Dr. Marcus’ text is a comprehensive, well-referenced collection dealing with approaches to chronic pain, intended to provide Primary Care Practitioners with a resource to refer to when they are looking for guidance about treating commonly encountered chronic pain conditions. A relatively small amount of time is spent dealing with philosophies of assessing and treating pain in general, while much more attention is given to specific chronic pain types, such as low back pain, neuropathic pain, etc.
The author chooses to begin each chapter with “Key Points” of the chapter, laying the groundwork for the material covered, and presumably giving the reader the opportunity to choose the potential value prior to reading the entire chapter. Following the key points is a case that is appropriate to the topic covered, illustrating to the reader a case that resonates with the way that clinicians think about these topics. Additionally, each chapter concludes with a “Test Your Knowledge” section, including 5-6 questions based on the topic. This approach is very effective.
Some chapters deal with chronic pain concepts, while others deal with chronic pain conditions themselves, or chronic pain in special populations. Each chapter that covers a specific clinical condition does so in an organized fashion, starting with an introduction of the condition, its epidemiology, steps to evaluate patients, and then treatment. In a few rare instances, there is an unexplainable separation of topics that seem linked to each other, such as pathogenesis of pain and gate theory, for example, which are covered in a chapter and an appendix, respectively, and might typically have been dealt with within a single chapter on pathophysiology. It is also unclear to this reviewer, why malingering would be covered in a chapter on the pathophysiology of chronic pain. Additionally, although the topic of opioid risk management is covered quite capably, there is a noticeable absence of recommendations of any specific tools, or the process of using them for assessing opioid risk, which might have been valuable to include when covering the subject.
Although it would be impossible to cover all aspects of these topics, Dr. Marcus does a good job of presenting a meaningful synopsis of them. It seems as though this book might serve clinicians best as a “go-to” reference as opposed to something to be read cover-to-cover. To that point, a CD version of the entire text is included with the hard copy.
Although it is not clear how often a clinician in practice would reach for this book as a handy reference on assessment and management, the information is there and presented in a quite clinically logical and meaningful way. This book could also have significant utility in teaching institutions, as an educational reference for training purposes, and is perfectly suited for that purpose.
Dawn A. Marcus completed a neurology residency at the University of Pittsburgh Medical Center, and is a Diplomate of the American Board of Neurology and Psychiatry. Since 1990, she has been a faculty member at the University of Pittsburgh Medical Center, and is currently an Associate Professor in the Department of Anesthesiology. She has treated patients with a variety of chronic pain complaints at the Pain Evaluation and Treatment Institute at the University of Pittsburgh. She is also the Director of Research at the Multidisciplinary Headache Clinic.