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Book Review
Pain Causes and Management
Jan Hawthorn & Kathy Redmond
1998 Blackwell Science
Annette Walker
School of Health and Nursing, University of Western Sydney, Parramatta Campus, NSW
This text provides general nurses with a comprehensive but succinct coverage of the physiology of pain, specific pain types, common clinical conditions where pain is a persisting feature, nursing assessment and appraisal techniques and a guide to common approaches to pain management.
There are eight chapters, a list of contents, an index and a useful glossary of common pain terms, in a compact 250 pages. Numerous tables break up the text and difficult concepts are made accessible to the non-specialist reader by these and by the uncluttered and unpretentious prose style. There is an excellent reference list.
Chapter 1 introduces important issues in pain and its management, with an emphasis on the nurse's contribution. Chapter 2 covers neurophysiology very well. Many recent advances in our understanding of neural plasticity, the phenomenon of 'windup' and hyperalgesia incorporated and made very clear to the reader through useful diagrams. Chapter 3 covers specific pain types and common painful conditions. Appropriately, since assessment and treatment are distinctive for each, acute, chronic and cancer pain types are distinguished. Chapter 4, The Pain Experience, explains the subjective and unique nature of pain, and factors influencing pain perception, including its meaning, cultural and religious beliefs, gender and present pain tolerance. Since professional nurses ought to have a sound knowledge base and since nursing interventions ought to reflect careful, person-centred assessment and a sensitivity to legal, ethical, cultural and contextual issues, this is a welcome chapter. Chapter 5, Barrier to Effective Pain Management, encapsulates recent research findings on systemic, staff and patient/family factors contributing to ineffective pain management, including fears of addiction. Happily, strong analgesic medications are correctly referred to as "opiates" or "opioid" rather than as "narcotics", a term which has "street-drugs" connotation. Pharmacological and surgical approaches to the management of pain are adequately covered in Chapter 7, and Complementary and Non-invasive techniques in Chapter 8.
The index appears in some respects to complement the Contents page. I found additional information on pain and the elderly and on ethical issues more accessible through browsing via the Contents page. In the table on neuropathic pain (p.51) Reflex Sympathetic Dystrophy, now referred to as "Complex Regional Pain Syndrome", is incorrectly described as a joint problem. Scant information about the author is included. These small shortcomings do not detract from the overall usefulness of the text.
Research has demonstrated for many years that too often, pain is undertreated. This text will assist nurses in most clinical settings to better understand the complexities of pain and its management and would be useful as a pain course text. It deserves a place in every hospital library and at A$61.00 is value for money.
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