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Gaynor JS, Muir WW. Mosby Elsevier, St. Louis, Missouri, USA, 2009. 641 pp. ISBN 9780-3230-4679-4. CDN $73.95.
This book is the 2nd edition to be published under this title. The preface states that this edition contains updated drug doses, protocols, and, in addition to revisions, has included sections on pain relief in specific species (cats, birds, horses, cows, reptiles, ferrets, and rabbits). The author’s target audience is both practitioners and students, as a quick reference and textbook supplement from a “clinically applicable” perspective.
Divided into 4 parts: Principles of Pain Management; Recognition and Evaluation of Pain; Therapy for the Alleviation of Pain; and Acute and Chronic Pain Management, the book is further divided into 30 separate chapters (written by various authors) designed to further explore topics such as ethics, assessment of pain behaviors, specific drug families, approaches to specific species, and various modalities of pain management (both conventional and alternative). Each chapter ends with a list of cited papers as well as suggested readings for further study. An appendix that has a condensed list of dosages and side-effects of the drugs described in the book follows.
As a reference book, the discussions on pathophysiology, recognizing and scoring pain, pharmacokinetics and pharmacodynamics, and the drugs used to treat pain are very useful. The chapters have easy to read tables, graphs, and diagrams that complement the easy to easily readable discussions. There is just enough detail to further the understanding of basic concepts in these chapters, but not so much as to create the feeling of slogging through a textbook. In the chapters discussing drugs, the authors have attempted to list all the generic names of drugs in that family. As a result, many of the drugs described may not be available to practitioners in some countries. The lack of warnings with regard to the use of fentanyl patches (heating pads and changing absorption) and the possible potential abuse of sending the patches home with clients is disconcerting. While practitioners should always be familiar with the proper use of products such as fentanyl patches, by drawing attention to some of the potential problems of using these products, this book can aid practitioners in making more informed decisions on the best choices for their patients.
The chapter on local and regional anesthetic techniques would be useful to those who are already familiar with the techniques and just need a refresher; however, many of the diagrams and or descriptions are inaccurately drawn and poorly worded and may confuse those who are inexperienced. There was no discussion on considering the toxic dose of local anesthetics in these procedures, nor was there any information regarding the combination and additive toxicities of using multiple types of local anesthetics (for example, lidocaine and bupivacaine) which the authors of this chapter advocate routinely.
Various alternative pain management modalities such as acupuncture and homeopathy are covered, and information on physical therapy and rehabilitation programs and techniques is provided. While interesting to read as a general introduction to these practices, practitioners should not attempt any of these techniques without first consulting an experienced practitioner in these modalities. The author of this chapter did not adequately warn the reader to consider the following facts: While acupuncture needles placed incorrectly would be relatively benign (with the exception of needles placed in the joints); however, chiropractic adjustments could have much more serious consequences.
A case-based approach to acute and chronic pain management provides a signalment, the source of the pain, and suggestions for possible treatments, and the rationale for each of these treatments for each case. A summary box at the end of each case provides a quick reference of drug dosages used in that case example. While providing the practitioner with suggestions for analgesia, many of the drugs listed are not currently used by the general practitioner, or available in Canada (buprenorphine, however, should be available within the next few years). The authors did not provide a list of alternative drugs and dosing regimes which would have helped guide the practitioner in choosing other effective analgesic drugs. In addition, their assessment of drugs that would be sufficient analgesia for various procedures has often been insufficient. Regardless of whether one follows these examples or not, practitioners should always be prepared to supplement their patients with additional analgesics as necessary from the pre- to the post-operative period, as every animal has different responses to specific analgesic drugs.
The chapters on specific species differences with regard to managing pain will be particularly useful to the mixed animal practitioner and those who deal with rabbits, reptiles, birds, and/or ferrets as part of their caseload. Though not exhaustive in detail, each chapter describes how pain is perceived in each species, provides some assessment tools, and gives both systemic and regional therapy suggestions for analgesia. As these species can be notoriously difficult to assess for pain and to provide adequate analgesia, these chapters are a good general reference source.
The example charts for pain scoring and a discussion on quality of life issues and palliative care were very useful. The authors have provided some scoring charts and questionnaires to help guide treatments and decisions to euthanize.
Overall, this is a good reference book for the practitioner and final year students. Veterinary technicians may also find much of the information in this book relevant.