Edited by F. Michael Gloth III, M.D. New York, Humana Press/Springer Science+Business Media, 2011. ISBN-10: 1607616173. ISBN-13: 978-1-60761-617-7. Pages: 220. Price: $109.00.
In light of the recent Institute of Medicine report of 116 million Americans experiencing chronic pain coupled with the growing number of baby boomers living longer, it is a delight to know that there is an easy-to-read, well-written text explaining in fair detail most of the aspects of safely treating this growing population. There are certainly approaches to treating the older patient who has chronic pain that differ from the treatment of younger adults, and Handbook of Pain Relief in Older Adults: An Evidence Based Approach, Second Edition points them out in areas as diverse as pharmacologic management to spiritual considerations.
As part of a series on Aging Medicine from Humana Press, the handbook offers a broad overview of many aspects of pain management and is written in a concise manner for quick reading. A review of the 2009 update by the American Geriatric Society's Guidelines for Pharmacological Management of Persistent Pain in Older Adults is included as a chapter and should be appreciated as a reference for those treating the geriatric population. It should be noted that the Geriatric Society does not refer to their guidelines being for geriatric patients. It refers to the population as “older adults,” as does this text. Older people tend not to like to be called geriatric.
From the clinical perspective, there is detailed coverage of pharmacologic management, including opioid and nonopioid medications, with chapters dedicated to both, highlighting the impact of these drugs on the older adult. The chapter on interventional treatments is broad and covers most techniques used in clinical practice while referencing the level of evidence in support of the procedures. One chronic pain issue common in older adults is lumbar spinal stenosis, and the chapter is up to date enough to make mention of a new technique known as the MILD®procedure that is showing promise in treating this common condition.
The last third of the handbook delves into some areas that are not often thought about by clinicians who treat chronic pain. These areas include nursing home care and local and national politics. When patients enter nursing homes, it is apparent that pain becomes part of the daily lives of many, whereas the resources to treat their pain become limited. The chapter reviews many of the barriers involved and links them to the ongoing political issues that continue to make effective care of our long-term care patients difficult.
There are several chronic pain syndromes that occur more frequently in the older population, including postherpetic neuralgia, vertebral compression fractures, and lumbar spinal stenosis. The text might be improved with a chapter focusing on some of these pain issues in more detail and providing a capstone to the clinical treatment options available in these common problems.
Highlighting some of the political concerns in which the pain medicine field is engaged is also appreciated, as is the call to get involved. Pain is a highly politicized chronic medical problem that is not going away any time soon. There are issues of which we, as the treating practitioners, must be aware and in which we must be involved, and this text provides a nice introduction to some of these areas.
Our population is an aging one, and chronic pain was not supposed to be part of the deal. Unfortunately, it is, and preparing physicians to properly treat pain in “older adults” is a worthy cause. This text does an excellent job of providing a conceptual framework to accomplish this worthy goal.