There are very peculiar ways in which one can mark time. We often do so by observing the rate at which our siblings, children, or grandchildren grow, especially when we are not in daily contact, or by how we inevitably underestimate the length of time transpired since we last encountered an old friend. In this context, it seems remarkable that over 20 years have transpired since I first discussed with Chuck Ciccone the prospects for a text on pharmacology for our Contemporary Perspectives in Rehabilitation. The realization that the first edition of Pharmacology in Rehabilitation appeared more than two decades ago is even more astounding. The basis for the genesis of such a book was founded on the belief that rehabilitation specialists received little formal training about drug interactions and how any single pharmacological agent could impact either treatment plans or outcomes. Chuck took it upon himself to generate a text that would address this educational and clinical shortcoming. The result is very clear. Pharmacology in Rehabilitation is the “gold standard” among all texts addressing this content for nonphysician rehabilitation specialists.
So why is it important to create a fifth edition? Why is a more superficial compendium of information about drugs and their actions inadequate? The answer to these questions is directly related to the rapidly emerging responsibilities incumbent upon rehabilitation specialists. During the past 12 years, the advent of clinical doctoral programs in physical and occupational therapy has heralded a rapid transformation in these educational arenas. Several attributes now take on a meaning that previously might have been underappreciated. First, the label of “doctor” implies an expectation on the part of the consumer that the practitioner is the penultimate expert on providing an analysis and treatment plan for improving upon the pathology of any system’s movement, whether muscle, joint, pulmonary, etc. Second, given the status associated with the professional label, there is an associated obligation on the part of the practitioner to address all aspects of the patients’ signs and symptoms. This obligation requires that the clinician differentiate patient responses to treatment from patient responses to pharmacy. As one physical therapist so astutely told me, her recognition that a patient was not responding to pain medication taken well above the specified dosage, in the absence of any evidence for malingering behavior, resulted in the subsequent detection and successful removal of a renal tumor. Third, as practitioners, the DPT or DOT now assumes a greater responsibility for keeping a contemporary knowledge base about the interface between treatment plan and concurrent synergies or exacerbations that might result from single or multiple medications taken by the patient.
This collection of attributes can be best appreciated if the student is first informed and the clinician is educated about the most recent medications, their pharmacokinetics, and the interactions they have with patients with specific diagnoses. Since the drug industry is arguably one of the most dynamic corporate structures in the world, changes in pharmacy occur at an alarmingly fast rate, one that will increase even more dramatically as transplants and the sequelae resulting from genetic engineering (as two examples) take on greater roles in medicine. Such rapid changes, then, call for contemporary and comprehensive updates in available information. Such updates must be presented in a manner that is compelling, yet easy to understand.
Inclusive in this perception is the absolute requirement that the student or clinician be able to relate to the text meaningfully. Toward this important goal, the 5th edition of Pharmacology in Rehabilitation is designed to address rehabilitation relevance in every clinical chapter as well as to present important case histories to reinforce this relevance. New materials on agents used in or even as complementary and alternative medicines have been added. Moreover, we have made efforts to add to the appeal of the book through the addition of colorization, use of double columns, and encasing the text within a newly designed hard cover. These changes are in contradistinction to one standard that remains immutable—Dr. Ciccone’s remarkable gift for taking complex material and making it easy to understand.
For those clinicians who have in their possession early editions of this book, I invite you to compare your copy to the 5th edition as validation for the assertions made in this Foreword. We have not compromised the comprehensive nature of this volume in favor of a “simpler” approach to understanding pharmacology. We believe that the topic, by its very nature and from the implications inherent in its knowledge base, requires a comprehensive, yet user-friendly, delivery. This belief system remains unhindered in this latest edition; yet the problem-solving and evidence-based nature of the content is preserved and enhanced.
The thought of having a reference text for rehabilitation specialists was considered by us to be a unique concept 20 years ago. Today, many doctoral programs include pharmacology as a separate course or as an important component in teaching the rationale for treatment approaches and their assessment. There is much gratification to be gained from recognizing this transformation and in knowing that the content of this book contributes to the evolving maturation of our educational programs and our clinical services.
Steven L. Wolf, PT, PhD, FAPTA