Pain in Older Persons, Progress in Pain Research and Management, Volume 35. S. J. Gibson and D. K. Weiner (editors). Published by IASP Press, Seattle, USA. Pp. 432; indexed. Price US$ 81.00 (IASP members US$ 66.00). ISBN 0-931092-59-0
This book is edited jointly by a psychologist and a physician in the care of the elderly, with contributions from practitioners in the full range of specialties involved in the management of pain in older adults, in both the acute and chronic settings. The recurrent message of the book is that aging and pain are not synonymous, although attitudes of patient, carers and, alas, clinicians may incline this way, so that some patients who could be helped by better management may suffer unnecessarily.The book is divided into five unequal parts. Part I is a short chapter outlining the prevalence of pain, most commonly musculoskeletal pain, as a presenting symptom in the elderly. Subsequent parts, of roughly equal length, deal successively with age differences in pain, pain assessment in the older adult, pain treatment modalities and common painful disorders. There is considerable overlap in the content of the chapters in Parts I and II, which bemoan the dearth of studies investigating the age differences in pain perception, processing and psychosocial influences between young and old patients. The repetition of references from chapter to chapter and the publisher's style of repeating authors' names and date of publication each time the work receives a mention, rather than quoting a reference number, spoils the flow of reading in this opening quarter of the book, which sets the background to the clinical sections that follow.
Part III focuses on the assessment of pain. Wherever possible, self-reporting of pain is deemed most reliable, particularly in relation to present pain. The use of numerical, verbal and non-verbal scales is compared in various settings of patient care. In patients with cognitive impairment, the role of pain behaviour measurement scales is discussed. Functional reach and trunk rotation have been shown to be the most discriminatory performance based measures in the assessment of low back pain. Repeated assessment is the key to interpreting disturbances in psychological well-being.
Part IV includes chapters on oral analgesia, the principles of physiotherapy, interventional methods, and complimentary and alternative medicine. In my view, there are two outstanding chapters in this section of the book. The first covers the growing evidence for the value of tailored cognitive behavioural therapy in the management of older adults with pain. Patient commitment has been demonstrated and community based programmes reinforced by telephone and even e-mail components have been tried. Similarly, the discussion of multidisciplinary pain management programmes run predominantly by physicians in the care of the elderly argues strongly against the age related barriers to patient admission to management programmes and in favour of incorporating such programmes into standard care at the primary level.
The final section (Part V) includes four chapters that discuss the specific assessment and treatment of low back pain and its components (osteoarthritis, fibromyalgia, myofascial pain, osteoporosis and sacroiliac joint disease), neuropathic pain, postoperative pain and cancer pain. This section has useful management flowcharts and tables of doses and side-effects of drugs used in the treatment of these pain conditions in elderly patients.
There are few books, which focus on the management of pain in older persons. Despite my initial reservations regarding the repetitive features of the opening chapters, taken as a whole, I would recommend the book as a reference volume on this subject. It is up to date with references as recent as 2005 and gives pointers towards the modernization of services for the care of pain in the elderly community.
Bristol, UK
E-mail: leslie.shutt{at}ubht.nhs.uk
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