Abstract
Edited by Eduardo D. Bruera and Russell K. Portenoy. New York: Cambridge University Press, 2010, 643 pages, $230.00.
The number of patients affected by cancer pain is large and growing. By 2020 it is estimated that there will be 20 million new cancer cases diagnosed per year and multiple studies suggest that pain management is a serious issue in up to 96% of all cancer cases. In addition, with improving therapies, increasing numbers of people are either cured or living with cancer as a chronic condition. Pain management in this growing population often involves challenges distinct from those met in other medical settings. Cancer Pain, though subtitled Assessment and Management, encompasses much more, providing a truly interdisciplinary approach and broad scope. Topics covered range from cranial ablative procedures to tai chi and Pilates, and from pathophysiology of bone pain to ethical foundations of pain management. In addition, this book distinguishes itself in its exceptional coverage of the medical management of patients with cancer as well as issues that influence the delivery of care to this special population.
The book provides a solid review of the basic science and epidemiology of pain, with particular attention paid to pain caused by cancer or its treatments. Assessment and management are extensively covered. In fact, assessment alone merits several chapters, attesting to the complexity of even this seemingly straightforward issue. Descriptions of commonly used pain scoring systems are covered at length, illustrating a variety of approaches. In addition, there are discussions of assessment in special populations that may require a more nuanced approach, such as the pediatric population or patients receiving palliative care. An especially welcome chapter is that covering pain syndromes in cancer survivors, an increasingly important topic as our ability to cure cancer or to manage it as a chronic condition improves.
The review of the basic science behind pain and its management, including neurophysiology and pharmacology, will be valuable to anyone dealing with pain management in general, not only for those working within the field of cancer pain. A discussion of the most current research in pharmacogenetics provides insight into this emerging field and its potential impact on future directions in pain management.
The chapters on neural blockade and neurosurgical interventions provide helpful technical explanations for practitioners who do not themselves routinely perform invasive procedures. While drastic measures such as cordotomy and brainstem tractotomy are fortunately not often necessary, a survey of the neurosurgical options available is both fascinating and useful for the less surgically inclined practitioner.
In a departure from other medical pain textbooks, a large portion of the book focuses on topics specific to pain and suffering in the context of cancer. For example, there is a section on the often neglected topics of psychological interventions and rehabilitation medicine. The chapter on rehabilitation medicine is comprehensive and useful for the practitioner who may not be overly familiar with this important field. A fair amount of attention is paid to less traditional interventions such as yoga, Pilates, and acupuncture. It is also refreshing to see the role of the family and caregivers discussed more than once over several chapters, emphasizing the importance of psychosocial issues for proper pain management.
The field of palliative care has developed rapidly in recent years, and the topic of pain management in this context recurs throughout the book. For example, the chapter on radiation therapy notes the importance of factors such as life expectancy and negotiation of realistic goals as crucial in deciding when and how radiation may prove useful. A chapter on palliative chemotherapy tackles the complicated medical, ethical, and psychological issues that go into the decision-making process regarding appropriate use of chemotherapy for pain management. Thorny issues surrounding pain management and decision making in special populations such as the chemically dependent, the elderly, and children are thoughtfully addressed, providing some measure of guidance for navigating care in these settings. Home and hospice care for the dying are likewise covered at length.
The final section looks more broadly at systems of care and how care is delivered; this includes discussions of the history and development of palliative care, and pertinent ethical and legal issues. Importantly, several chapters are quite forward-thinking in providing a framework for approaching program development and continued advancement of the field. For example, the discussion of clinical trials in pain management highlights challenges in carrying out research at the end of life. The detailed description of past and current experience with regulation of opioids in the United States is particularly interesting, providing insight into our current status. It is gratifying to see how far we have progressed from a time when, as cited in Chapter 32, a 1941 issue of the Journal of the American Medical Association stated, “The use of narcotics in the terminal cancer patient is to be condemned.” A description of emerging programs in developing countries is both fascinating and at times disturbing, speaking to the enormous challenges that still lie ahead.
Each chapter, written by leaders in their fields, provides an in-depth discussion from history and basic science and continuing through current practice and future directions. Chapters are well annotated, with plenty of references for further reading. In addition to strong sections on pain assessment and management, this book offers the invaluable addition of chapters dealing with much broader issues that influence the ways in which pain is managed in the setting of cancer. The stated goal of the book in the preface is to “lead to a better understanding of this illness and contribute to continued improvement in care.” Indeed, the book lives up to both of these goals, and will be valuable for anyone interested in not only cancer-related pain, but the growing field of hospice and palliative care.