Current issues of ACP Journal Club are published in Annals of Internal Medicine


Resource Corner

An Evidence-Based Resource for Pain Relief

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ACP J Club. 2001 Sep-Oct;135:A15. doi:10.7326/ACPJC-2001-135-2-A15



The purpose of An Evidence-Based Resource for Pain Relief is to provide a useful resource for clinicians on the management of pain. The efforts of McQuay and Moore represent a huge step forward in the struggle to make sense of the evidence in pain management. The book is a collection of systematic reviews of a spectrum of pain management problems.

The first part of the volume is the most important because it guides the reader step by step through the process of how pain studies are done, the system used by authors to determine which studies should be included in their systematic reviews, and the analytic process used to draw the conclusions. In most chapters, the studies included in the systematic reviews are described and tabulated clearly. The authors also provide a conclusion about the efficacy of the treatment by including a number needed to treat—a very useful tool for practicing clinicians.

The reviews in the book discuss both acute and chronic pain. Such common problems as choosing acetaminophen or acetaminophen plus codeine for the management of acute pain and assessing the role of nonsteroidal anti-inflammatory drugs in acute and chronic pain are addressed. Specific treatments for such chronic pain problems as back pain or neuropathic pain are also examined, and both pharmacologic and nonpharmacologic treatments are discussed.

McQuay and Moore do not presume to have covered every area of pain management. For example, one major area that is not addressed is the use of long-acting narcotics in the management of cancer pain. The authors express the intent to update the text, but they do not set out a timetable for this. They do, however, maintain (and quote from) a database of controlled trials on pain management, which is available on the Internet (1).

I am interested in the evidence for pain management in palliative care. Controlled studies in palliative care patients are quite rare, but extrapolations from other chronic pain models described in this book provide acceptable proxies for palliative care situations. For example, tricyclic antidepressants are likely to work in controlling neuropathic pain, whereas the evidence for local analgesics is less clear-cut.

An Evidence-Based Resource for Pain Relief is a high-quality textbook that will inform clinicians practicing in pain management for some time to come. It also issues a challenge to other disciplines to organize their research similarly to enable rational assessment of the evidence to assist clinicians who are not expert in the field.

Geoff Mitchell, MBBS
University of Queensland, Brisbane
Brisbane, Queensland, Australia


Reference

1. Bandolier.www.jr2.ox.ac.uk/Bandolier/

Ratings

Methods/Quality of Information: 5 of 5 stars

Clinical Usefulness: 5 of 5 stars

McQuay HJ, Moore RA. An Evidence-Based Resource for Pain Relief. Oxford: Oxford University Press; 1998.

An Evidence-Based Resource for Pain Relief can be purchased online at www.oup-usa.org/isbn/0192630482.html for U.S. $65.00. The table of contents can also be viewed at this site.