Mary Lynn McPherson, PharmD, BCPS, CPE, is Pro-fessor and Vice Chair, Department of PharmacyPractice and Science, University of Maryland Schoolof Pharmacy, Baltimore, MD, USA.

Vol. 40 No. 6 December 2010 941Book Reviews

chapter on pain evaluation includes a list of self-report pain scales, objective and behavioralmeasures of pain, and their strengths and weak-nesses. Three remaining chapters address opi-oids, adjuvants, and an analysis of each step inthe World Health Organization analgesicladder.

The next seven chapters address commonsymptoms such as gastrointestinal, neurologi-cal and psychological symptoms, feeding andhydration, dyspnea, and skin symptoms. Patho-physiology, etiology, and management are dis-cussed in practical terms, with helpful tablesand management algorithms. The chapterson nausea/vomiting and dyspnea are remark-ably practical; the former includes a flow chartoutlining ‘‘a rational approach to antiemesis’’.

After the chapter on pediatric palliative emer-gencies, the next several chapters cover specificdiseases commonly seen in pediatric palliativecare. There is a general overview of malignantdiseases, and more in-depth coverage of themost common pediatric malignancies, alongwith a general discussion on management ofcancer-related symptoms. Specific nonmalig-nantdiseases areoutlined inmoredetail, includ-ing clinical features andmanagement strategies.

The concluding chapters provide a worth-while practical overview of the clinical issues sur-rounding death, the major religious issuesrelated to death, funeral practices, bereave-ment, coping and communication skills, educa-tion, and training. As with many pediatricbooks, a pediatric formulary is included, withrecommended dose ranges based on the child’sweight, and notes pertinent to each drug.

Each chapter is primarily presented in out-line form, with several current references pro-vided at the end. This makes the handbookeasy to read and understand. On the otherhand, the descriptions of palliative care servicesfor children refer exclusively to services in theUnited Kingdom and could be less relevant toreaders from other countries. In addition, theformulary includes several medications thatare unavailable in the United States.

As the authors point out in the preface of thisbook,most children with life-limiting conditionswill be cared for not by pediatric palliative medi-cine specialists but by general pediatric orsubspecialist teams. Hospice teams, medical stu-dents, pediatric residents, pediatricians, and on-cology fellows will appreciate this practical

introduction to pediatric palliative medicine.The handbook also will benefit adult palliativecare fellows who are rotating through their pedi-atric palliative training.

The authors have succeeded in producinga handbook that provides basic concepts andinformation for the professional without spe-cialty training in pediatric palliative medicine.The handbook can serve as a framework forthose professionals endeavoring to providegood palliative care for children.

doi:10.1016/j.jpainsymman.2010.09.006

Back to the Not-So-Basics:The Pharmacologyof PainMary Lynn McPherson, PharmD, BCPS, CPE

Pharmacology of PainBy Pierre Beaulieu, David Lussier,Frank Porreca, and Anthony H. DickensonPublished by IASP Press, Seattle, WA, USA2010, 622 pages, $100.00 (Hardcover)

This International Association for the Studyof Pain Press text represents the first compre-hensive reference entirely devoted to the basicand clinical pharmacology of pain-relievingmedications published in over a decade. Edi-ted and written by an international group ofexperts, chapters in this text range from thebasic sciences of pain physiology and mecha-nisms of drug action to the clinical applicationof this knowledge in caring for specific patientpopulations. Chapters are extensively refer-enced and drawn from recent literature.

The text is divided into four parts. Part I(‘‘Background’’) includes a chapter on appliedpain neurophysiology that is comprehensive

Ebtesam Ahmed, PharmD, is Clinical Coordinator,Department of Pain Medicine and Palliative Care,Beth Israel Medical Center, New York, NY, and Assis-tant Clinical Professor, St. John’s University Collegeof Pharmacy and Allied Health Professions, Queens,NY, USA.

942 Vol. 40 No. 6 December 2010Book Reviews

yet succinctly written and very understandable.The chapter concludes with an excellent dis-cussion on the role of glial cells in the develop-ment and treatment of pain and the riskfactors for developing chronic pain. The onlyother chapter in Part I proposes a new taxon-omy for analgesic agents.

Part II of this reference is devoted to ‘‘SpecificPharmacological Pain Targets.’’ Representingapproximately half the book, I believe thesechapters are of value to basic scientists and clini-cians alike. The first two chapters address themechanism of action, toxicities, and roles intherapy of the cyclooxygenase inhibitors andacetaminophen. The authors confront and elu-cidate controversial issues pertinent to theseagents. Subsequent chapters in this sectionaddress the opioids, other physiologic systemsthat influence pain (e.g., cannabinoid system,sodium/potassium/calcium channels andothers), and cover more recent research, suchas the transient receptor potential family andnew pain treatments in late development.

The third part (‘‘Special Topics in the Pharma-cologyofPain’’) addressesmorecontemporary is-sues in the pharmacotherapeutics of painmanagement, such as pharmacogenetics, pla-cebo analgesia, opioid tolerance/dependence/addiction, and models of pain. The chapters arewell written and give the reader a greater depthof understanding of analgesic pharmacology,with attention to clinical relevance.

The remaining section of the book (Part IV,‘‘Clinical Pharmacology of Pain’’) will be ex-tremely useful for clinicians. Chapters addresspainmanagement in vulnerable patient popula-tions, including obstetric patients, infants/chil-dren, older patients, obese patients, patientswith hepatic or renal failure, and pharmacolog-ical considerations in palliative care. Thesechapters build on the basic science that was pre-sented earlier in the book and provide valuableclinical insight into patient management. Thepharmacokinetic issues associated with thesepatient populations are explained, and the im-plications for specific analgesic therapies are ex-plored, with clear clinical direction provided.

Overall, I found this to be an excellent text,and as a pain/palliative care practitioner, Iwould want this book on my shelf. Importantly,this is not intended tobe apocket reference, butit does lend itself to either reading straightthrough like a novel or ‘‘dropping in’’ as specific

circumstances come up. Thewriting is clear andengaging and nicely supplemented by figuresand tables. I believe the readership of the Jour-nal of Pain and SymptomManagementwill find thisbook to be of use, as it fosters a deeper under-standing of themechanisms of analgesic action,and allows thepractitioner to craft ‘‘rational pol-ypharmacy’’ analgesic regimens.

doi:10.1016/j.jpainsymman.2010.09.007

A User-Friendly Guideon Opioid ConversionCalculationsEbtesam Ahmed, PharmD

Demystifying Opioid Conversion Calculations:A Guide for Effective DosingBy Mary Lynn McPhersonPublished by the American Society of Health-System Pharmacists, Bethesda, MD, USA2009, 200 pages, $35.00 (Paperback)

Opioid therapy is playing an increasingly im-portant role as a component of chronic painmanagement. Opioids have a broad therapeu-tic range, allowing for titration to balanceefficacy and potential adverse effects. Toler-ance to analgesic effects and variability ofresponse among patients and types of pain re-quire knowledge of opioid pharmacology andthe practice of switching from one opioid toanother (i.e., opioid rotation). This is a chal-lenging topic for health care professionalscaring for patients with acute or chronic pain,but there has been little practical guidancefor this common practice. Dr. McPherson pres-ents a very useful and practical handbook