Psychosocial Factors in Pain: Critical Perspectives.

Psychosocial Factors in Pain: Critical Perspectives Gatchel RJ, Turk DC, eds. New York, NY 10012, The Guilford Press, 1999, hardcover, 510 pp, $60.

As stated in the preface, this book is intended to help clinicians, clinical researchers, and students understand the role that psychosocial factors play in both the etiology and treatment of pain. The book is divided into 3 parts. Part I, containing chapters 1 to 9, deals primarily with the etiology of pain and the role of psychological, sociocultural, and religious influences. Part II, containing chapters 10 to 20, describes a variety of pain syndromes and emphasizes the role of psychosocial factors in both the etiology and treatment of these pain syndromes. Part III, chapters 21 to 30, addresses issues related to the prevention and management of pain.

When the book deals with both chronic and acute pain, its focus is decidedly on chronic pain. This emphasis seems appropriate in view of the psychosocial aspects of various chronic pain syndromes. All of the chapters, except one, seem directed at the given purpose of the book. Chapter 9, however, describes the role of the psychologist as an expert witness in court cases involving personal injury. I consider this topic to lie beyond the intended purpose of the book.

The content quality of this book is generally very good. However, I found the book to be tediously repetitious, both within and among the various chapters. For example, the psychosocial factors in the perception of pain and the biopsychosocial model of pain are topics that are continually described throughout the book. Although bordering on wordiness, each of the chapters in the book tends to be well written. The overall organization of the book, however, is less than desirable. The content of the chapters does not flow from one chapter to the next, and most of the chapters tend to be freestanding. This fragmented organization possibly resulted in the repetition that is present throughout the book.

In addition, this book (apparently written entirely by psychologists) tends to be chauvinistic and somewhat mean-spirited toward clinicians or groups choosing to approach the treatment of pain without an emphasis on a psychological approach. One of the professions the authors denigrate is physical therapy. On page 222, the book states that "professional physical therapy is not usually necessary" in the treatment of temporomandibular joint disorders, "and most patients can provide the needed physical therapy themselves at home." On page 440, the book also states that "not all physical therapists can work well in an interdisciplinary treatment team," because they are taught to work in isolation and do not adequately accept input from other health care professionals.

In my opinion, the 3 best features of this book are: (1) part II, which reviews various specific chronic pain syndromes, (2) the detailed descriptions of the enormous number of surveys currently used to evaluate depression, anxiety, and attitude, and (3) the scholarly use of numerous references.

The limited scope of this book and its fragmented organization would make this a poor choice as a textbook for most courses on pain. However, it would make an excellent reference book lot psychosocial issues related to the etiology and management of pain. Used as a reference, this book would have obvious value to any physical therapist who treats individuals with pain; however, the book would probably be most beneficial to those who treat people with chronic pain.

SG Patrick Hardy, PhD, PT University of Mississippi Medical Center Jackson, Miss

Dr Hardy is a professor in the physical therapy program, where he teaches neuroanatomy and gross anatomy. He also conducts basic neuroscience research pertaining to cortical and subcortical influences on blood pressure and pain.