Hitherto many textbooks, mainly intended for psychiatrists, focused either on psychological or psychopharmacological treatments for chronic pain. This left a gap for a pragmatic resource providing a more global approach to the multi-disciplinary specialists involved in the care of patients in a comprehensive pain clinic, i.e. a bio-psychosocial perspective on chronic pain management. The reader immediately feels that the editors have the essential qualities for this publication: they emanate from a specialized pain and psychiatric background, and are actively involved in the reform of pain and psychiatry fellowship training programs in the USA. They convened an impressive group of specialists (spanning from psychologists and nurses to anesthetists, psychiatrists, neurologists, and physical medicine specialists) who expertly outline the best uses of behavioral, psychotherapeutic and psychopharmacological approaches for chronic pain relief. This comprehensive overview, which fully embraces the complexity of the interactions between pain and psychiatric co-morbidity, is quite novel.
The book is organized in five sections. The short first section presents the bio-psychosocial perspective on chronic pain, explaining the current knowledge on the interactions between pain perception and psychological state or socio-cultural factors, and providing convincing evidence to support the use of psychological approaches in this context. The second section details pain assessment strategies and tools. Overall, the complexities of measuring a subjective perception are clearly discussed, along the necessity to assess eventual psychiatric co-morbidity and potential emotional consequences of pain. Interesting clinical vignettes illustrate the intricacies between pain and psychiatric conditions. The standardized scales, behavioral observations and psychophysiological measurements at hand are made available in a practical format, both for clinicians using them in their practice and researchers selecting outcome measures for clinical trials. The third section discusses the principles underlying the use of behavioral, psychopharmacological and psychotherapeutic therapies, as well as issues regarding the integration of these different components of treatment. Psychotherapeutic approaches and neuromodulatory techniques are presented, along case examples. Regarding the pharmacological approaches, the major classes of psychotropic drugs and non-opiate analgesics are covered briefly including their mechanism of action and the major caveats in their use. An interesting chapter is devoted to the crucial issues in chronic opioid therapy. The fourth section describes specific pain syndromes' pathophysiology, along with guidelines for evidence-based psychological and pharmacological interventions. These chapters focus on spinal and neuropathic pain, fibromyalgia, headache, arthritis, as well as pain in palliative, geriatric and pediatric contexts. Further editing could have helped to keep these syndrome-specific chapters tighter and to group the general discussions in a clearer order in the relevant parts of section 3, as there are some overlaps. However, since the textbook could be equally used as reference manual, and not necessarily read in continuity, this is a minor issue. Finally, the brief fifth section outlines new research possibilities in the field of interdisciplinary pain therapy, as well as policy and ethical issues involved the treatment of pain in the USA.
Throughout the book, a very laudable effort is made by all authors to remind the reader about the multifaceted approach one should aim for, e.g. ‘medical therapy should be but one component of a comprehensive multidimensional treatment plan’ (p. 135). Pragmatic advice is given on how to integrate different therapeutic modalities. The specific chapters on the different pain syndromes provide further assistance by outlining treatment algorithms and underlining specific diagnostic and therapeutic considerations. The book's only shortcoming, in my view, is the absence of a perspective from non-US healthcare structures and specialists. Perhaps the editors will seize a future edition as an opportunity to expand on that topic.
In summary, this textbook fully meets its goal to inform an interdisciplinary team on the delivery of integrative care for patients suffering from chronic pain by incorporating behavioral, psychotherapeutic and pharmacological treatments. It allows specialists with backgrounds in different disciplines to update themselves on important psychological and pharmacological aspects that should complete their therapeutic toolbox. Along the way, the authors provide many tables that can guide practice (e.g. prioritized goal-oriented management plan table, p. 136, or pharmacological treatment table p. 332), as well as thought-provoking paragraphs that can nurture deeper reflections, for example on the qualities required by the practice of pain medicine (p. 129), or on novel research designs (chapter 27). Given this special combination, I believe that most readers, whatever their level of expertise or background, will turn towards this book repeatedly.
