One does not normally welcome book review invitations. We are busy people and the prospect of plowing through pages of sometimes turgid lifeless prose is not appealing. Such is not the situation presented by A Physician's Guide to Pain and Symptom Management in Cancer Patients. Reading this book is a pleasurable experience. The style is sprightly, the language engaging, and among medical texts the work may be described as a 'page-turner'.

The book is written by a single author, who would have earned an 'A' in an advanced literary writing course. Readers will have the feeling that they are gaining experience from a gifted clinician. Case examples are plentiful, illustrative, and fully coordinated with the accompanying text.

Dr Abrahm tells us her approach to palliative care—what she does and why she does it. She employs the first person singular throughout (a powerful tense), and doesn't avoid difficult issues—you know her views. You do not encounter statements such as “Hospital patients have been reported, on occasion, to experience delays in receiving p.r.n.—as needed—medication. It has been recommended that the use of p.r.n. medication be properly reviewed and appropriately adjusted.” Rather, Dr Abrahm on page 157 simply says, “hospitalized patients can experience significant delays in receiving needed p.r.n. medication. For these patients, instead of ordering opioids “p.r.n.” I use a 'patient – may – refuse' order.” The patient is offered the medication on a regular basis, and the patient has the option to take it or refuse it.

Dr Abrahm's personal approach is refreshing and is backed up by appropriate references. The book includes 432 pages of text, case outlines, tables, references and 'where to find it' information, and contains 172 pages devoted to pain assessment and management. There are also excellent chapters on talking to patients and their families and on interdisciplinary communication, together with insightful discussions on a variety of ethical, psychosocial and spiritual issues, including bereavement, and physician follow-up after patient death. These chapters constitute 140 pages. There is relatively little discussion on non-pain-related symptoms—discussion of these symptoms is packaged in one chapter of 79 pages—but nevertheless the main issues are addressed, helpful practice points are presented, and a good reference base is provided. Indeed, the reader benefits from a series of clearly expressed practice points distributed throughout the entire book.

Dr Abrahm is trained in hypnosis, and writes a lucid account of the benefit of integrating nonpharmacologic techniques (i.e. hypnosis, yoga, music therapy, relaxation, mindfulness meditation and spiritual counseling) with pharmacologic therapy. Indeed, this is one of the best presentations of the topic that I have read. Dr Abrahm's personal experience enhances one's appreciation of this topic. For example, we learn about her personal use of yoga (page 284): “While I do not yet practice yoga daily, the techniques taught to me by Mary Jane Ott, a member of our pain and palliative care team, have made it possible for me to find the equanimity I need.” In the section 'The Last Days' we learn the potential value of the hug—“If hugging comes naturally to you and seems to be called for now, this, and the tears that may accompany it, are also OK. Just be sure to mitigate the manifestations of your sorrow so that the family doesn't feel the need to take care of you.” The mordant wit illustrated in the last sentence is noted in other parts of the book. Dr Abrahm may be one of the few people who use Rasputin as a reference point for the value of hypnosis (as fitting as this may be).

As Dr Abrahm is, no doubt, a superb rounding physician, I am sure that she will welcome questions from her residents and students. Example questions they may ask are included on page 99; for instance: “Can we really achieve 95% symptom control?” (a question that may lead to a broader discussion on our inabilities to handle devastating symptoms such as fatigue); “Isn't the COX-1 enzyme present in body cells other than stomach, kidney and blood vessels?”; and “Isn't COX-2 sometimes found in tissues which are not inflamed?” On page 332, Dr Abrahm asks why mycostatin cannot also help prevent (not treat) esophageal candidiasis if used in a 'swish and swallow' fashion—must we always use more expensive oral fungicides, which sometimes complicate drug metabolism for this purpose?

The book is surprisingly topical for one published in 2005. Nevertheless, there are a few recommendations that are, in the light of recent information, no longer tenable. These include the use of erythropoietin for cancer-related anemia. It seems that the use of erythropoietin under these circumstances may be associated with some stimulation of tumor growth, and I believe that this practice is, therefore, changing. On page 151, valdecoxib is mentioned as a suitable therapeutic COX-2 inhibitor. This agent, at least in North America, is no longer available because of concerns about cardiovascular effects. In 2005, methylnaltrexone was a drug of promise in the management of opioid-induced constipation. It still is, but it seems to be active only in the subcutaneous form; studies on oral methylnaltrexone have not been impressive, and research continues in an attempt to discover improved formulations and methods of administration.

There are in addition a few points of information that are unfamiliar to the reviewer. These include a recommendation on page 183 for the use of methylphenidate to control withdrawal when opioid doses are lowered. This is not usual practice; therefore, a reference needs to be provided for this recommendation. On page 360, a 220 mg/day dose of zinc is recommended as part of a multivitamin/mineral routine in patients with pressure ulcers who are likely to be malnourished. This dose goes beyond current recommendations, which give upper limits for sustained use in the 40–50 mg range.

Despite these points, I highly recommend this book. The work is superbly crafted, containing as it does the personal style and wisdom of Dr Abrahm, which is evident throughout. We are reminded that patient management is not “all about us” but well done only when the physician and his/her team has included the patient and family as partners in care rather than passive recipients. The book is directed toward clinicians, presumably of all stripes. I fully agree that the book will benefit this community and think that it will also be read with interest by nurses and other people participating in an interdisciplinary care team. Buy the book—it's a bargain.