Advances in pain research and therapy, vol. 11. the drug treatment of cancer pain in a drug orientated society

Book Review Advances in Pain Research and Therapy, Vol. 11. The Drug Treatment of Cancer Pain in ~1 Drug Orientated Society, edited by C.S. Hill, Jr. and W.S. Fields, Raven Press, New York. 1989, 380 pp., Price U.S. $107.50. Most readers of Pain know that approximately 80% of pain due to cancer can be relieved by straightforward pharmacological means, and the mainstay of this treatment is opiates. Indeed in many other medical contexts we rely on opiates to relieve patient’s pain. Despite this obvious need. and the clear clinical benefit obtained from opiate use, governments seek to restrict the medical availability of opiates. It is often unclear. and equally unclear amongst the medical profession, on which grounds governments think that such a restriction is a good thing. Is it to protect the individual or to protect society? There is a great deal of data to suggest that medical availability plays a minimal role in ‘street’ drug problems. This book is the proceedings of a conference held in Houston in 1988 to discuss this issue. The papers include articles by clinicians who treat pain, pharmacologists, philosophers and even government representatives. The title of the book is almost misleading, in that it suggests that we are too ready to treat pain with drugs because of the drug focus of our society. This is the complete opposite of what happens, and this is reinforced by many of the papers. Put simply, patients do not get what they need because of prescriber ignorance and because of government restrictions. While such government restrictions may vary from country to country. prescriber ignorance seems to be common across cultures. Dr. Jaffe in his paper reports 3 personal brushes with this ignorance, each episode separated by a

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0 1990 Elsevier Science Publishers

decade or so. In each case totally inadequate doses of opiate were prescribed for the legitimate treatment of pain and perhaps most harrowing there seemed to be no improvement in the practice with time. The book is eclectic, reflecting the wide disciplinary base of its eminent authors. Some of the pharmacological material I have seen before but it is usefully gathered in this volume. While the bias is unashamedly American, I think the issue is worldwide and much of their data in the book is applicable to us all. Although some progress has been made in educating other doctors about opiate prescribing, particularly in cancer pain management. it is shamefully slow progress. We should not forget that it is patients who suffer as a result of this failure. We are all aware that miserly prescribing abounds in postoperative pain management. While the prescriber in that context is protected by the fact that both the pain and the patient go away, it would be interesting if the consumers demanded a better service from us. One particularly worrying aspect is the trend to prescribe opiate use in pains which are not due to cancer, made usually on the grounds of protecting the patient from the harmful effects of opiates. When there is no other effective treatment. and when opiates are effective. whose interests are really being protected by such an embargo? The utility of this book for me is firstly that it tackles these confused and confusing issues and secondly that it acts as a source on which I can draw to defend the patient’s right to effective pain relief.

B.V. (Biomedical

H. McQuay Oxford Regional Pain Relief Unit, A bingdon Hospital, A bingdon, Oxon. OX1 4 IA G (U. K. I

Division)