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Opioid analgesics in the management of clinical pain. Advances in pain research and therapy, vol. 8
283
Compliance. The Dilemma of the Chronically Ill, edited Nehemkis, Springer, New York, 1986, 239 pp.
by K.E. Gerber
and A.M.
The book presents a careful analysis of the multifactorial aspects of compliance in chronically ill patients. It is clearly written, so that it is easily understood. Compliance is treated by different authors in well integrated chapters and covers most of the important aspects of the topic. A good bibliography follows each chapter. Chronic pain is, however, not treated enough: we cannot for example agree with the statement that in cancer ‘the significance of pain must pale in the face of more profound psychological and existential issues’ (p. 163). We completely agree, however, that ‘the development of greater sensitivity of physicians, particularly those in training, to the underlying issues affecting compliance should represent a major effort of future research and medical education’ (p. 234). In conclusion, the book seems useful for every health professional. P. Procacci Cattedra di Terapia Medica Sistematica, Universitd degli Studi di Firenze, Florence (Italyl
Natural Pain Control, 948400-5, $3.50.
by V. Coleman,
Century
Arrow
Books,
1986, ISBN
0-09-
This book has been written for people with pain and not for the medical and paramedical professions. It is excellent and easy to read. Much searching of the literature and knowledge of the subject has gone into the making of the book, and everything quoted and recommended is correct. The author’s advice is helpful and he quotes the experiments on which it is based. The book is too optimistic but presumably a book for those suffering from constant or frequent pain needs to be. However, the chapter on Pain Clinics is totally inadequate. It is likely that most pain clinics of the National Health Service in the U.K. lend patients apparatuses for TENS and many treat patients with acupuncture: the author does not know this. His chapter on alternative medicine will not satisfy those who practice such forms of treatment honestly. But these are minor carpings; this is a book to be recommended to patients and anyone else with pain. P.W. Nathan The National Hospital for Nervous Diseases, London (U.K.)
Opioid Analgesics in the Management of Clinical Pain. Advances in Pain Research and Therapy, Vol. 8, edited by K.M. Foley and C. Inturrisi, Raven Press, New York, 1986, 490 pp., U.S. $108.50.
284
The last two decades have seen a revolution in the drug treatment of cancer pain. The old routine of inadequate intermittent injections of ‘standard doses of opioid analgesics has given way to the concept of in~~du~ised dose regimens of regular oral morphine or other strong opioids. Novel modes of administration are being explored and the use of adjuvant drugs and physical treatments has been refined. The clinical use of opioid analgesics has developed on largely empirical grounds and the science is only just beginning to catch up. This book is a reflection of the degree of interest and research effort which is now being applied to this area. The book describes the proceedings of a workshop on opioid analgesics held at Memorial Sloan Kettering Cancer Center in July 1983. The aim of the workshop and thus of the book is to ‘identify and to clarify current controversies surrounding the clinical use of opioids.’ The first objective is achieved in masterly fashion in the opening chapter by Dr. Foley. She succinctly describes current areas of contention: choice of opioid, mode of ad~~stration, route of ad~~stration with particular attention to spinal opioids, relative potencies, and the questions of tolerance, dependence and addiction. The second objective - of clarification - is not so successfully achieved by what follows, but this is merely a reflection of our state of knowledge at present. Many of the papers are brief summaries of work published in more detail elsewhere, and researchers in this field will be familiar with much of it. For others the book provides a convenient overview of recent work with opioid analgesics in a single volume. The pharmacokinetics of morphine are discussed by several authors, and recent work on the pharmacokinetics and analgesic efficacy of diamorphine, meperidine (pethidine), ketobemidone, methadone, levorphanol and buprenorphine is also described. The discussion sessions form an important part of the book. They are well edited and pertinent. Frequently they present a critical view of the papers, and help put into perspective some of the more controversial interpretations of data. The prolonged gestation of the book (some 3 years from meeting to publication) has meant that events have overtaken some of the conclusions. We now know that the apparently predominant role of the kidney in morphine metabolism in some studies is a spurious reflection of a cross-reacting metabolite (probably morphine-6glucuronide) confounding estimations of unconjugated morphine. The clearly presented controversy surrounding the merits of diamorphine and the well-argued conclusion that this drug does not possess unique therapeutic properties, follows hot on the heels of the recent legalisation of diamorphine for therapeutic use in Canada and the continuing debate about the drug in North America. This is a useful book for those teaching about pain control, both in cancer patients and in other situations where opioid analgesics are used, and will be a convenient source of material for those researching in this area. It will also find a place in the libraries of pain clinics, hospices and other units involved in the care of patients with advanced cancer. G.W. Hanks Royal Marsden Hospital London S W3 655 (U.K.)
Compliance. The Dilemma of the Chronically Ill, edited Nehemkis, Springer, New York, 1986, 239 pp.
by K.E. Gerber
and A.M.
The book presents a careful analysis of the multifactorial aspects of compliance in chronically ill patients. It is clearly written, so that it is easily understood. Compliance is treated by different authors in well integrated chapters and covers most of the important aspects of the topic. A good bibliography follows each chapter. Chronic pain is, however, not treated enough: we cannot for example agree with the statement that in cancer ‘the significance of pain must pale in the face of more profound psychological and existential issues’ (p. 163). We completely agree, however, that ‘the development of greater sensitivity of physicians, particularly those in training, to the underlying issues affecting compliance should represent a major effort of future research and medical education’ (p. 234). In conclusion, the book seems useful for every health professional. P. Procacci Cattedra di Terapia Medica Sistematica, Universitd degli Studi di Firenze, Florence (Italyl
Natural Pain Control, 948400-5, $3.50.
by V. Coleman,
Century
Arrow
Books,
1986, ISBN
0-09-
This book has been written for people with pain and not for the medical and paramedical professions. It is excellent and easy to read. Much searching of the literature and knowledge of the subject has gone into the making of the book, and everything quoted and recommended is correct. The author’s advice is helpful and he quotes the experiments on which it is based. The book is too optimistic but presumably a book for those suffering from constant or frequent pain needs to be. However, the chapter on Pain Clinics is totally inadequate. It is likely that most pain clinics of the National Health Service in the U.K. lend patients apparatuses for TENS and many treat patients with acupuncture: the author does not know this. His chapter on alternative medicine will not satisfy those who practice such forms of treatment honestly. But these are minor carpings; this is a book to be recommended to patients and anyone else with pain. P.W. Nathan The National Hospital for Nervous Diseases, London (U.K.)
Opioid Analgesics in the Management of Clinical Pain. Advances in Pain Research and Therapy, Vol. 8, edited by K.M. Foley and C. Inturrisi, Raven Press, New York, 1986, 490 pp., U.S. $108.50.
284
The last two decades have seen a revolution in the drug treatment of cancer pain. The old routine of inadequate intermittent injections of ‘standard doses of opioid analgesics has given way to the concept of in~~du~ised dose regimens of regular oral morphine or other strong opioids. Novel modes of administration are being explored and the use of adjuvant drugs and physical treatments has been refined. The clinical use of opioid analgesics has developed on largely empirical grounds and the science is only just beginning to catch up. This book is a reflection of the degree of interest and research effort which is now being applied to this area. The book describes the proceedings of a workshop on opioid analgesics held at Memorial Sloan Kettering Cancer Center in July 1983. The aim of the workshop and thus of the book is to ‘identify and to clarify current controversies surrounding the clinical use of opioids.’ The first objective is achieved in masterly fashion in the opening chapter by Dr. Foley. She succinctly describes current areas of contention: choice of opioid, mode of ad~~stration, route of ad~~stration with particular attention to spinal opioids, relative potencies, and the questions of tolerance, dependence and addiction. The second objective - of clarification - is not so successfully achieved by what follows, but this is merely a reflection of our state of knowledge at present. Many of the papers are brief summaries of work published in more detail elsewhere, and researchers in this field will be familiar with much of it. For others the book provides a convenient overview of recent work with opioid analgesics in a single volume. The pharmacokinetics of morphine are discussed by several authors, and recent work on the pharmacokinetics and analgesic efficacy of diamorphine, meperidine (pethidine), ketobemidone, methadone, levorphanol and buprenorphine is also described. The discussion sessions form an important part of the book. They are well edited and pertinent. Frequently they present a critical view of the papers, and help put into perspective some of the more controversial interpretations of data. The prolonged gestation of the book (some 3 years from meeting to publication) has meant that events have overtaken some of the conclusions. We now know that the apparently predominant role of the kidney in morphine metabolism in some studies is a spurious reflection of a cross-reacting metabolite (probably morphine-6glucuronide) confounding estimations of unconjugated morphine. The clearly presented controversy surrounding the merits of diamorphine and the well-argued conclusion that this drug does not possess unique therapeutic properties, follows hot on the heels of the recent legalisation of diamorphine for therapeutic use in Canada and the continuing debate about the drug in North America. This is a useful book for those teaching about pain control, both in cancer patients and in other situations where opioid analgesics are used, and will be a convenient source of material for those researching in this area. It will also find a place in the libraries of pain clinics, hospices and other units involved in the care of patients with advanced cancer. G.W. Hanks Royal Marsden Hospital London S W3 655 (U.K.)