Cancer Pain: Assessment and Management.

Bruera ED, Portenoy RK, eds. New York, NY 10011-4211, Cambridge University Press, 2003, hardcover, 498 pp, illus, ISBN: 0-521-77332-6, $160.

This outstanding text covers the examination and management of patients with cancer pain. Each chapter is written by experts in the field of cancer therapy and includes up-to-date, evidence-based research. A reference list, with most articles published in the last 10 years, is included at the end of each chapter.

The book is divided into 8 sections with several chapters each. The first section covers the mechanisms and epidemiology of cancer pain. Extensive information on the undertreatment of cancer pain, usually attributed to insufficient examination, is included.

The second section covers the examination of patients with cancer pain and cancer pain syndromes. The editors present research on different tests and measures and the value of these tools. The editors place importance on all aspects of how the pain is affecting the patient. This is the first time in the book that the psychological aspect of pain is presented along with concerns about the use of opioids. The final chapter addresses pain syndromes that can be attributed to treatment (eg, lumbar punctures, surgery, side effects of chemotherapy) and how to thoroughly examine patients to differentiate cancer pain from other types of pain.

Section III is an excellent look at pharmacological treatment. It begins with a chapter on analgesic pharmacology. The next 2 chapters extensively review the use of opioid drugs and how to manage the side effects. The final 2 chapters address the use of nonopioid drugs and adjuvant analgesic drugs.

Section IV reviews the nonpharmacological approaches to cancer pain. Chapters on anesthesiologic procedures, psychological interventions, rehabilitation interventions, and neurosurgical techniques are included. The chapter on rehabilitation interventions is a very comprehensive review of how physical therapy can be an integral part of managing pain and improving function in people with cancer, which is often overlooked. As with the rest of this book, however, none of the chapter authors are physical therapists.

Section V addresses the role of antineoplastic therapies. One such treatment is palliative radiotherapy. Excellent illustrations accompany the chapter on this intervention.

The next 2 sections address pain in special populations as well as difficult pain problems. Chapters on cancer pain in children, pain management in the patient who has a chemical dependency, and cancer pain in the elderly are included. Additional chapters cover depression, neuropathic pain, breakthrough pain, and bone pain.

The final section, "Special Topics," covers ethical issues, understanding clinical trials in pain research, legal and regulatory aspects of opioid treatment in the United States, and, finally, the role of family caregivers in cancer pain management.

I found this comprehensive text on cancer pain to be a very valuable reference for physical therapists who treat people with any type of pain.

Karen Holtgrefe, PT, OCS 

College of Mount St Joseph

Cincinnati, Ohio

Mrs Holtgrefe is an Instructor in the Physical Therapy Program. She has wide range of interests including orthopedics, cardiopulmonary, chronic pain, wounds, lymphedema, and acute care.