Coping With Chronic Pain

BOOK REYJEWS features of each stage and thera peutic approaches to each.

Psychosocial Basis of Medical Practice

.

The

final

section

is devoted

to the

By Charles L. Bowden and Alvin G. Bur

adaptation of the physician in par

stein, 231 pp. $1 1.95, Baltimore,

ticular.

Wilkins,

Williams

&

1979.

U This very practical and readable

book is written with several points in mind: the recognition

agement

of common

and man

emotional

disorders among nonpsychiatric patients, the understanding of fac tors influencing the physician-pa

tient relationship,

the significant

factors in growth and development

throughout the life cycle, and the formation of a basis for the under standing and management of more specifi'cally psychopathologic con ditions. Early chapters have to do

with basic subjects such as the phy sicià @,the patient, the diagnostic process, sociocultural and eco

nomic factors in illness, interview ing techniques, and patterns of de fense and adaptation.

Each item is

covered concisely but with enough detail to provide a comfortable working foundation. Troublesome patterns that might be encountered in any phase of medicine—anger, affection, rigidity, pain, depression,

hypochondriasis,

Emphasis

is placed

on

effectively.

drug temptation, alcoholism, high suicide rate, role strain, and rejec

distinguished from chronic pain, which tends to be a disease in itself

tion of the sick role as hazards of the profession. They conclude with a series of practical suggestions for prevention and care of physicians' health problems. This brief, effIciently organized volume sets forth a wholesome ap proach to the practice of medicine that, if followed, would yield far more satisfied patients. It should be read by every health care practi tioner and practically devoured by

and can easily become a lifestyle that includes addiction, unneces sary surgery, doctor-shopping, and desperation. In an early chapter, the authors deal with the anatomy, physiology, and biochemistry of pain percep tion. Classical conditioning, it is shown, can produce the experience

those in family practice. Once read, it should then be reviewed regu larly since it has relevance for ev eryday physician-patient en

traction, and cultural background,

counters. Fred 0. Henker III, M.D. University ofA rkansas

Coping With Chronic Pain by Nelson H. Hendler and J@idithA. Fenton,

tion, and helpful

for

state: “¿You can stop

the pain, and so can your doc tor . . . “¿ Later they emphasize that, for some patients, total relief can not be achieved although pain can be minimized and dealt with more

health care, about which physicians are notoriously careless. The au thors focus on denial of symptoms,

and death—are dealt with in sepa rate chapters. In each case the au thors give enlightening information on the dynamics involved, the meaning or function of the condi instructions

unrealistically

Acute pain, which is a warning, is

of pain without a peripheral stimu lus; and factors impacting on pain, such as mental fatigue, fear, dis are also described.

Pain patients are categorized as “¿Copers,―“¿Exaggerators,― “¿Mopers,― and “¿Malingerers,― and treatments appropriate to different personality

types

are discussed.

Pain is rarely used as a conversion symptom, the writers maintain, be cause you can't get attention from an invisible symptom. This seems naive, since the need for attention

is

190pp. $10, New York, Clarkson Potter, Inc. 1979.

common to almost all pain patients and conversion dynamics are fre

U Much of the misery of chronic pain patients arises from lack of

quent in this population. It seems

knowledge, problems with medica

label conversion “¿unconscious ma lingering.―They state that, regard

less than kind for the authors

to

the problem's management. Part two deals with adaptation

tions and physicians, and limita tions in their own power to cope

less of etiology, if the patient really

and changes

with pain and its effects on them and their families. This book is in tended to provide a resource for such patients. The authors describe an ap proach with no “¿magic cures―yet

wants to get better, he has a good chance of succeeding; but if he has found a special use for his pain, the most sophisticated treatment may not alleviate it. The discussion of diagnostic

through

the stages of

the life cycle from infancy through old age. J-I@rethe authors discuss, from the standpoint of psychosocial development, the significant achievements and troublesome 612

PSYCHOSOMATICS

BOOK REVIEWS methods deals mainly with two psychological tests, plus thermog raphy and CT scanners. A self-ad ministered psychological test pur ports to help the person determine his classification as a pain patient. Chapters on treatment contain a good section on detoxification, de

scribe the destructive effectsof ha bituating agents in chronic pain, and consider surgery, transcutane ous electroneural stimulation,

to the

chotic drugs in a chapter that deals

importance of patient motivation versus the need to be sick in affect ing recovery, its numerous caveats about narcotics and tranquilizers, and its elimination of some of the

with schizophrenia, organic brain disorders, and other conditions in

dude its repeated

references

mystery of chronic pain. Its weak nesses lie in suggesting some unre

alistic expectations (most patients described were cured after proving they had “¿real― pain by a “¿pain

detection

test―—thermography)

nerve blocks, hypnosis, acupunc

and in applying some unkind labels

lure, psychotherapy, group ther apy, and family therapy. The au

to individuals whose self-esteem is already low.

thors seem to support the purchase

Edward C. Covington, M.D. Cleveland Clinic Foundation

of biofeedback machines by pa tients. There is a list of home exer cises as well as brief information about body mechanics.

Pain clinics

are described, along with their goals—which may include many things other than pain relief. The point is well made that the patient must be an active participant in his recovery and not a passive recipi ent. In the description of behavior modification, the reader is shown how to employ related techniques.

Drugs that are often used for chronic pain are categorized and explained in a chapter where the authors

assert, “¿The long-term

use

of addictive drugs can lead to al tered personality, depression, and in some cases can produce perma nent residual brain damage.― The family disruption produced by chronic pain is noted, as in the need of some families to have a sick member who makes the others feel useful. Some physician-patient conflicts are attributed to the frus trating impotence of physicians who are faced with chronic pain problems. The strengths of this book in JULY 1980' VOL 21 . NO 7

which the cognitive sphere is pri manly

disturbed.

He deals

with

anxiety, depression, and mania in conjunction with antianxiety, anti depressive, and antimanic (lithium) drugs in the chapter on affective disorders. Drugs that are used for chemical dependencies and aggres

sive, sexual, and activity disorders are handled in the chapter on be havioral disorders. Dr. Lion discusses the various drugs thoroughly in the light of the most recent pharmacologic search and brings up-to-date

re infor

mation to bear on the case exam ples. The text is well buttressed

The Art of Medicating Psychiatric Patients ByJohnR. Lion, 149pp.$13.95,Baltimore, Williams & Wilkins.

by a

complete, recent reference section and an adequate index section. The book's only problem lies in its use as a quick reference guide for medications. Because it focuses on clinical cases, the reader may become lost while trying to com prehend the overall perspective on a given drug. Each chapter requires

aThis compact paperback isa positive contribution to the ever

expanding number of books on clinical psychopharmacology. It has a sound practical approach emphasized by case examples with thorough discussions of nonspecific effects of drugs, the psychology

of

drug prescribing and taking, com pliance, and the physician-patient

relationship. Dr. Lion's clinical acumen comes through when he teases out the pharmacologic implications from a large number of case vignettes. These serve as the basis for his discussion

of a large

number

of

widely used drugs. He discusses clinical syndromes and drug treat

ments under the commonly used divisions of thought,

affective, and

behavioral disorders. He considers phenothiazines and newer antipsy

reading in its entirety for continuity

and complete understanding. This book should be very useful for psychiatrists, psychiatric resi dents, nurses, and family physi cians. It offers guidance

to all who

deal with the difficult interaction of drugs and persons with psychologi cal problems. It also touches on the difficulties of prescribing drugs for

anyone, not just those with psychi

atric disorders. The book is partic ularly helpful in providing answers to questions commonly asked by patients and in casting light on the problem of the significance of med ications

to patients

affects prescription

and how this

patterns

and 617