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Book Review: Powerful Medicines: The Benefits, Risks, and Costs of Prescription Drugs

Therapeutic Area and Audience: This book focuses specifically on pain management. As described in the forward, the book is intended to serve the needs of primary care clinicians from a variety of professions including pharmacists, physicians, and nurses. Purpose: The editor indicates that the book is “intended to provide basic information necessary to identify, assess, and manage most common types of pain in the primary care setting.” The book was intended to provide specific and concise guidance to a practitioner rather than indepth scientific reviews of topics. Content: The book is organized as a series of chapters that could be placed into roughly 4 categories: drug information, general principles of pain management, specific topics in pain management, and other issues. Each chapter is written by at least 2 authors from the health professions including pharmacy, medicine, and nursing. Usability: The book’s price, especially for members of the American Society of Health-System Pharmacists, seems reasonable given the quantity and quality of this resource. This text would be useful in a course for pharmacists, nurses, or physicians regarding pain management. It would also be a useful resource for a generalist practitioner who routinely manages pain to purchase for an institutional or personal library. The book would need to be supplemented by another drug information resource for details regarding drug product selection, adverse event monitoring, and other issues. Highlights: General chapters include discussions of pain assessment, opioid analgesics, non-opioid analgesics, acute pain, chronic malignant pain, and chronic nonmalignant pain. Condition-specific chapters include headache, arthritis, pediatrics, geriatrics, and palliative care. Additionally, very useful chapters about assessing pain management outcomes, ethical and legal issues, and institutionalizing pain management have been included. The book provides some excellent resources for pharmacists and other practitioners. The opioid dosing principles as presented on page 65 are very clearly presented to the reader. The chapter that summarizes the management of acute pain includes simple yet very specific guidelines for the use of opioids when used with patient-controlled analgesia. The chapter on chronic malignant pain includes an excellent table that summarizes noninvasive alternative routes of administration of opioids. Limitations: From the perspective of a pharmacist, the weakest chapters are those that deal with specific aspects of drug therapy. For example, valproic acid was not mentioned as an alternative therapy for neuropathic pain. The authors may feel that the strength of evidence regarding its effectiveness is less than that for carbamazepine and gabapentin, but given its wide-spread use, some discussion would be appropriate. A table and more detailed discussion of converting opioid doses from different agents or routes of administration would have been welcome. Alprazolam is the only benzodiazepine specifically mentioned where benzodiazepine use is discussed for anxiety and agitation in the chapter on palliative care. The algorithm to be used in the management of osteoarthritis was actually the one for rheumatoid arthritis and vice versa. Reviewer: David P Elliott PharmD FCCP, Professor, Department of Clinical Pharmacy, West Virginia University Health Sciences Center– Charleston Division, Charleston, West Virginia