Book Review: Pain Measurement and Assessment (original) (raw)

The Canadian Journal of Psychiatry, 1986

Abstract

Among many excellent chapters, there are a few which are superb an~ wo~th particular mention. Syrjala and Chapman, m their chapter on "measurement of clinical pain" present a careful review of various approaches in pain measurement, and a critical appraisal of each of these with helpful suggestions for prospective researchers. Butler has provided a very comprehensive review with an excellent bibliography dealing with use of tricyclic antidepressants in c~ronic pain therapy. Following an introductory chapter by RIchard Sternbach, Turner and Romano have written a very helpful review of psychological interventions for chronic pain. This, in fact, is a follow-up of the very comprehensive review by Turner in 1982. The strategy for their review is to examine outcome studies and to use a "meta analysis" to compare outcomes and elements to which we might attribute success. Methods compared include relaxation therapy, biofeedback therapy, operant conditioning, hypnosis, and cognitive behavioral therapies. This is followed by a discussion of methods and logical issues that ought to be useful for anyone either considering reviewing literature on this and similar topics, or engaging in research. This chapter complements nicely, the earlier chapter on the measurement of clinical pain. There. are also other chapters which are worth reading. Procacci and Maresca have written a very scholarly history of the pain concept in Western civilization. Terman et al consid.er pain inhibition by various mechanisms, especially stress induced analgesia. Yaksh, et ai, review neurochemistry related to pain, which ought to be of interst to psychopharmacologists and those with an interest in neurophysiology. Harkins, et al have produced a chapter on "pain and the elderly" with a good bibliography. Turner and Roman? review ~he prevalence of coexisting pain and depression. There IS a chapter dealing with multidisciplinary approach to pain management and several other chapters dealing with acute pain, cancer and post-operative pains with due consideration given to psychological factors and approaches that might be combined with medical and surgical methods. Perhaps the only point of criticism I found in this book was in the chapter by Brena and Chapman dealing with "chro.nic pain states and compensable disability an algorithmic approach". Among other things, in this chapter they try to propose an "inconsistency profile" for discerning malingering. Their intentions are good, but such an approach is apt to be shallow. Very often, the reasons for i~consistent behavior are not apparent, and the patient himself may be unaware of the psychological forces which determine his symptoms that may, on the face of it seem inconsistent. It is precisely here that psychiatric and psychodynamic expertise is needed to help patients with chronic pain and coexisting psychosocial dysfunction and disability. It is the need for this recognition that has led many of our psychiatric colleagues to' take a real interest in pain management and research, and for them, this book will ove.rall, provide a very helpful and up-to-date review of vanous aspects of the pain field, including several aspects relevant to psychiatric practice.

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