Topical Issues in Pain 3: Sympathetic nervous system and pain. Pain management. Clinical effectiveness.
Edited by Louis Gifford.
Like all therapists with a heavy clinical caseload it becomes increasingly difficult and arduous keeping up to date with latest research and trends in relevant pain science and pain management. That is why Topical Issues in Pain 3, the third volume inspired by the work of the Physiotherapy Pain Association (PPA), is such a wonderful relief.
Louis Gifford and all the contributors have rationalised and reviewed all the most recent research in pain and pain management into a beautifully concise and logically readable book.
Ronald Melzak’s opening essay introduces us to his current pain theories of ‘neuromatrix’, ‘neurosignature’ and ‘neuromodule’ – terms which may well become as commonplace to physiotherapists as Louis’ ‘Mature Organism Model’ and the biopsychosocial model of illness.
Chapter 1 provides a clinical overview of all compartments of the autonomic nervous system with a bias to its relationship to pain and physical impairments. This review explores a particularly neglected area of physiotherapy training and helps to explain with concise diagrams the interrelationship between it, the sensory and the central nervous system. In addition, there are sections on the nerve supply to the gut; the effects of deep tissue pathology on somatic tissues, the autonomic innervation of the immune system, the impact of stress on the immune system and a review of mind body pathways and links.
Complex regional pain syndrome (CRPS) is categorised and discussed in chapters 2 and 3. In chapter 2 all the new terminologies are explained and illustrated as well as a full review of the various clinical manifestations of the disorder. The terms sympathetically maintained pain, sympathetically independent pain and reflex sympathetic dystrophy are all clarified. The rest of this chapter and chapter 3 deal with the current theories and mechanisms that have been proposed to explain the symptoms and signs of CRPS.
Chapter 4 takes a critical look at the current evidence that supports and opposes the role of the sympathetic nervous system in pain. Some of the findings will surprise and challenge many of our long held assumptions here.
Chapter 5 reviews the literature relating to physiotherapy management of reflex sympathetic dystrophy /complex regional pain syndrome. The two discussion sections raise some interesting, important and somewhat controversial matters: addressing, firstly, ‘Manual therapy, sympathetic effects and the sympathetic slump’ and secondly ‘Models for care – a plea for an ordered approach’.
Via case history and clinical example, Suzanne Brook’s two chapters (6 & 7) present treatment reasoning and management plans relating to the marked pain and disability encountered in CRPS. Both chapters are in view with current thinking and research helping practitioners to side-step the dogmatic reductionist and often toxic and invasive biomedical treatments offered for CRPS sufferers, to embrace a more diverse and empowering biopsychosocial assessment and management approach.
For me Main and Watson’s chapter on the distressed and angry low back pain patient (Chapter 8) was a welcome and familiar friend! This chapter is simply ‘an essential’ study guide to all of us who deal with ‘difficult’ patients and who wish to extend their understanding, and assessment and management skills of the ‘yellow-flag’ or psychosocial factors. It is an excellent complimentary chapter to those by Watson and Kendal in Topical Issues in Pain volume 2.
The final two chapters review and explain clinical effectiveness, evidenced based medicine and practice and provides plenty of access to further resources. In particular, those involved in or contemplating research or those who might quote or criticise it would do well to take on the material here.
Again the PPA and especially Louis Gifford have made a huge contribution towards physiotherapists’ knowledge and it is wonderful to think that all this information is immediately available in such an accessible book.
Viv Gleave MCSP