Methods in Cell Biology, Vol. IX

of some presumed mechanisms for pain in contracting muscle, the book becomes intensely practical, dealing with such subjects as percutaneous stereotactic radiofrequency trigeminal tractotomy, percutaneous stereotactic cingulumotomy, transcutaneous "electrical cordotomy," and research dealing with these modes of therapy. Again, a highly conservative tone is maintained throughout, and as many data as can be packed into a small space are presented. In addition to the neurosurgical approaches mentioned, the group presents a catalog of nonsurgical techniques, including narcotics and psychotropic agents, radiation therapy, a number of anesthesiological techniques, including regional block and new approaches such as hypnosis and biofeedback. Here, the tone of presentation is somewhat variable and occasionally one finds the spirit of the enthusiast gaining somewhat over that of the practical clinical evaluator. Nevertheless, these excursions are valuable and illustrate the breadth of approach taken by the group. J. J. Pinsky presents a psychodynamic and psychotherapeutic approach to the treatment of patients with chronic intractable pain based upon solid clinical experience and interpersonal interaction. The organizational structure of a Pain Center is then presented, with discussions of the role of the social worker, the nurse, and the occupational therapist. In a number of centers, the notion of a group of specialists devoted to the treatment of pain is gaining acceptance. As exemplified in this documentation of the efforts at the City of Hope, such groups, in their present state of evolution, have reached what is perhaps the optimal situation that can be attained in the treatment of a patient by a committee. Very few of the medical or surgical, as distinct from the paraprofessional, personnel deal exclusively with problems of pain. Such groups are, as a result, quite expensive to operate, both in money and in time. The lack of independent professional status for physicians treating problems of pain constrains them to diversify their efforts (as for example, into general neurosurgery, oncology, and other "more important" matters) and of necessity dilutes the resources available, while it decreases the level of care afforded. The City of Hope Pain Center, if seen as a way station along the road to development of a comprehensive medical-surgical specialty dealing with the problems of pain, is illustrative of what even a partial approach can accomplish. It is a fine experience to read about, and a sobering one, one which can be read with profit in one or another of its chapters, by physicians dealing with chronic "benign" pain, pain of malignancy, or the problems of the dying patient.