Reviews of Educational Material  |   July 2009
Pain Management: Evidence, Outcomes, and Quality of Life: A Sourcebook.
Author Affiliations & Notes
  • Christopher Gilligan, M.D., M.B.A.
  • *Massachusetts General Hospital Center for Pain Medicine, Boston, Massachusetts.
Article Information
Reviews of Educational Material / Pain Medicine
Reviews of Educational Material   |   July 2009
Pain Management: Evidence, Outcomes, and Quality of Life: A Sourcebook.
Anesthesiology 7 2009, Vol.111, 221. doi:10.1097/ALN.0b013e3181a96ffd
Anesthesiology 7 2009, Vol.111, 221. doi:10.1097/ALN.0b013e3181a96ffd
Pain Management: Evidence, Outcomes, and Quality of Life: A Sourcebook.  Edited by Harriet M. Wittink, Ph.D., and Daniel B. Carr, M.D., DABPM, FFPMANZCA. New York, Elsevier, 2008. Pages: 448. Price: $99.95.
As physicians caring for patients with pain, we know what we want: High-quality evidence to help us to identify treatments that will benefit our patients and discard those that will not. As always, the devil is in the details; when we review the evidence we find that relevant clinical trials frequently differ too greatly to allow for aggregation of their results, most individual trials contain significant flaws, and therapies are frequently not compared to alternatives or placebos. Pain Management: Evidence Outcomes and Quality of Life: A Sourcebook  , edited by Harriet M. Wittink and Daniel B. Carr represents a positive, comprehensive, and helpful response to this conundrum.
Each of the 24 chapters covers a specific topic, and Wittink and Carr have done a commendable job in their choice of subjects. The first 10 chapters focus principally on methodology for pain-related outcomes measurement and clinical trials. The remaining chapters cover specific conditions and patient groups. This structure makes the book easy to use and helpful for both investigators designing and conducting clinical trials of pain therapies and for clinicians analyzing the results of such trials. The chapter authors comprise an esteemed and global group and represent a wide variety of relevant areas of expertise.
In the opening chapter, Wittink, Scott A. Strassels, PharmD, BCPS, and Carr set the stage nicely with a discussion of the definition and historical context of health outcomes measurement. They note that because of challenges of time, money, methodology, and ethical limitations, 80% of commonly used medical treatments have not undergone the randomized controlled trials necessary to demonstrate efficacy! Equally important, they observe that the aggregate response of a study population to a given treatment does not necessarily correspond to the response that subgroups or individuals will have to the same therapy.
In other highlights, Debbie Kralik, Ph.D., R.N., Tina Koch, Ph.D., R.N., and Kay Price, Ph.D., R.N. contribute an eloquent chapter on qualitative research of people with chronic pain. Their well-chosen quotations from chronic pain patients will remind all physicians of the great burden that so many of our patients bear. In their chapter, Liana Fraenkel, M.D., M.P.H. and Wittink clearly describe methods for measuring patient treatment preferences that can help clinicians and patients predict which of the available treatments best fits a particular patient at a given time. The chapters on pain assessment in clinical trials and on placebo effects in clinical trials were also well done. The chapters all share a common organization, with the body concisely summarizing the topic at hand and the conclusion offering the authors’ recommendations on which tools and measures are most helpful. This structure makes the book particularly useful as a practical reference.
The promise of evidence-based medicine remains great, but clinicians currently do not have adequate, high-quality evidence to guide many of the clinical decisions they face. The adoption of evidence-based medicine principles by payers and regulators has only added to the pressure and urgency surrounding this issue. Wittink and Carr’s book provides a useful and practical guide for how the emerging discipline of pain medicine can generate and interpret high-quality evidence to guide us in the care of our patients suffering with painful disorders.
*Massachusetts General Hospital Center for Pain Medicine, Boston, Massachusetts.