Textbook of Pain, 2d ed.

Texthook of Pain, ed 2

Wall PD, Melzack R, eds. New York, NY 10036, Churchill Livingstone Inc, 1990, hardback, 1,064 pp, illus, $169.

Wall and Melzack have assembled an internationally renowned group of 111 pain experts, whose expertise spans both basic sciences and application phases of algology. The texthook is appropriately named. The comprehensive and contemporary manner in which each chapter has been written, combined with the remarkable breadth of concept, truly makes this work the yardstick against which all other texts on the subject must be measured.

The book is divided into three sections: basic aspects, clinical aspects of disease in which pain predominates, and therapeutic spects. The basic understanding of pain transmission and modulatory, mechanisms is further divided into individual contributions within peripheral, central, and psychological domains. Collectively, the issues in this section offer a comprehensive treatment of peripheral nerve nociceptive transmission, anatomy, and pathophysiology; endogenous pain control mechanisms; differentiation of somatic and visceral pain; pharmacology of pain transmission; deafferentation and central pain; and topics addressing differences between acute and chronic pain, as well as assessment and measurement procedures.

Clinical aspects of disease in which pain is a major symptom are uniquely divided into five domains: soft tissue joints and bone, deep and visceral pain, nerve and root damage, children, and carcinoma. Each chapter within this section offers a comprehensive clinical, anatomical, and physiological overview. There are some inconsistencies, however, that might he perceived as bothersome to compulsive readers. For example, not all chapters provide discussions on management or treatment (genitourinary pain, abdominal pain, eye pain, muscle pain, heart pain), whereas some are quite detailed burns, myofascial pain, the failed hack), and others are myopic in scope (osteoarthritis, labor, tic douloureux, cancer). Nonetheless, the breadth of topics covered in these 28 chapters more than compensates for the idiosyncracies and inconsistencies in format and design.

Perhaps the most intriguing section for clinical physical therapists addresses therapeutics (section 3). This section is partitioned into 7 components, housing 31 chapters, These components include pharmacology, local blockade, lesions, stimulation, physiotherapy (remember this text was assembled and edited in Britain and Canada), radiotherapy and chemotherapy, and psychotherapy. Of particular interest are the topics in the stimulation section, which include transcutaneous electrical nerve stimulation (TENS) and vibration, folk medicine and sensory modulation, acupuncture, and spinal cord and brain stimulation. The discussions on TENS and central nervous system stimulation are detailed and contain appropriate and thorough referencing. in light of recent controversies surrounding the efficacy of TENS in the treatment of chronic low back pain, physical therapists are encouraged to read Melzack's documented accounts of the data supporting clinical benefits from this intervention.

The chapters written byjessup (biofeedback), Turk and Meichenbaum (cognitivebehavioral management), Sternbach (behavior therapy), and Rowat and Jeans (collaborative mode of care) are within the psychotherapy component of this section. These presentations will be of particular interest to physical therapist clinicians because they emphasize interventions and strategies that therapists either use individually or in cooperation with psychologists when team approaches are taken in the treatment of patients with chronic pain.

By far, the most intriguing and relevant portion of this text addresses physiotherapeutic interventions. Though the chapter written by two physiatrists (Lehmann and deLateur) lacks substantial, contemporary data, their discussion on use of ultrasound, shortwave, microwave, and superficial heat and cold in the treatment of pain is fair and accurate. Scott Haldeman's chapter on manipulation and massage is informative, but cursory. Contained within this chapter is an excellent table summarizing controlled studies on spinal manipulation. The topic of mobilization could have included more detail on manual techniques. Wells and Lessard from McGill University are the only contributors identified as physical therapists. The emphasis of their presentation is on exercise. Rather than detailing the unique qualities of treating pain symptomatology, their approach is pedestrian at best and could easily have been written for any target audience.

This excellent text is a must for any student of pain phenomena, clinician, or researcher. It is state-of-the-art material certainly worthy of any physical therapy clinic library. Unfortunately, the degree of detail is probably beyond the needs of most physical therapist assistants, and the price of the book is probably beyond the pockethooks of most physical therapists. Steven L Wolf, PhD, PT, FAPTA Emory University Atlanta, Ga