts, confidentiality, disability evaluations.
Pluses: It is short and easy to read (although the style is a bit dry and would benefit from the addition of some case studies, frequently-asked-questions, or test questions for each chapter). There is good coverage of some lesser-known areas. Chapter 5 on pharmacology is detailed enough to be particularly useful.
Minuses: Although the coverage is generally good, it is spotty, especially in areas where a book like this is most needed. I'd claim that the single greatest area of overlap between psychiatry and the treatment of pain is the issue of treating pain in substance abusing patients. This issue has been addressed in some lengthy review articles, some of which are cited in the book. However, the coverage in this book is surprisingly brief, and spread out over several chapters. Many clinicians are quite uncomfortable treating addicts with pain problems, and resort to simplistic heuristics, such as "never give opiates." This can result in poor treatment, and this book is ideally placed to address this issue head on. It needs at least one long chapter devoted to this single topic. It's also not completely clear who would benefit from reading the whole book. For example, the psychotherapy chapter is a very brief review of a complex topic - far too short to be anything other than a quick reminder of what a good psychiatrist will have learned elsewhere.
The book is nicely produced with a quality binding. Like most of what's published by APPI, it's a bit on the expensive side.
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Useful, but has some weaknesses, August 30, 2008
recommend it, November 11, 2007
