Pharmacology of Pain

A heavyweight editorial team, a long list of influential contributing authors and the first such IASP book on this subject for over ten years was always going to make for a strong publication and this does not disappoint. There have been huge advances in the understanding of pharmacology and physiology of pain since the last key text on the subject and an update was over due. There is an excellent reappraisal of pain neurophysiology and the taxonomy of analgesia in the opening chapters. The efficacy of the COX pathway and it`s safety is explored in detail. There are excellent chapters dedicated to the oft underestimated Paracetamol (Acetominophen), to opioid systems and cannabinoids. I particularly found the comprehensive chapter (16) on Complex Regional Pain Syndrome of interest.

A chapter on the latest pain treatments in development gives a flavour of the future direction of travel in this field. Chapter 18 on the vulnerability to opioid therapy and particularly the clinical implications of such care is very welcome although rather short at just four pages. Placebo is explored in detail in Chapter 20 and the final section (part IV) covers the more clinical aspects of obstetrics, infants and children, the older patient and the obese, renally impaired and hepatically impaired who present specific management challenges of their own, palliative care concluding the book at Chapter 26.

Diagrams, both colour and black and white are used well throughout and are clear and helpful and make a welcome addition to the somewhat but predicatably dry scientific text. All chapters are extensively referenced with up-to-date sources and the book is very much a reference publication not a handy pocket guide and is overall probably one for the purists and unlikely to attract a professional with a mere passing interest however it thoroughly and comprehensively updates reference knowledge in this topic.

Perhaps the only surprise was that IASP have not taken this opportunity to address the issue of medication costs and accessibility across the world and the humanitarian difficulties this poses however it may have been decided not to overtly politicize the publication which would be understandable. It would however have served as a reminder that the pharmacological management of patients depends very much upon where you reside or practice.

“Pharmacology of Pain”, Beaulieu, Lussier, Porreca & Dickenson, Hard Cover 622pp, IASP Press, Seattle, ISBN 978-0-931092-78-7

Review by Mr Martin Hey MSc, Grad Dip Phys, MCSP. Martin is Clinical Manager for Pain Services, Training and Development at the Mid Yorkshire Hospitals NHS Trust, UK. He is also chairperson of the Physiotherapy Pain Association in the UK.