Herta Flor and Dennis Turk have contributed greatly in their careers to the expansion of research in chronic pain and psychology. In Chronic Pain: An Integrated Biobehavioral Approach, the co-authors pull together a vast field of research and advocate a model to unite the biomedical and psychological approaches to pain medicine, which all too frequently are used separately. The model is intended primarily for the numerous musculoskeletal pain syndromes that make up the majority of chronic pain, but the authors consider the approach, with minor modifications, to be useful for any chronic pain.

The book is arranged in three sections and includes a CD replete with 65 appendices that comprise many useful guides and tools for both patients and providers. Part I of the book provides an excellent and comprehensive review of the basic and historical concepts of pain and the neural and psychological mechanisms. At the end of this section, the authors present their biobehavioural model which is the focus for the remainder of the book. There is much evidence presented to support their view, but there is also an acknowledgement of the significant gaps in research regarding the way in which learning and psychological processes influence the development and maintenance of chronic pain syndromes. The information is presented in a readable style with sufficient background to allow practitioners who may be less familiar with psychology and learning in chronic pain to digest and integrate the ideas into their own concepts and practice.

The focus of Part II is the multiaxial assessment of people with chronic pain. To emphasize the importance of a broad context for assessment, the authors are quick to point out the distinction between an assessment of pain and an assessment of a person with chronic pain. The structure of Part II is similar to the first section. There is an introductory chapter covering the objectives, tools, and limitations of a multiaxial assessment and subsequent chapters dedicated to physical assessment, psychophysiologic assessment, pain characteristics and behaviours, and psychosocial assessment. These are well-written summaries of the vast literature on pain assessment. They are not exhaustive but condensed to a discussion of methods and procedures with acceptable psychometric properties in common use. Limitations and weaknesses of approaches are also discussed. Anger and post-traumatic stress disorder are given more dedicated attention as the authors consider their importance in chronic pain to be underrepresented in the literature.

In the final chapter of this section, which is the heart of the book, the authors describe an integrative assessment process which brings together subjective (patient responses to interviews and questionnaires), behavioural (casual and standardized observation and pain diary), and physiological (surface electromyography and autonomic responses) information to identify patient subgroups and match them to treatment. They present research validating the work and provide examples of improved outcomes. The authors also place attention on the importance of predicting disability early during the acute to chronic pain transition period and suggestions are given. However, they acknowledge that much improvement is still needed in this area and in a cost-effective manner.

In Part III of the book, the authors deal with the treatment of chronic pain, and topics include general principles, relaxation and biofeedback, operant therapy, and cognitive-behavioural therapy. The literature on these treatments is too large to cover in a comprehensive fashion, but the authors were able to summarize the topics in an especially readable and useful manner. The appendices on the CD are particularly helpful with many documents and tools to help practitioners and patients. The traditional biomedical treatments are treated lightly; hence, readers searching for more on the use of medications and interventional procedures will be disappointed.

Several interesting and new approaches to treating chronic pain are presented in the final chapter. These include cortical remapping using sensory discrimination training, mirror therapy, pain extinction training, and neurofeedback using electroencephalogram. The use of virtual reality and stimulation approaches, such as transcranial magnetic stimulation, are also described.

The authors have succeeded in writing a book that will appeal to any practitioner treating patients with chronic pain. The book is well organized with consistent formatting and clear introductions and summaries in each chapter. There are a number of appropriate and easy to read diagrams and tables which add to the material presented. There is one apparent limitation to the book: although this assessment approach is customary in a tertiary chronic pain centre, it would likely be difficult for many providers to implement this methodology in the current healthcare system in Canada. There is a lack of cohesion and not nearly enough capacity for all people with musculoskeletal pain syndromes to be afforded access to such assessment and treatment. However, regardless of where or how providers are practicing, they should begin with a good framework for understanding the complexities of their patients. In this book, Drs. Flor and Turk have provided both a foundation and a means to move forward.