Acute Pain Medicine

Abstract

Acute Pain Medicine is a book with an innovative goal to apply case-based learning to acute pain medicine. This is a very readable book, in which leading physicians in pain medicine communicate their lifetime professional experience and knowledge, to give the reader the impression of having learned a valid clinical approach by being with them for years. The book is organized into 3 sections with chapters that treat several topics related to perioperative and nonperioperative pain conditions. Section I (The Practice of Acute Pain Medicine, Chapters 1–2) details the economic problem of implementing acute pain medicine services. This section underlines the value of pain management as a service and the centrality of acute pain services in the integration between multimodal analgesia, regional analgesia, protocols of enhanced recovery after surgery (ERAS), and the use of procedure-specific postoperative pain management (PROSPECT) protocols. Section II (Case-Based Acute Pain Medicine, Chapters 3–25) constitutes the most interesting part of the book. It offers a variety of scenarios in acute pain medicine that can be encountered in practice. The range of topics is wide and includes orthopedic, thoracic, abdominal, and pediatric surgery, as well as some nonperioperative pain conditions and polytrauma. The structure of the case-based chapters is exceptional and represents an excellent method of clinical thinking. The authors start with questions that arise daily in clinical practice. At the beginning of each chapter, the authors put forward a case-based pain problem (in Greek πρό [pró, “before”] + βάλλω [bállō, “throw, cast”] mean, “to put forward”). The authors advance their reasoning through the problem’s fundamental expression, “the question,” spanning clinical, diagnostic, and therapeutic considerations. All chapters contain a special focus on pharmacology. Up-to-date references and guidelines support each section. This is a book made of many good questions with corresponding concise but sufficiently detailed answers. Readers will find an immediate response to all aspects of the proposed pain problem. They will also appreciate the fact that questions and answers cover all aspects of each single case in a truly holistic fashion. For future editions, we expect that clinical cases will be organized into a more defined etiological classification and also include obstetrical pain syndromes and more nonorthopedic pain conditions. The third section of the book (Advanced Regional Anesthesia and Analgesia, Chapters 26–60) is an updated version of the Military Advanced Regional Anesthesia and Analgesia Handbook (MARAA II) where almost every type of regional block can be found. Image quality of regional procedures for specific areas of the body is good; the text is simple but complete and includes basic pediatric regional anesthesia, acupuncture treatments on the battlefield, acute pain nursing, acute pain treatment in the battlefield, and air transport of the critically injured patient. With this text, the authors underline the problem of experience and its transmission into medical education in the 21st century. Dealing with pain clinics requires a skilled use of intelligence. In its Latin origin (intus/inter + legere) the word “intelligence” means literally “to read through, read inside.” However, who can help us to read reality and increase our clinical experience? In this unique era of the history of medicine, we have plenty of readily available information supported by improved scientific methodology, but we again need to “read through” and to pick what is more adapted to the individual clinical situation, because every patient is unique. “Experience, as development of the person, connotes the fact of becoming aware of one’s growth in the understanding of reality.”1 As opposed to what happens in the scientific field, where we can add today’s advances to those of the past, experience in its basic form is not simply an additional process.2 Experience needs to be transmitted by someone who has gained it through intelligence and needs to be renewed during a lifetime’s work for knowledge. The clinical eye of a good mentor on the treatment of a patient can be learned only from the mentor himself (Figure 1).3 That is why mentorship and case-based learning are the original and fundamental methods of learning in medicine. The Acute Pain Medicine book is unique, and it attempts to bridge the gap by transmitting the experience of great mentors. For these reasons, fellows and residents should have this book, and the book is also recommended to those physicians who know that the long journey to knowledge never ends.Figure.: André Brouillet. Un Leçon Clinique à la Salpêtrière (Jean-Martin Charcot demonstrating in a clinical lecture to his colleagues). 1887. Université Paris Descartes, Paris. From Wikipedia; available at: https://www.google.com/search?q=andre+brouillet+salpetriere&client=ms-android-huawei&prmd=nimv&sxsrf=ALeKk02q9w_Ks2S-6pf45k2zrdUDNk86Ug:1591737381299&source=lnms&tbm=isch&sa=X&ved=2ahUKEwjt_L_p0_XpAhW1WxUIHfM1DK0Q_AUoAnoECBUQAg&biw=480&bih=656#imgrc=wEDppSZRfwtxvM.Zhirajr Mokini, MDDhurata Vrenozi, MDDepartment of AnesthesiologyClinique Saint FrançoisChâteauroux, France[email protected]