Atlas of Implantable Therapies for Pain Management

Abstract

This book is edited and half written by a widely published anaesthesiologist and has contributions from 111 North American and one European specialist implanters, half of whom are anaesthesiologists and half neurosurgeons. It has 28 chapters in just under 200 pages and is divided into four parts: 1) spinal cord stimulation, 2) peripheral nerve and peripheral field stimulation, 3) neurostimulation of the cranium and head and 4) intrathecal drug delivery. This book covered a lot of ground within the field of implantable therapies. Being an Atlas it is a technical vade mecum and the focus is on how to do the implantation procedures and the pitfalls to avoid. It does not set out the place of such implantation therapies amongst the gamut of pain relieving treatments. Nor does it set out the adjunctive treatments that may be critical in obtaining the best results from the employment of such therapies. It is thus left up to the reader to decide when and if such expensive and invasive therapies are indicated and which other treatment modalities may need to coexist for the optimum outcome. It therefore assumes a prior understanding of the subject. It is written from a very North American perspective. It makes scant reference to the European experience and research in this field and thus for me lacked balance. There were some inconsistencies. For example the programming chapter deals with a tripole and yet in the surgically implanted lead chapter there are bipoles to the new penta lead with five parallel arrays that straddle the posterior columns and thus provide theoretically greater programming possibilites. There is considerable variation in chapter layouts and the font sizes are too small. Illustrations are not centred with the text, their size is too small, and many are crowded together. Fewer larger illustrations would have been clearer and more instructive. The references quoted which informed the text were taken mostly from the North American medical literature and missed out on a wealth of European research and experience. A lot of the references quoted cohort studies, often quite old, which were not controlled studies and offered weak evidence at best. Generally the book endeavoured to cover a lot of ground but it lacked clarity at times because of insufficient detail. There was a significant omission of discussion of high frequency neuromodulation in relation to conventional neuromodulation but there was a chapter devoted to EMG/ SSEP for the positioning of a particular tripolar lead which many practitioners would consider an unnecessary extra expense with little proven value. For the practitioner new to the field of implantable therapies this book shows the scope of this particular branch of pain medicine. It is full of good advice on techniques and how to avoid complications. It is sadly let down by the layout and the brevity of the chapters. For the experienced practitioner it is frustrating in its lack of detail. One is left with the feeling that if it contained half the number of illustrations and that the text dealt with the subject matter in more detail quoting worldwide experience and research that it would be a very useful addition to the pain management library.