Pain Treatment Educational Resource Reviews

Note: The magazines, books, and other resources reviewed in this section have been determined to be of interest for healthcare providers concerned with effective pain management practices. The resources may be obtained from the sources cited. Pain Treatment Topics has no financial interest in these offerings and does not receive any compensation from their publishers or providers. See also, Disclaimer below.

= entry added or changed during latest update.

Magazines/Newsletters

Practical Pain Management (Magazine)

From PPM Communications, Inc. See review…>

The Pain Practitioner (Magazine)

Magazine of the American Academy of Pain Management. See review...>

Books/Monographs

Avoiding Opioid Abuse While Managing Pain: A Guide for Practitioners

Lynn R. Webster, MD, FACPM, FASAM, and Beth Dove. See review...>

Concise Encyclopedia of Pain Psychology

Roger B. Fillingim, PhD. See review...>

12 Steps For Those Afflicted With Chronic Pain:
A Guide to Recovery from Emotional and Spiritual Suffering

Stephen Colameco, MD, MEd. See review...>

Clinical Management of the Elderly Patient in Pain

Gary McCleane, MD, Howard Smith, MD, editors. See review...>

Handbook of Opioid Bowel Syndrome

Chun-Su Yuan, MD, PhD, editor. See review...>

A Clinical Guide to Opioid Analgesia

Perry G. Fine, MD, Russell K. Portenoy, MD.  See review...>

Multimedia (Audio, Video, Slides)

Take Control With Exercise (DVD – Arthritis)

Arthritis Foundation (Peggy Brill, PT). See review…>

Live Seminars (Ongoing Series)

None listed as yet.

Other

None listed as yet.

Pain Treatment Magazines/Newsletters

Practical Pain Management (Magazine)

Publisher:  PPM Communications, Inc.; Glen Mills, PA
Publication Frequency:  8 Times/Year
Length/Cost:  Approx. 70-85 pp. (varies); Subscriptions free to medical practitioners ($70/yr for non-qualified subscribers).
To Order:  Online ordering available at: http://www.ppmjournal.com/Subscribe.HTM. Access checked 12/30/2007.

Pain-Topics.org Reviewer:  Stewart B. Leavitt, MA, PhD. September 2006; updated December 2007.

As the name of this advertiser-supported periodical suggests, Practical Pain Management (PPM) offers a wide spectrum of useful, clinically-oriented guidance on pain conditions and their treatment for busy healthcare practitioners. Under the skilled editorial direction of practicing pain specialists – each edition features easily-assimilated articles on medical management, interventional treatments, physical rehabilitation, behavioral therapies, and more.

The approach throughout is clinically-oriented, and tutorial, rather than academic. Authors tend to include practicing physicians or specialists who draw from their everyday experience as much as from evidence-based literature on each subject.

Practical Pain Management often features articles on unique and vital clinical topics overlooked by other publications. Such as a discussion on the negative effects of vitamin D deficiencies in patients with pain (July/August 2006). Or, a first of its kind study on opioid serum levels in patients receiving high dose opioid analgesia for chronic pain (March 2006). At the same time, complementary and alternative medicine (CAM) therapies are taken into account; such as a discussion by Lynn Webster, MD, on interventional therapies and the continuum of care (July/August 2006).

Many editions also contain CME-accredited pull-out monographs on clinical subjects of special interest. For example, one in the July/August 2006 edition addressed the relationship of psychopathology (eg, mood or anxiety disorders) and substance abuse in patients with pain. Another brief CME course proposed a commonsense five-step approach for opioid prescribing and dispensing (April 2006).

The PPM website, http://www.ppmjournal.com/, provides convenient indexes for issues going back to September/October 2000, when the publication was founded, along with comprehensive synopses of each article. The magazine is available free of charge to medical practitioners (which might include a wide range of professionals in the field) and even at $70/year for a paid subscription this publication is well worth the investment. Copies of back issues can be ordered for a reasonable $10 each via a printout/mail-in form available at the website.

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The Pain Practioner (Magazine)

Publisher:  American Academy of Pain Management.
Publication Frequency: Quarterly Magazine 
Length/Cost:  Approx. 90 pp. (varies): Annual subscription $35.00 USD (non-Academy members).
To Order: Back issues and subscription order form available at the Academy Web site at http://www.aapainmanage.org/literature/PainPrac.php. Access checked 6/1/2006.

Pain-Topics.org Reviewers:  Scottie Kersta-Wilson, MFA; Stewart B. Leavitt, MA, PhD.; June 2006.

The Pain Practitioner, published quarterly, is the official magazine of the American Academy of Pain Management. It is provided free with Academy membership, while others may subscribe for a nominal fee. Older issues may be downloaded in full from the Academy website in PDF format, and the website also provides a searchable article database by topic and/or author.

Each issue of The Pain Practitioner contains useful information on a current pain topic of importance from an interdisciplinary perspective, and the publication is sufficiently non-technical to be of interest to anyone in a healthcare setting. There is always a focus or theme, which is addressed from various perspective throughout the magazine; for example, Fall 2005 highlighted “Back Pain” (pictured) and Spring 2006 highlighted “Complex Regional Pain Syndrome (CRPS).” There are typically feature articles, interviews with practitioners and patients, essays or commentaries, personal stories, advocacy information, resource listings, and excerpts from recent journal abstracts relating to the issue’s focus.

Some feature articles discuss alternative pain management techniques, with contributions by behavioral therapists, physical therapists, massage therapists, acupuncturists, and even artists/musicians. For example, artwork in the Spring 2006 special issue on CRPS was contributed by a patient who used his artistic endeavors as adjunct therapy in concert with traditional treatments.

Healthcare providers are realizing that treating the whole person is increasingly important in managing chronic pain, and The Pain Practitioner offers important knowledge and insights to achieve that goal. It helps fulfill the Academy’s mission to “improve the availability, breadth, and quality of interdisciplinary healthcare for those in pain.”

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Pain Treatment Books/Monographs

Avoiding Opioid Abuse While Managing Pain: A Guide for Practitioners

Authors: Lynn R. Webster, MD, FACPM, FASAM, and Beth Dove.
Publication Date: June 2007.
Publisher: Sunrise River Press.
Length/Cost: 202 pages, soft cover (6” x 9”); $24.95 USD (ISBN 978-0-9624814-8-2, Item #SRP148).
To Order: Call 1-800-895-4585 or purchase online, see: http://www.lifetreepain.com/opioidbook.htm (Access checked 11/6/2007). Also available online from: http://www.amazon.com.

Pain-Topics.org Reviewer: Stewart B. Leavitt, MA, PhD, June 2007.

Of all prescribed drugs, opioid analgesics incur the greatest misuse and abuse. Although these agents can be dangerous in the hands of the “wrong” persons, opioids are also beneficial or even lifesaving for millions of people who otherwise would live with chronic pain, and they are often the first-choice therapy for acute and postoperative pain.

Yet, healthcare providers are often caught between their professional obligation to relieve suffering and their desire to avoid contributing to the misuse or diversion of controlled substances. Therefore, Avoiding Opioid Abuse While Managing Pain is a much-needed guide for all practitioners concerned with pain management and opioid pharmacotherapy, written by leading pain expert Lynn R. Webster, MD, FACPM, FASAM, and Beth Dove of Lifetree Pain Clinic. In a mere 202 pages, the text clearly sorts out the clinical, regulatory, and ethical issues associated with opioid analgesics.

Much already has been written on the subject of this book and the information presented here is based on the works of numerous experts in the fields of pain management and addiction medicine – all duly referenced. On one’s own, it could take weeks to access and read the many documents consulted for this book or, much better, one can invest several hours studying the 8 chapters in which Webster and Dove have already done the hard work of assembling the best resources available and interpreting them in a concise and, most important, useful fashion. Even a quick reading of Avoiding Opioid Abuse While Managing Pain will certainly provide helpful understandings and actionable ideas for any healthcare practitioner; however, there are too many ideas to absorb at once, so this also is a book that should serve as an ongoing reference.

This book presents a balanced perspective in advocating effective pain control via opioid analgesics, when appropriate, yet cautioning the reader about the many associated risks and pitfalls. The authors include step-by-step protocols for assessing patients’ risks of opioid abuse as well as for legally protecting the opioid prescriber. An emphasis is on acknowledging and addressing drug-related behaviors that sometimes compromise effective pain treatment with opioids. Therefore, little space has been devoted to clinical pain management itself; for this, the authors refer readers to two other guides [available for free access here, click on link]: A Clinical Guide to Opioid Analgesia and The PainEDU.org Manual: A Clinical Companion.

Webster and Dove point out that primary care physicians, nurse practitioners, and other first-contact clinicians are uniquely positioned to make a difference at the beginning of medical treatment. Research indicates that a patient with chronic pain or a substance-use disorder is far more likely to seek treatment from a general practitioner than from a specialist. This creates an opportunity for front-line healthcare providers to maximize the chances for success when patients begin opioid therapy. However, they note, “The challenge is to curtail the abuse and diversion of prescription opioids while ensuring their availability for patients who benefit from their use.”

Law-enforcement and other regulatory agencies often seem to take an intense interest in whether patients are misusing, diverting, or becoming addicted to prescribed opioids. Yet, Webster and Dove assert, “The need to watch for aberrant behavior does not mean that a clinician is legally obligated to always be right about a patient’s motivations and can never be fooled. Physicians and other healthcare professionals assess their patients for opioid compliance to ensue the efficacy of pain treatment and to diagnose and treat any possible complicating disorders. They are not responsible for any patient’s choice to behave irresponsibly or criminally.” This book provides the tools for detecting opioid risks and documenting their presence, and then for developing treatment plans and compliance monitoring strategies that can benefit patients while protecting prescribers in the event of legal/regulatory scrutiny.

About the authors: Lynn Webster lectures widely on the subject of preventing opioid abuse and criminal diversion in chronic pain patients. He is board certified in anesthesiology and pain management and also is certified in addiction medicine. In his private practice, he treats chronic pain patients, many of whom have complex diagnoses, as well as opioid-addicted patients. Beth Dove, a medical researcher/writer and former journalist, works full time with Webster. A portion of the profits from this book will be donated to Lifesource (http://www.lsource.org), a nonprofit organization founded by Webster and William L. Townsend that is devoted to curbing prescription drug abuse in America.

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Concise Encyclopedia of Pain Psychology

Author(s):  Roger B. Fillingim, PhD.
Publication Date:  September 2005
Publisher:  The Haworth Medical Press (now Taylor & Francis)
Length/Cost:  203 pages; Hard Cover ISBN-10: 0-7890-1893-4; Soft Cover ISBN-10: 0-7890-1894-2.
To Order:  Available from booksellers and online from Amazon.com at:

http://www.amazon.com/Concise-Encyclopedia-Psychology-Roger-Fillingim/dp/0789018934. Access checked 4/16/2008.

Pain-Topics.org Reviewers:  Scottie Kersta-Wilson, MFA; Stewart B. Leavitt, MA, PhD.; June 2006.

Biopsychosocial concepts of chronic pain have become increasingly recognized by healthcare providers; consequently, a pain “language” has evolved incorporating elements of biology, psychology, and sociology. The Concise Encyclopedia of Pain Psychology is an excellent guide to that language.

Author Roger B. Fillingim, PhD provides an alphabetical listing of 127 common terms and phrases in an easy-to-read format. A major strength of his approach is its evidence base: definitions for each term or phrase are extensively supported by citations from medical literature, and nearly half the book is devoted to an extensive bibliography listing reference sources for each entry.

The word “psychology” in the title might be somewhat misleading, since this book also contains many essentials for understanding the overall science of pain medicine. However, Fillingim defines pain psychology as “the application of psychological principles and methods to enhance the understanding of pain.” He places the Concise Encyclopedia of Pain Psychology in context by suggesting three guiding principles that he credits as the basis for pain psychology:

• mind-body dualism must be abandoned;
• pain is a mentally constructed (subjective) experience;cand
• stronger integration of psychological approaches and principles into pain research and treatment will foster much more rapid progress in conceptual, clinical, and scientific endeavors.

Therefore, this text is an excellent resource for the novice in pain psychology as well as the seasoned practitioner. Physicians, nurses, other clinical professionals, and/or students will also appreciate this book as a reference tool. It can be read cover-to-cover or one can productively skip from item-to-item of interest; either way, this is a unique book that can help bridge communication gaps between the fields of psychology and medicine. It allows each to work in concert to provide better pain management.

Fillingim is an associate professor at the University of Florida, College of Dentistry, and a staff psychologist with the North Florida/South Georgia VA Health System. He is a member of the American Pain Society, the American Psychosomatic Society, the International Association for the Study of Pain, and the Society of Behavioral Medicine. Most recently, Fillingim has focused his research on individual patient differences in pain and analgesia; specifically, the biopsychosocial factors underlying sex-related and ethnic influences on pain.

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12 Steps For Those Afflicted With Chronic Pain: A Guide to Recovery from Emotional and Spiritual Suffering

Author(s):  Stephen Colameco, MD, MEd.
Publication Date:  June 2005
Publisher:  BookSurge, LLC
Length/Cost:  152 pages; Soft Cover $12.99 USD (ISBN: 1-4196-0621-2).
To Order:  Available directly from the publisher by calling 1-866-308-6235. or online from BookSurge at
http://www.booksurge.com/Twelve-Steps-For-Those-Afflicted-With/A/1419606212.htm. Access checked 5/24/2006. Also available online from http://www.amazon.com  ($10.65 USD).

Pain-Topics.org Reviewers:  Scottie Kersta-Wilson, MFA; Stewart B. Leavitt, MA, PhD.; May 2006.

As the old aphorism suggests, “Pain is often inevitable, suffering can be optional.” While modern medicine can do much to allay the physical experience of pain, if properly applied, there are other dimensions of pain, particularly chronic pain, that are more difficult for practitioners to address.

As the title/subtitle of this book propose, 12 Steps For Those Afflicted With Chronic Pain by Stephen Colameco, MD, MEd, provides “A guide to recovery from emotional and spiritual suffering.” To accomplish this, Colameco builds on the successes of 12-Step programs — a spiritual (not religious) movement founded in 1935 to help persons addicted to alcohol. It has helped millions of individuals worldwide, and the model has been extended to other substances of abuse, overeaters, gamblers, out-of-control spenders, and those obsessed with sex.

Colameco’s book uniquely applies the tried-and-proven 12-Step principles to coping with chronic pain. Moreover, it has much to offer pain patients who have become dependent on their medications and are facing the double dilemma of pain and possible addiction.

Where traditional medications, surgery, injections, and the like have failed, Colameco proposes that chronic pain may be helped with psychological and theological modalities. He states, “Our beliefs profoundly affect how we experience pain. We now need to identify the beliefs that contribute to our suffering, and decide whether we can change them.”

In adapting the traditional 12 Steps of Alcoholics Anonymous to persons with chronic pain, Colameco’s 152-page book is appropriately divided into 12 chapters, each similar in structure:

• a personal story;
• discussion of the step as it relates to chronic pain;
• inspirational readings;
• a prayer specific to the step; and
• written exercises to help put the step into action.

Through stories, patients come to learn that they are not alone in their situation. There is great comfort in knowing that others have felt the same way and are finding respite. And, while one cannot inevitably vanquish one’s own pain, prayer holds a promise of divine relief coming from belief in a Higher Power.

Although many healthcare providers may feel uncomfortable delving into the realms of spirituality and prayer, this is not the case for most of their patients. In a 2006 poll sponsored by USA Today, ABC News, and Stanford University Medical Center, more than half of respondents said they used prayer to control pain. Of those, 90% stated prayer worked well or very well for them. Another survey in 2006 – the Parade/Research America Health Poll – found that 74% of respondents relied on prayer as an alternative practice for addressing their health problems.

A graduate of Temple University School of Medicine, Colameco’s clinical practice has concentrated on pain management and addiction medicine. He recognizes that many patients with substance abuse and addiction also suffer from chronic pain; conversely, many patients with chronic pain suffer adverse consequences of treatment with opioid medication. Along with that, Colameco specializes in chronic pain patients who have failed traditional treatments and who suffer from emotional distress. This book was developed as a workbook of sorts for his patients, to help them tame the emotional suffering of chronic pain, one day at time.

12 Steps For Those Afflicted With Chronic Pain is unique and very modestly priced; so, any healthcare provider dealing with pain patients should have a copy on hand. It can then be provided to or recommended as an alternative for select patients who are grappling with chronic pain and/or related medication dependence, and who also might be receptive to a spiritual approach for dealing with the fear, worry, blame, isolation, and resentment that so often accompany chronic pain conditions.

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Clinical Management of the Elderly Patient in Pain

Author(s): Gary McCleane, MD, Howard Smith, MD, editors.
Publication Date: Expected May 2006.
Publisher: Haworth Press (now Taylor & Francis).
Length/Cost: 360 pages; Hard Cover ISBN-13: 978-0-7890-2619-4; Soft Cover ISBN-13: 978-0-7890-2620-0.
To Order: Available for purchase at bookstores or online from Amazon.com at:

http://www.amazon.com/Clinical-Management-Elderly-Patient-Pain/dp/0789026198. Access checked 4/18/2008.

Pain-Topics.org Reviewer: Stewart B. Leavitt, MA, PhD; February 2006.

As this book - Clinical Management of the Elderly Patient in Pain - strongly emphasizes, pain is a multifaceted and multiply determined phenomenon, yet it is individually experienced. Everyone "knows pain"; although, everyone knows pain differently.

Given that broad outlook, the unique perspective of this 360-page text edited by physicians Gary McCleane and Howard Smith focuses on the most rapidly growing segment of the population - persons aged 65 and older. Of critical concern, healthcare professionals are increasingly expected to understand and to provide diagnostic services and pain treatments that take into account the special needs these senior citizens, both physically and psychologically.

Joined by some of the world's leading authorities on pain management, the editors describe the particular challenges that arise in providing pain relief to elderly patients. They examine conventional treatments with opioid and non-steroidal anti-inflammatory drugs, as well as a broad range of alternatives to consider when first-line medications fail. Some approaches are still in development, while others might be considered unconventional. Non-drug options for pain relief from the fields of physical medicine and psychology also are explored, The text is extensively referenced throughout, at all times providing an evidence-based perspective that lends credibility to the recommendations.

Clinical Management of the Elderly Patient in Pain is divided into 19 chapters, addressing such essential topics as:

• pain as an aspect of advancing age;
• diagnostic difficulties in patients who may be sedated or cognitively impaired;
• how pharmacodynamics and pharmacokinetics may differ in elderly patients;
• available therapeutic options, including opioids, non-steroidal anti-inflammatory drugs, anti-epileptic drugs, tricyclic antidepressants, membrane stabilizers, topical agents, and others;
• physical therapy approaches;
• psychosocial factors and related therapy options for ameliorating pain in the elderly.

The last chapter - "Treatment of Common Conditions," authored by editor McCleane - should be of particular interest to busy clinicians. It summarizes options for initiating treatment for a variety of pain-producing disorders, taking into account the need for effective analgesia that is well-tolerated in the elderly. Topical, oral, and parenteral therapies are presented for 16 common conditions of concern in this population, including: osteoarthritis, fracture pain, diabetic neuropathy, peripheral vascular disease, sciatica, and others. The author is mindful that the patient must be considered as a whole person, and therapies that may be complicated by adverse reactions may pose greater problems than untreated pain.

A 17-page Appendix describes important potential interactions of agents used for analgesia with other medications. This always is of concern, since polypharmacy is so common in these patients and an awareness of drug-drug interactions should influence the choice of alternatives.

There is much to learn from Clinical Management of the Elderly Patient in Pain for treating pain across the age spectrum, but it obviously would be of most significance for any healthcare provider concerned with the particular needs of aging patients. Therefore, physicians, physician's assistants, nurses, pharmacists, physical therapists, social services staff, and others would find elements in this book of interest and usefulness in their daily practices; helping them to provide greater comfort in this growing patient population.

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Handbook of Opioid Bowel Syndrome

Author(s): Chun-Su Yuan, MD, PhD, editor.
Publication Date: November 2005.
Publisher: Haworth Press (now Taylor & Francis).
Length/Cost: 256 pages; Hard Cover ISBN-13: 978-0-7890-2128-1; Soft Cover ISBN-13: 978-0-7890-2129-8.
To Order: Available at bookstores or online at Amazon.com at:

http://www.amazon.com/Handbook-Opioid-Bowel-Syndrome-Chun-Su/dp/0789021293.  Access checked 4/16/2008.

Pain-Topics.org Reviewer: J. Peter Kusel, PhD; December 2005.

The Handbook of Opioid Bowel Syndrome, edited by Chun-Su Yuan, MD, PhD, is a multi-authored work by clinicians experienced in dealing with opioid-induced bowel dysfunction, and serves as a useful reference for healthcare professionals managing opioid therapy in day-to-day practice.

Epidemiological studies in the general US population of healthy adults have found the overall prevalence of constipation to be nearly 15%, whereas surveys of patients on long-term opioid regimens found prevalence rates as high as 97%. Using lower doses of opioids will not prevent constipation because the opioid dose required to produce constipation is much lower than that required for analgesia, according to these authors.

Therefore, since constipation frequently attends the use of opioids, some suggest that prophylactic measures should precede their administration, while others argue that not all patients develop constipation and prefer to take a wait-and-see attitude. Which approach to follow is a matter of clinical judgement that may vary with each patient's unique circumstances, and the many factors to consider are discussed in this book.

The Handbook of Opioid Bowel Syndrome is divided into 11 relatively short, but well-focused chapters. Two introductory chapters review the pharmacologic effects of opioids on gastrointestinal physiology that lead to bowel dysfunction and constipation. A brief 3rd chapter summarizes current knowledge of opioid-induced immunosuppression. The 4th chapter presents information on the epidemiology of opioid bowel dysfunction. The following 4 chapters describe opioid-induced bowel dysfunction in palliative care, in the management of acute and chronic nonmalignant pain, and in managing the post-operative pain of abdominal and gynecologic surgeries. The final 3 chapters review current experimental work on the use of opioid antagonists to manage bowel dysfunction induced by opioid drugs.

Three classes of opioid receptors are found on cell surfaces in many tissues throughout the body. These include the mu, kappa, and delta receptors, which are known to respond to endogenous opioid peptide agonists secreted within the body (endorphins, dynorphins, and enkephalins, respectively). Tissues within the central nervous system (CNS) and within the gastrointestinal (GI) tract contain all 3 receptor classes.

The effects of opioids on GI tissues are mediated mainly by the mu-opioid receptors. Available opioids do not discriminate between mu-1 and mu-2 receptor subtypes. A systemically administered opioid produces analgesia by activating mu-1 CNS receptors, and may simultaneously disrupt normal bowel function by activating mu-2 GI receptors. Morphine and other opioid agonists inhibit the propulsive peristaltic movement of contents through the gut, leading to abnormally long residence times, and a greater than normal absorption of water from the gut contents. The simultaneous inhibition of mucous secretions within the lumen further impedes movement of feces through the intestines, leading to constipation and even fecal impaction.

The authors note that a chief stimulus to colonic peristalsis is physical activity, so patients should be encouraged and enabled to be as mobile as physical limitations and circumstances permit. Adequate water intake should be encouraged to hydrate stools. Anticholinergic drugs and drugs with some anticholinergic effects (psychotropics, antidepressants, and some antiemetics) may also have constipating effects of their own, but avoiding their use may be impractical.

Laxative therapy may involve stool softeners and/or stimulants. Softening the stool involves increasing its bulk, which produces localized mild distension of the bowel wall that in turn stimulates reflexive enteric muscle contraction. However, the use of gross bulking agents, such as methylcellulose or psyllium (ispaghula), should be avoided, as these can lead to painful localized non-propulsive muscle spasms (colic). The authors recommend instead the use of softening agents such as liquid paraffin, polyethylene glycol, sodium docusate, lactulose, or magnesium hydroxide or sulfate (Epsom salts). Drugs that directly stimulate peristalsis include the anthracenes senna and danthron, and the polyphenolics bisacodyl and sodium picosulfate.

In sum, this book represents a unique and convenient collection of clinically relevant information regarding opioid effects in disrupting normal bowel function, as well as helpful suggestions for preventing or ameliorating these adverse effects. It would be useful reading for physicians, pharmacists, or clinics that frequently prescribe, dispense, or administer opioid medications to their patients.

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A Clinical Guide to Opioid Analgesia

Author(s):  Perry G. Fine, MD, Russell K. Portenoy, MD
Publication Date:  2004
Publisher:  The McGraw-Hill Companies, Inc.
Length/Cost:  135 pages, free PDF download by chapter or entire book
To Access Free Copy:  http://www.stoppain.org/pcd/content/forpros/opioidbook.asp.  Access checked 6/1/06.

Pain-Topics.org Reviewers:  Scottie Kersta-Wilson, MFA; Stewart B. Leavitt, MA, PhD, June 2006.

The stated purpose of A Clinical Guide to Opioid Analgesia is “to improve knowledge and skills related to both the principles of prescribing and the management of risk.” In this seminal and comprehensive guide (published in 2004 and now available for Internet download at no cost), Perry G. Fine, MD, and Russell K. Portenoy, MD, discuss opioids from their first mention in a Sumerian ideogram, depicting the opium poppy as “the plant of joy,” through the tensions created by today’s needs to support therapeutic uses of opioids, address potential abuse and addiction, and minimize societal harm. Fine and Portenoy describe this need to weigh expanded access to opioid analgesics with a proactive effort to limit their misuse as the “principle of balance.”

The authors present 13 chapters, a resources listing, and an index. Each chapter focuses on a distinct topic, for example: Management of Poorly Responsive Pain, and Opioid Analgesia in the Very Young and the Very Old. Additionally, each chapter includes descriptive and useful tables, and ends with an overall conclusion and list of suggested readings on the topic. While the chapters can be read as discrete units, professionals will benefit from reading the book as a whole.

This is an excellent reference book for all healthcare providers; interesting to read, easy to understand, and robust in its content. The authors address standards of care for detailed assessments of patients and the management of moderate to severe chronic pain. They recognize and discuss the controversial issues surrounding the management of nonmalignant pain, and extensively deal with potential adverse opioid effects, including differences between physical dependence, tolerance, and addiction.

StopPain.org (http://www.stoppain.org/), the website for book retrieval, is a service of the Department of Pain Medicine and Palliative Care at Beth Israel Medical Center. It provides information for caregivers, patients, and healthcare professionals. The site for professionals is at: http://www.stoppain.org/for_professionals/default.asp (access checked 6/1/06).

Fine is a Professor of Anesthesiology at the Pain Management Center, University of Utah School of Medicine. Portenoy is Chairman of the Department of Pain Medicine and Palliative Care at Beth Israel Medical Center, and a Professor of Neurology at Albert Einstein College of Medicine.

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Pain Treatment Multimedia (Audio, Video, Slides)

Take Control With Exercise (DVD - Arthritis)

Presenter: Peggy Brill, PT
Publication Date: 2006
Publisher: Arthritis Foundation
Length/Cost: 60 minutes; DVD $19.95 USD (Item #835.9035)
To Order: Available directly from the Arthritis Foundation by calling 1-800-283-7800 or order online at: http://afstore.arthritis.org/AFConsumerStore/SearchProductAction.do?_$action=Search&text=Take%20Control  Access checked 10/31/07.
Pain-Topics.org Reviewer: Winnie Dawson, RN, BSN, MA; September 2006.

Research studies of patients with arthritis show that regular exercise can improve their quality of life in terms of reduced joint pain and improved mobility. The Arthritis Foundation also promotes regular exercise for muscular and cardiovascular health. However, many patients may be hesitant to begin an exercise program due to their fear of increased pain or a personal history of long-term inactivity.

This new DVD from the Arthritis Foundation, Take Control With Exercise, has been produced for arthritis patients of any age who are interested in beginning an easy, balanced routine. It is based on principles of the organization’s well-proven exercise classes, which have been developed for the patient who is getting very little exercise and has concerns that exercise will increase pain.

Take Control With Exercise is nicely divided into an introduction and several exercise segments:

• range-of-motion to increase flexibility;
• exercises to strengthen muscles and improve posture;
• endurance routine to improve stamina, followed by a cool down activity;
• relaxation segment with breathing and visualization exercises; and
• 3 additional advanced exercise routines for endurance and strengthening.

The introduction is a separate section so, after viewing it once, the user can proceed directly to the exercise routine of choice. In addition, the background music is quietly upbeat and the exercise routines proceed at a reasonable pace with each exercise repeated only about 3 times. Many positional tips and reminders are offered so that the participant can learn to perform the exercises in a safe and effective manner; frequent cautions remind learners to ease into each motion and to exercise within individual comfort zones. The participant will need to provide a mat, pillow, towel, and a straight-backed chair. The strengthening routines require the use of resistance bands.

Healthcare professionals can confidently recommend this program to patients who suffer from the pain of arthritis because the exercise content and tempo are designed specifically for this population. Peggy Brill, the presenter, frequently acknowledges the common feelings of helplessness patients experience and gently encourages the user to “take control and begin exercising now.” One minor criticism is that 3 of the 4 participants in the video appear to be relatively young (age 50 or less). While the presenter states that 2 of these people have had recent total hip or knee replacements, some viewers might feel that this exercise program would be a “better fit” if more participants in the demonstration video were older.

The Arthritis Foundation, publisher of this program, is a national nonprofit organization that provides educational programs, supports research efforts, and advocates for better health policies for patients with all types of arthritis. Your patients can learn much from the information presented on their website at http://www.arthritis.org/ (access checked 10/31/07).

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Pain Treatment Live Seminars (Ongoing Series)

None listed as yet.

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Other Pain Treatment Educational Resources

None listed as yet.

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