Physiotherapy July 2002/vol 88/no 7

443

Book reviews

Churchill Livingstone, Edinburgh2000 (ISBN 0 443 07068 7). Illus. 280 pages

edited by Marion Trew and Tony Everett £12.95This book has been a standard text for students involved inmovement studies, in particular physiotherapy students. Themain themes of the book remain similar to earlier editionsthough the existing and new contributors have enabled thetext to be updated in view of recent evidence and research.

It remains well-written and readable. The chapters are wellorganised, each starting with learning objectives and endingwith relevant references. There is an easy-to-follow contentslist for each chapter and the index is inclusive.

Changes to previous editions include enlargement of thechapter on biomechanics of human movement to make itmore relevant to clinical practice. The chapter on motorlearning has been rewritten and there is a new chapter onscales of measurement. This chapter limits itself to the morequalitative measuring tools for functional status and qualityof life and as such the chapter title is a little misleading. Theprevious chapter on measuring and evaluation of humanmovement considers quantitative instruments.

The editors indicate in their preface that the fourthedition of this book will ‘give the reader an easy-to-readcomprehensive introduction to the study of humanmovement’. In this they have been successful. The revisededition of this book would be a useful addition todepartmental or university libraries.

Peter Yung BA MA MSc MSCP DipTP

Human MovementAn introductory text

BIOS Scientific Publishers Ltd, Oxford2002, 2nd edn (ISBN 1 85996 038 3). 212 pages

by K M Grady, A M Severn and P R Eldridge £24The second edition of Key Topics in Chronic Pain attempts tocover this difficult area using the principles of evidence-based medicine as a guide.

The importance of evidence-based medicine is consideredin an even-handed review of the assessment of evidence. Therecognition of bias in randomised controlled trials andsystematic reviews highlights the limitations of a purelyresearch-based approach. In fact the assessment of evidencechapters are very refreshing reading for clinicians whobelieve in the important role of additional evidence, such asclinical expertise and patient experience, in their clinicalmanagement. This reflects a key aspect of the recommendedmanagement for patients with chronic pain. As the authorsstate: ‘The clinician taking a history of chronic pain must be prepared to set aside the preconceptions on whichtraditional medical diagnosis is taught’ (page 17).

Throughout the text there are qualifications of traditionalrules that in treatment of chronic conditions need to be questioned (eg ‘Straight leg raising limited by theproduction of back pain does not necessarily imply nerveroot tension’ – page 21). In addition there is an excellentsummary of the psychosocial aspects, but this is brief and thetext is dominated by medical and surgical interventions forpain. This obviously reflects the target groups of the book –biomedically trained health professionals.

Further, the opening paragraph appropriately outlinestreatment of ‘a chronic pain syndrome’ as not focusing on‘symptomatic treatment of pain symptoms’, yet the majorityof the book then emphasises such ‘symptomatic man-agement’. This includes various lists of symptoms thatindicate specific diagnoses. These symptoms include termssuch as ‘constant or progressive pain’, ‘night-time pain’,‘continuous pain’, ‘pain worsened by flexion or extension’and ‘back pain radiating to buttock and leg’. These allappear quite high on the lists which could indicate thatthese symptoms are greatly valued diagnostically. Thepresence of these symptoms, sometimes concurrently, in achronic pain syndrome is not uncommon, however, andattempts to treat this symptomatology can worsen thesyndrome. The use of these symptom lists may present amixed message to readers who, as a result, may choose aniatrogenic course of management.

For physiotherapists the main omission from this text isthe application of the concept of neural sensitivity and with that, neuroplasticity. There is some mention of this(page 47) but it is not extrapolated to other parts of the text.It is essential for physiotherapists to be well aware of theimpact of the role of neuroplasticity on neural sensitivitywhen managing all painful conditions, and especiallychronic pain syndrome.

In summary, this book offers many insightful and valuablecomments about evidence-based medicine and chronic painmanagement, but it is not the most suitable text forphysiotherapists.

Lester Jones MSc MEd(PM) MCSP

Key Topics in Chronic Pain