Topical Issues in Pain 2 -reviews.

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Professor Chris J. Main PhD

Topical Issues in Pain 2: Biopyschosocial Assessment and Management: Relationships and Pain. Louis Gifford (ed)

For the last 20 years, research has demonstrated the power of psychosocial influences on treatment outcome. Located within the biopsychosocial model of illness, this new way of understanding pain – associated dysfunction places physiotherapists at the helm of the ship. Locating the ‘bio’ within a ‘psychosocial’ intervention might be conceptualised as a sort of ‘psychophysiotherapy’. We are not talking here about a woolly, warm, and fuzzy holistic approach, but delivery of traditional physiotherapeutic skills within a systematic approach to psychosocial obstacles to recovery. This book should be viewed as a landmark publication for the profession. The technical quality and overall presentation of the book is superb.

Space precludes comment on all of the chapters but the chapter on interpreting the results of treatment by Peat is of particular importance, as is the chapter by Roberts on potential ‘Red Flags’. The three chapters by Watson and Kendall offering a superb integration of the nature and content of psychosocial assessment and management. Later chapters on sexual dysfunction by Newton-John and Brook, and chronic pain in the context of pregnancy and child-rearing by Papadopoulos and Harding, in particular are full of useful clinical and practical advice.

The volume is not only a superb achievement for which Gifford in particular is to be congratulated but it puts the PPA at the forefront of professional development. It was a particular privilege and pleasure to be asked to review this publication.

Professor Chris J. Main PhD
Department of Behavioural Medicine. Hope Hospital, Salford, UK.

Published in: Manual Therapy (2001) 6(1) p58 Harcourt Publishers Ltd

Gordon Waddell’s DSc MD FRCS Review

Gordon Waddell DSc MD FRCS Consultant Orthopaedic Surgeon and author of ‘The Back Pain Revolution’.

Published in the December 2000 edition of Physiotherapy Journal.

The first year book from the Physiotherapy Pain Association was a hard act to follow, but this second year book is even better. This a diverse collection of essays on selected aspects of pain which is inevitably somewhat disjointed and variable in style and quality, but that lets it explore a number of rarely visited, fascinating topics. Although the authors come from a range of professional backgrounds, they all have considerable “hands on” clinical experience of physiotherapy for patients with pain. Indeed, one of the major achievements and attractions of this book is the highly successful blend of the latest concepts and research on pain with practical illustrations of how that can be applied in practice. That practice ranges all the way from routine out-patient physiotherapy to a tertiary pain management clinic, and the one general criticism is that sometimes the setting of a particular essay is not made clear. For example, lessons from the highly selected patients in a pain management programme are not always applied to more routine practice. However, once the reader realises that different authors may sometimes be talking about different patients, it is possible to draw these lessons from oneself. Altogether, this is a rich kaleidoscope of the latest thinking and research, which includes some real gems.

Each reader will find their own favourites, but a very personal selection that tickled my fancy included the chapters on interpreting the results of treatment, the challenge of change in practice, the impact of patient preferences on treatment outcome, applying yellow flags in clinical practice, pain perceptions and attitudes, and most of the section on “relationships” including in particular pain stories, pain couples and the INPUT Patient Handout on Chronic Pain and Pregnancy. These include some original, highly pertinent and stimulating perspectives.

The major achievement and value throughout the book are the many examples of how biopsychosocial principles can be applied in clinical practice. This is a delightful little book for all physiotherapists and indeed all other health professionals who actually treat patients with pain, not only for those working in pain clinics. The Physiotherapy Pain Association and the editor, Louis Gifford, are once again to be congratulated on producing such a marvellous collection of essays.