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People in pain. Guidelines for pastoral care
274
tic for this audience. Biofeedback and behavioural therapy are too cursorily treated and the value of dorsal column stimulator overrated. Why a chart of the root supply of all the muscles in the body, yet no acupuncture chart? Table I showing long-term results of TENS treatment inaccurately reports at least one author’s work. The account of initial testing of TENS on patients is vague and our unit at least is surprised to learn that patients are advised to try the stimulator for 15-30 min at a time. Surely the best results are obtained by prolonged use for many hours at a time. The opportunity has been missed to present the evidence for the effectiveness of TENS and acupuncture as against placebo. It is not made sufficiently clear that TENS must be given over areas with normal sensory input. It is extraordinary how often patients are told to stimulate over anaesthetic areas (in plexus lesions for example) or over painful areas (when it is unacceptable). There is an unacceptably high rate of misprints, misspellings and colloquial expressions. On page 10 Fig. 2 is referred to instead of Fig. 3. The use of TENS in Raynaud’s and other circulatory disorders is not mentioned, nor advice given as to whether its use is acceptable in pregnancy or not. The final section presents a number of case histories and these are of much value and interest. I hope the authors will enhance the undoubted value of this book by taking account of these comments in future editions. Even as it stands, it is an excellent introduction to the art. C.B. Wynn Parry Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middx. HA 7 4LP (U.K.) People in Pain. Guidelines for Pastoral Care, by W.E. Westminster Press, London, 1985, 156 pp., & 8.95.
Oates
and
C.E.
Oates,
Here is an interesting joint effort of father and son authors, father a theological college professor, son neurologist. Their aim is to help Christian clergy or lay workers participate in the management of chronic pain states and in this they will to some extent be successful. Confusion arises, though, because ‘chronic pain’ is never defined and there is no clear exposition of the (admittedly debatable) factors underlying it. In particular, a British cleric may be startled to extrapolate from the figures given in the text and find that it is apparently almost as normal for his parishioners to be suffering from chronic pain as not; on reading further, he may also be surprised to find himself being taught to oversee his flock’s calorie requirements as part of a ‘positive reworking of food,’ as well as how to enforce their behaviour modification programmes. Meanwhile, he will have ploughed through a lengthy treatise on ‘neurophysiology’ which will certainly have improved his neuro-anatomy but probably not his understanding of chronic pain. After this he will have read a list of ‘chronic pain syndromes,’ which by no means all give rise to chronicity of pain in every case, and
a potted coverage of treatments from aspirin to acupuncture whose relevance is more to acute pain than to chronic pain as this is understood in the rest of the book. The chapters on the spiritual concerns of the pain patient contain some valuable insights from a specifically Christian vie~oint, their outlook according with the hospice concept of Total Pain as containing not only physical but also social, mental and spiritual sources of distress. However, cancer pain is particularly badly described in this book, being lumped together with other ‘chronic pain syndromes’ despite the fact that 95% of such patients can be pain-controlled. It should be stated that behaviour~ programmes like those the reader is urged to cooperate with play little or no part in cancer symptom control. On the other hand, it is sad to see treatment for malignant pain apparently limited to the discredited Brompton cocktail while damaging myths about the use of morphine mixtures are perpetuated. Once it is clearly understood that the pastoral initiatives in People in Pain aim at individuals suffering from pain caused largely by operant or psychological mechanisms, whose therapy is mainly directed towards beha~our modification, it becomes a useful book, Unfortunately, the ‘medical’ chapters cloud the issue and in Britain the underlying concepts and the treatment strategies will be unfamiliar to many of its intended audience.
Trauma of the Central servos System, edited by R.G. Dacey, H.R. Winn, R.W. Rime1 and LA. Jane, Raven Press, New York, 1985, 359 pp., U.S. $76.50. This volume is one of the volumes in the series ‘Seminars in Neurolo~cal Surgery,’ There can be no doubt about the importance of trauma since it is regarded as the third most important cause of death in the U.S.A. and for younger people (under the age of 38 years) it is probably the most import~t cause of death. Unfortunately, the undoubted importance of this subject is not really reflected in the present volume. The present volume is based on a symposium and it suffers From the usual problems of multi-author and multi-edito~al books. Because of the complexities of modem-day medicine it is unreasonable to expect any worthwhile or definitive work to be written by a single person. Where this is successful, it is nearly always the work of an outstanding figure up-dating a pre-existing text book. There are obvious exceptions but these exceptions are rare. In the present volume, multi-authors~p has been carried to the extreme and reviewing it is like trying to review an issue of a medical journal. The volume has 4 editors and there are 78 authors in a book of 341 pages including the index. The number of authors per chapter ranges up to 6 and to take an extreme example, there is a chapter of 6 authors for 6 pages of which about 2.5 of those pages are taken up with graphs and a fairly irrefevant photo-micrograph - giving about 300 words per ‘author.’ The result is a book which has good and bad parts and is virtually impossible to read, though it may be useful as a source for references. Some of the chapters read like
tic for this audience. Biofeedback and behavioural therapy are too cursorily treated and the value of dorsal column stimulator overrated. Why a chart of the root supply of all the muscles in the body, yet no acupuncture chart? Table I showing long-term results of TENS treatment inaccurately reports at least one author’s work. The account of initial testing of TENS on patients is vague and our unit at least is surprised to learn that patients are advised to try the stimulator for 15-30 min at a time. Surely the best results are obtained by prolonged use for many hours at a time. The opportunity has been missed to present the evidence for the effectiveness of TENS and acupuncture as against placebo. It is not made sufficiently clear that TENS must be given over areas with normal sensory input. It is extraordinary how often patients are told to stimulate over anaesthetic areas (in plexus lesions for example) or over painful areas (when it is unacceptable). There is an unacceptably high rate of misprints, misspellings and colloquial expressions. On page 10 Fig. 2 is referred to instead of Fig. 3. The use of TENS in Raynaud’s and other circulatory disorders is not mentioned, nor advice given as to whether its use is acceptable in pregnancy or not. The final section presents a number of case histories and these are of much value and interest. I hope the authors will enhance the undoubted value of this book by taking account of these comments in future editions. Even as it stands, it is an excellent introduction to the art. C.B. Wynn Parry Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middx. HA 7 4LP (U.K.) People in Pain. Guidelines for Pastoral Care, by W.E. Westminster Press, London, 1985, 156 pp., & 8.95.
Oates
and
C.E.
Oates,
Here is an interesting joint effort of father and son authors, father a theological college professor, son neurologist. Their aim is to help Christian clergy or lay workers participate in the management of chronic pain states and in this they will to some extent be successful. Confusion arises, though, because ‘chronic pain’ is never defined and there is no clear exposition of the (admittedly debatable) factors underlying it. In particular, a British cleric may be startled to extrapolate from the figures given in the text and find that it is apparently almost as normal for his parishioners to be suffering from chronic pain as not; on reading further, he may also be surprised to find himself being taught to oversee his flock’s calorie requirements as part of a ‘positive reworking of food,’ as well as how to enforce their behaviour modification programmes. Meanwhile, he will have ploughed through a lengthy treatise on ‘neurophysiology’ which will certainly have improved his neuro-anatomy but probably not his understanding of chronic pain. After this he will have read a list of ‘chronic pain syndromes,’ which by no means all give rise to chronicity of pain in every case, and
a potted coverage of treatments from aspirin to acupuncture whose relevance is more to acute pain than to chronic pain as this is understood in the rest of the book. The chapters on the spiritual concerns of the pain patient contain some valuable insights from a specifically Christian vie~oint, their outlook according with the hospice concept of Total Pain as containing not only physical but also social, mental and spiritual sources of distress. However, cancer pain is particularly badly described in this book, being lumped together with other ‘chronic pain syndromes’ despite the fact that 95% of such patients can be pain-controlled. It should be stated that behaviour~ programmes like those the reader is urged to cooperate with play little or no part in cancer symptom control. On the other hand, it is sad to see treatment for malignant pain apparently limited to the discredited Brompton cocktail while damaging myths about the use of morphine mixtures are perpetuated. Once it is clearly understood that the pastoral initiatives in People in Pain aim at individuals suffering from pain caused largely by operant or psychological mechanisms, whose therapy is mainly directed towards beha~our modification, it becomes a useful book, Unfortunately, the ‘medical’ chapters cloud the issue and in Britain the underlying concepts and the treatment strategies will be unfamiliar to many of its intended audience.
Trauma of the Central servos System, edited by R.G. Dacey, H.R. Winn, R.W. Rime1 and LA. Jane, Raven Press, New York, 1985, 359 pp., U.S. $76.50. This volume is one of the volumes in the series ‘Seminars in Neurolo~cal Surgery,’ There can be no doubt about the importance of trauma since it is regarded as the third most important cause of death in the U.S.A. and for younger people (under the age of 38 years) it is probably the most import~t cause of death. Unfortunately, the undoubted importance of this subject is not really reflected in the present volume. The present volume is based on a symposium and it suffers From the usual problems of multi-author and multi-edito~al books. Because of the complexities of modem-day medicine it is unreasonable to expect any worthwhile or definitive work to be written by a single person. Where this is successful, it is nearly always the work of an outstanding figure up-dating a pre-existing text book. There are obvious exceptions but these exceptions are rare. In the present volume, multi-authors~p has been carried to the extreme and reviewing it is like trying to review an issue of a medical journal. The volume has 4 editors and there are 78 authors in a book of 341 pages including the index. The number of authors per chapter ranges up to 6 and to take an extreme example, there is a chapter of 6 authors for 6 pages of which about 2.5 of those pages are taken up with graphs and a fairly irrefevant photo-micrograph - giving about 300 words per ‘author.’ The result is a book which has good and bad parts and is virtually impossible to read, though it may be useful as a source for references. Some of the chapters read like