Cancer Pain Management

Editors: Michael J. Fisch, MD
Allen W. Burton, MD
Publisher: McGraw Hill Medical
www.books.mcgraw-hill.com
319 pages, 84 tables, 91 figures
Price: $99.00

Reviewed by
JUDITH A. PAICE, PhD, RN, FAAN
Research Professor of Medicine
Division of Hematology-Oncology
Northwestern University
Feinberg School of Medicine
Chicago, Illinois

Given the prevalence of pain in people with cancer, Cancer Pain Management is an excellent resource for all oncologists, oncology nurses, and other professionals. The editors are outstanding pain clinicians and investigators who have published and lectured extensively on this topic. By representing different specialties (oncology and anesthesiology), they bring a wealth of experience and diverse approaches that nicely complement one another. The majority of the 54 authors are highly regarded experts in the field; those who are not as easily recognized likely will be in the future. In particular, M.D. Anderson Cancer Center is well represented, with 28 authors coming from that institution.

The book is a manageable 319 pages, divided into four sections encompassing 20 chapters. Most chapters include treatment algorithms, numerous tables, and useful illustrations. References are comprehensive and current. In addition, there are four appendices and an easy-to-use index.

Part 1: General Principles in Cancer Pain Management addresses topics such as assessment, pharmacology, treatment of opioid side effects, settings of care, and basic neurobiology. The assessment chapter is unique in that it includes very specific physical assessment methods employed to differentiate pain syndromes that are common in oncology. The illustrations in this chapter provide a nice visual guide to these techniques. This chapter is quite comprehensive and clinically relevant.

As the title suggests, the "Pharmacology of Opioids and Other Analgesics" chapter emphasizes opioids. Particular strengths of the chapter include the extensive use of tables, as well as consistent attention to the effects of renal insufficiency and hepatic dysfunction when using each opioid. An entire page is devoted to methadone, although the appendix on this topic is not referenced. The reader looking for a quick answer to a clinical question related to methadone might miss the excellent text in the back of the book. Although nonopioids and adjuvant analgesics are included, more emphasis on these agents would be beneficial, including newer drugs, as well as renal and hepatic dosing.

The "Application of Pain Management Principles in Specific Cancer Care Settings" provides a unique perspective not usually addressed in texts on pain. The setting of care clearly presents unique challenges and the author addresses sites where oncology patients are treated during the trajectory of cancer care, from the emergency department to postoperative care, and the intensive care unit to hospice. The final chapter in part 1, "Basic Neurobiology of Cancer Pain," is well written with excellent illustrations that nicely complement the content. The convention in most pain-related texts is to place this chapter first and that might have been useful in this text, since assessment and management strategies are built upon an understanding of the neurobiology.

Part 2 includes excellent chapters on bone, neuropathic, and wound-related pain—cancer pain syndromes that can be challenging for both patients who endure the pain and professionals trying to provide effective management. The content in the chapter titled "Skin Pain and Wound Management" is rarely included in books on pain, and yet this can be a significant source of pain in oncology. This chapter is quite practical, using numerous photographs to illustrate a variety of wounds, along with the strategies used to enhance healing and provide relief.

The eight chapters in part 3 incorporate diverse, yet essential, topics when considering cancer-related pain. Psychiatric issues, cultural concerns, family dynamics, and the impact of spirituality all affect the pain experience, and ultimately, how professionals must address cancer pain. Special topics, including ethics, rehabilitation, complementary and alternative approaches, and pediatric care, are welcome additions to the holistic approach to cancer pain control. Of note is the exceptional chapter on pain in those who are cured, an overlooked and understudied population.

Part 4 addresses interventional therapies, surgery, and radiotherapy for pain control. Each chapter delineates which patient might benefit and when these techniques should be employed. Figures illustrate the procedures, and photographs are quite effective in demonstrating the benefits of some of these procedures in specific patients.

Four appendices comprise the final section. These are focused, clinically relevant topics, each 2 to 5 pages long: "The M.D. Anderson Approach to Cancer Pain," "Troubleshooting Intrathecal Infusion Pumps," "Practical Options for Distress Screening," and "Dosing Strategies for Oral Methadone." Because these appendices might be overlooked in the back of the book, it may have been more clear to place this content in the most relevant chapter.

The editors have approached the topic of cancer pain management with expertise and creativity. Despite some suggestions for improvement, I strongly recommend this text. It should be essential reading for oncologists, fellows, residents, medical students, oncology nurses, pharmacists, and other health-care professionals who provide care for people with cancer.

—Judith A. Paice, PhD, RN, FAAN