Managing persistent pain

Fast facts: chronic and cancer pain. 2nd ed.

Michael J Cousins, Rollin M Gallagher. Oxford: Health Press, 2011 (167 pp, $25.00). ISBN 97819059832859.

Australian Michael Cousins and American Rollin Gallagher are both internationally recognised pain medicine physicians, active in research, teaching and clinical work. Which is why, when my review copy of their book arrived in the post, I was surprised to find it to be so small.

It made me recall Mark Twain’s famous comment: “I wrote you a long letter because I did not have the time to write a short one”, and hoped that the necessary time and thought had gone into this little handbook. I was not disappointed.

The book explains the new insights into the physiology of persistent pain in a simple fashion. It is well illustrated and provides an up-to-date guide to various treatments. The chapters cover trigeminal neuralgia, complex regional pain syndrome, diabetic and post-herpetic neuropathic pain, central pain, musculoskeletal pain, visceral pain and headache.

It is ideally suited to all medical practitioners treating pain including hospital medical officers, general practitioners and various medical specialists. It would also be useful to nurses, allied health clinicians, teachers and medical trainees.

The book is balanced in its viewpoint, emphasising the multifactorial nature of persistent pain conditions, and that treatments require both medical as well as restorative approaches to physical function and psychological aspects.

The chapter on cancer pain is well done. It offers a good overall summary of pathophysiology of cancer pain and the complications of therapy associated with pain. It summarises pharmacological, non-pharmacological and interventional strategies to manage cancer pain very succinctly. However, it comprises only a small section of the book and fails to cover palliative care or the existential nature of cancer pain and suffering.

The introduction reminds readers that “regardless of specialty, clinicians will see patients with persistent pain”. I agree with this statement and, in my opinion, there is a need for concise texts about pain. The authors have definitely tapped into this need with this book.