Chronic Pain Management for the Hospitalized Patient
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Chronic pain is a common condition. Although reported rates vary widely, it affects at least one in five adults. Patients with chronic pain frequently present to the hospital with complaints that are both pain-related and not pain-related. These patients are often not easily managed, with optimal pain control being difficult to obtain. Many clinicians are not comfortable treating these patients, partially because of their own limited training in pain management. This timely book provides a useful reference to all care providers involved in managing hospitalized patients with chronic pain.
Chronic Pain Management for the Hospitalized Patient is divided into six parts. The first part provides an overview of chronic pain as a disease and the basic premises of its treatment. Each chapter starts with a summary of key points, a pattern that is followed throughout the book. The information provided is clear and concise, establishing a template for the rest of the text. The second section deals with the management of chronic pain in specific hospital settings, such as the emergency department and the labour and delivery unit. Common presenting conditions and potential pitfalls in management are discussed, as are appropriate strategies for specific settings and patient populations. This section is clinically relevant and informative. It is particularly useful for the clinician who has no specialized training for treating pain, but it also can serve as a good review for the regular pain clinician.
The third section of the book describes the role of the various allied health professions in managing the chronic pain patient. Physicians caring for patients with chronic pain will find this section an interesting introduction to the contributions made by allied professionals. Nurses, pharmacists, psychologists, and physiotherapists will find useful suggestions to guide them in providing care to these complex patients.
The fourth portion of the book deals with pain management for specific clinical conditions. One of my favourites is the chapter on chronic pain in patients with substance abuse. Tables summarize the features of common substances that are abused and their treatment in a quick, easy-to-access format. There are also suggestions for perioperative management. The chapter ends with an excellent list of management tips applicable to the drug-abusing patient in any setting.
Especially useful to the anesthesiologist, the fifth section of this book deals with the perioperative management of chronic pain. Chapters on preparation for surgery, general and regional anesthesia, and postoperative pain management provide a comprehensive overview of this topic. Tables and summary boxes provide important information at a glance, which is helpful for the busy clinician.
The final, sixth section of the book deals with the increasingly important topic of patient satisfaction and quality control in pain management. Although the regulatory framework discussed in this section is most pertinent to the United States’ experience, the principles of management are generalizable to other health systems. Useful techniques for measuring satisfaction and dealing with unhappy patients are discussed.
Overall, this book is well laid out. A summary of key points provided at the start of each chapter is helpful as a quick reference to each topic. Tables and summary boxes are used to present information in an easy-to-access fashion. The information presented is sufficiently in depth to provide a good review for the pain specialist while being useful and comprehensible to non-specialist physicians, nurses, and allied health providers. The information is up to date and well referenced.
Although there are occasional typographical and grammatical errors in several chapters, the book is otherwise a quick, easy read. The regulatory and legal frameworks discussed are specific to the United States, making some chapters - particularly those on patient satisfaction and quality control - somewhat more relevant to clinicians who practice there. Despite these minor drawbacks, this book is a worthwhile addition to the library of any clinician who sees patients with chronic pain. It will be especially useful for emergency and perioperative physicians, as well as for hospitalists who manage these patients on a daily basis. Finally, trainees in all disciplines will benefit greatly from reading the entire book. Chronic Pain Management for the Hospitalized Patient is an excellent introduction to chronic pain, an often intimidating, poorly understood topic.
Conflicts of interest
This submission was handled by Dr. Hilary P. Grocott, Editor-in-Chief, Canadian Journal of Anesthesia.