Book Review: Handbook of Pain Assessment, Third Edition
Every so often, an important book comes along that’s worth your attention. The Handbook of Pain Assessment is one of those books.1 The primary value of this book is the up-to-date review of a wide range of topics relevant to pain assessment. This volume should appeal to a large number of pain management specialists and primary care physicians (PCPs) who treat pain every day.
The authors point out that pain is a perception that is experienced by a conscious person. The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.”2 In my opinion, the importance of this definition is that pain is neither a sensory nor an emotional experience, but a combination of both.
This definition is primarily based on the work of Ronald Melzack, PhD, and Patrick Wall, PhD.3 Their work broke the dualistic Cartesian stranglehold on the understanding of the nature of pain. Because pain is a combination of emotional and sensory experience, it creates a challenge to the MD-trained pain physician who is well versed with the sensory side of pain but not the emotional component. This is another reason why the Handbook of Pain Assessment is an essential read for the physician who operates on and treats pain patients on a daily basis.
When I was on the anesthesiology faculty at the Oregon Health & Science University, I attempted to impress on our anesthesia residents that to be successful in treating pain patients, you need to treat the patient’s perception of his or her pain. In other words, you need to incorporate both the sensory and emotional components in a comprehensive multi-disciplinary treatment plan.
The Handbook of Pain Assessment is divided into five sections, with an introduction and conclusion by the authors. The first section, “Self-Report Measures of Pain,” addresses the assessment of pain. Included in this section are chapters on self-report scales used with adults and a chapter on methods of assessing other components of pain.
The second section focuses on measures of pain not dependent on self-report; the third section covers the assessment of special populations, including infants, children, and adolescents.
The fourth section addresses assessment of specific pain conditions and syndromes; the fifth section covers special issues and applications. This includes psychiatric disorders and chronic pain and disability evaluations. This section also includes chapters relevant to implantable pain technologies and the growing body of evidence that psychosocial factors play an important role in determining treatment response. Furthermore, there are chapters on epidemiological methods and quality-of-life issues in clinical trials.
Space limits me from commenting on each individual chapter. However, I would like to point out specific chapters that may be of interest for PCPs. These physicians are well aware that the most common reason patients present themselves at their office is due to pain.
Part I contains practical information for the PCP who has limited time and resources. Extensive psychometric assessment in the primary care office is not realistic or warranted. Therefore, a triage algorithm needs to be implemented that is efficient and provides useful information. Chapters 2 and 3 are relevant to this because they cover short, well-established self-report instruments that provide valuable information. In my opinion, based on experience and accepted standards of care, if the patient presents with persistent pain and has not been responsive to initial treatment, then a referral to a pain psychologist is indicated for a comprehensive evaluation.
Part II, has many relevant chapters for PCPs. Chapters 7 and 8 highlight psychophysical and neuroimaging and assessment of pain behavior. Pain patients will reveal valuable information just by observing their body language and listening to descriptive adjectives they use to describe their pain. (Refer to Chapter 3, Part 1 for the McGill Pain Questionnaire.)
Part III, is only relevant to PCPs who treat special populations, such as children, adolescents, or elderly patients.
Part IV, considers specific pain conditions and contains an excellent chapter on the clinical assessment of low back pain by Paul Watson. Low back pain is the most common pain presentation PCPs encounter. Dr. Watson is from the United Kingdom, but this should not distract US-trained physicians because it is an excellent chapter that is worth their attention.
In conclusion, the Handbook of Pain Assessment is an important resource for any physician who evaluates and treats chronic pain patients. I highly recommend this handbook to my pain psychology colleagues.