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Senior Medical Science Liaison, Neuroscience, Bristol Myers Squibb, US Pharmaceuticals Medical Affairs, Gaithersburg, MD
Published Online, July 25, 2006. www.theannals.com, DOI 10.1345/aph.1BH057
Audience: From the content, style, and level of writing, this book appears to be intended for all healthcare providers, including physicians, pharmacists, physical therapists, nurses, and psychologists, who care for older adults.
Purpose: This book's goal is to update and summarize the key areas relating to pain in older people and to highlight major accomplishments that have occurred since the first International Association for the Study of Pain publication on this topic. Pain is one of the most prevalent medical problems in older people, and all too often it is under-detected, not treated appropriately, or dismissed due to the (incorrect) belief that pain and aging are synonymous.
Content: The text is written by a well-rounded multidisciplinary group of healthcare professionals and researchers from various medical specialties, pharmacy, clinical pharmacology, nursing, psychiatry, psychology and behavioral sciences, neurosciences, and physical therapy. The book is divided into 5 sections containing 19 chapters, with a logical progression from one section to the next. The first section deals with the epidemiology of musculoskeletal, non-musculoskeletal, and chronic widespread pain. Section 2 contains chapters on the neurobiology of aging, nociception and pain, age-associated differences in pain perception and pain processing, age differences in clinical pain states, and age differences in psychological factors related to pain perception and reporting. Section 3 covers pain assessment in the older adult in a comprehensive manner by including chapters dealing with pain assessment of the older adult with normal verbal communication skills, assessment of pain in those with severe limitations of communication, functional assessment of older adults with pain, and measurement of mood and psychosocial function associated with pain. Likewise, Section 4 comprehensively covers treatment of pain and includes chapters on oral analgesics, physical therapy, cognitive behavioral therapy, interventional procedures, complementary and alternative medicine, and the multidisciplinary approach to pain management in older adults. Lastly, Section 5 deals with common painful disorders in older adults, including chapters on low-back pain, postherpetic neuralgia and peripheral neuropathy, postoperative pain management, cancer pain, and end-of-life issues.
Usability: Generally speaking, the book is very well written and easy to read. It contains much practical clinical information. The references are well balanced and contain classic as well as current papers. The price appears reasonable.
Highlights: One of the major strengths of this book is its comprehensive coverage of all aspects of pain in older adults, making it a useful tool for those involved in geriatric patient care and/or teaching. Chapter 4 (age differences in clinical pain states) is particularly useful in its presentation of clinical data that describe the generally atypical presentation of pain in older people versus that in younger people and the implications thereof. Chapters 6 and 7 provide clinically useful suggestions regarding the appropriate choice of pain scales that may be used in older adults with and without communication skill problems. Another strength can be found in the practical and specific pharmacotherapeutic recommendations provided in Chapter 10. Likewise, the discussion of complementary and alternative medicinal approaches to pain covered in Chapter 14 is useful in light of the popularity of these approaches. Lastly, I was particularly interested in Chapter 15, which describes multidisciplinary pain management clinics for older adults, how they should be structured, and the need for specialized care. The chapter concludes with a detailed description of such a clinic established 20 years ago by one of the editors in Melbourne, Australia, and with a discussion of the evidence of efficacy.
Limitations: There do not appear to be major limitations to this book. At times (eg, Section 2), reading becomes more work, as one must go through repeated discussions of animal and human data and where they are in agreement. However, considering the dearth of human data in some areas, this seems well justified.
Reviewer's Summary: Overall, this is a well organized, well written, and comprehensive book that meets the stated goals of the authors. It will be useful to all healthcare providers involved in caring for older adults and would also make a welcome addition to any academic library. Additionally, it would be a good reference for academicians who teach advanced courses in pain management and/or geriatric pharmacotherapy.
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