Chronic Pain: Biomedical and Spiritual Approaches.

Koenig HG. Binghamton NY 139041580, The Haworth Pastoral Press, 2003, paperback, 318 pp, ISBN: 0-7890-1638-9 (hardcover), 0-7890-1639-7 (paperback), $49.95 (hardcover), $24.95 (paperback).

As stated in the introduction, the purpose of this book is to "provide information to help relieve pain, emotionally cope with pain, behaviorally adapt to pain, and spiritually grow from pain." The book is written both for professionals (health care mad religious) and for the general public who may be directly or indirectly affected by chronic pain. In general, the book is largely successful in achieving its purpose. Although it has a wide scope, the book tends to be somewhat superficial in its depth, perhaps making it better suited for the general public. For example, in presenting the medical and complementary approaches to pain therapy, the treatments were briefly described but not critically evaluated. In essence, the author is saying that some people have found that a given treatment is effective in diminishing their chronic pain, and it might be effective for the readers of this book. In presenting the spiritual approaches to pain, the text primarily targets Christian fundamentalists and practices such as "laying-on-of-hands" and "spiritual visualization." Toward the end of the book, however, the author does state that "persons from other religious backgrounds should consider adapting these practices to their own faiths." (p260)

Regarding content quality, various considerations make this book both novel and interesting. First, this hook was written by a highly published psychiatrist who specializes in treating older adults with chronic pain. Second, the author himself has had chronic pain resulting from a rare rheumatoid condition for quite some time. As a result, he has firsthand knowledge of chronic pain as well as potential therapies. Third, the book briefly reviews a wide assortment of treatments for chronic pain, including: (1) prescription and nonprescription pharmaceuticals, (2) alternative and complementary treatments (eg, herbs, acupuncture and magnets), (3) psychosocial treatments (eg, visualization and hypnosis), (4) surgical procedures, and (5) spiritual approaches.

Although each of these approaches is potentially valuable for reducing chronic pain, the author's personal experience is that the spiritual approaches offered the most benefit. These spiritual approaches largely involve focusing the person's attention outside himself or herself Consequently, prayer and meditation that had an external focus were beneficial in helping the patient manage his or her pain. Similarly, in the author's opinion, helping other people and focusing on the needs of others was also effective in pain management.

My additional comments on content quality of the book have to do with the references, or lack of them. Although the references are largely recent, most of them are from secondary sources (ie, reviews). In a book that's largely directed to the general public, I think that it is acceptable to use these secondary references. The text, however, should indicate that these are review articles. Furthermore, some of the references are from literature that is not peer-reviewed, such as newspapers and Web sites. On a separate note, references are often missing in places where they should not have been omitted. For example, on page 209, three statements begin as follows: "Controlled studies show," "One study found," and "Studies have also shown." No references are given for any of these statements, however.

In general, the book is well organized and written in a manner that allows the general public to easily understand the content. To accomplish this, however, the author has inserted many parenthetical terms and comments. Occasionally these terms and comments are either questionable or technically wrong. For example, on page 16 the author states "reflex sympathetic dystrophy (resulting from immobilization of a body part to avoid pain)," and on page 22 he states "muscle ischemia (lack oxygen in the tissues)."

Although there are no figures, the book does contain 5 interviews of people with chronic pain. Each person has a different type of chronic pain (eg, back pain, headache). These interviews are guided by questions from the book's author, Each person is asked a similar set of questions that are designed to review the person's medical history, psychosocial influences on the person's personality, and both the medical and spiritual influences that the person found effective in dealing with the pain.

The book also contains 2 appendixes. Appendix I is a sequential listing of Bible verses that deal with suffering, pain, and healing. The author suggests that the people with chronic pain pick out the verses that are most meaningful to them and repeatedly chant them, either silently or out loud, while meditating on the words of each verse.

Appendix II is a listing of pain medications and their possible side effects.

Although it has a few minor flaws, I think that this book would be an excellent resource for most physical therapists, especially those managing patients with chronic pain. It offers a quick reference to a wide variety of potentially effective treatments for chronic pain. This might also be a nice book to recommend as reading for patients with chronic pain, especially if they are religious. Even if patients are not religious, this book contains a lot of good and potentially beneficial information.

SG Patrick Hardy, PT, PhD

University of Mississippi Medical Center 

Jackson, Miss

Dr Hardy is Professor in the Department of Physical Therapy, where he teaches neuroanatomy and gross anatomy. He conducts basic neuroscience research pertaining to cortical and subcortical influences on blood pressure, and clinical research on spinal motor neuron excitability and muscle strength.