Essentials of Pain Medicine

Abstract

The editors, and the long list of contributors, of this concise book are drawn entirely from North America with the vast majority from the USA. As stated in the brief preface, in addition to a complete revision of all chapters, the editors have deleted previous material related to regional and neuraxial anaesthesia, and added chapters of relevance, particularly to the practising American pain clinician, including the use of ultrasound, and DSM mental disorders of relevance to pain medicine. The book is split into nine sections; the first three sections offering basic science, clinical evaluation and examination, and pharmacology. Subsequent sections cover all therapeutic aspects including perioperative pain management. The largest section is composed of chapters dedicated to specific chronic pain syndromes. There is a section on interventional techniques, and one each on cancer and neural blockade. Chapters end with succinct summaries or conclusions where appropriate, and, in some chapters, key points. The breadth of this book's endeavour appears to be wide, but not at all at the expense of depth and detail. The book presents a state-of-the-art of current American practice with the result that some chapters are essentially redundant for non-American readers, for example, a chapter on legal and regulatory issues in pain management. A particular selling point of this book is that purchase of the book allows access to an online version. This produces some immediate benefits, including the placement of all references online, reducing the number of printed pages considerably and adding to the book's ease of use as a reference tome. Online, it functions as a full electronic version of the book, with easy and straightforward navigation, and very usefully incorporates word-search. The word-search facility draws up all related sections of the text in short form, which can of course be expanded by a click of the button. Search of the word ‘pain’ drew up more than 1500 entries, ‘magnetoencephalography’ just one. The references in the online text link to Pubmed for readers who wish to purchase the complete article. Frustratingly, however, the references are numbered in the text, but not in the reference section—which makes it difficult to match one with the other—a serious flaw which limits the ease of use in this respect. The book opens with a section which essentially serves as a refresher course on the physiology of pain processing at the peripheral and spinal cord level. This is succinct and up-to-date. The next section focuses on evaluation of the pain patient and includes a very useful chapter on spinal imaging, with lots of magnetic resonance imaging scan appearances of common spinal pathologies which is useful as a quick, although selective, overview. It also includes a chapter on determination of disability, but it is only two pages long, and written with a focus on providing medical evaluation with respect to US social security administration. This important topic deserved more, and its treatment here will have limited application outside the USA. Clinical pharmacology is well represented, with a chapter on drugs in myofascial pain disorders, which includes evidence of efficacy—well conceived and useful. As might be expected, a particular strength of the book is material related to interventions, and as an example the chapter on transforaminal epidural injection of steroids does not disappoint. Although the chapter is not an exhaustive step by step guide, it is a co-ordinated account with discussion of rationale, anatomy, technique, complications, and outcomes, and is commendable. It is one of many in the section ‘Chronic Pain Syndromes’, which is the section of most relevance to the busy practising pain clinician and is very good overall. There is a separate section on Interventional Techniques, with whole chapters devoted to procedures of unproven worth, for example, intradiscal electrothermal annuloplasty, discography, and also less controversial and accepted techniques such as intrathecal drug delivery and spinal cord stimulation. These chapters are useful summaries for the generalist, but are not sufficiently detailed for the specialist. In contrast, the section on Nerve Blockade (8 chapters) could be a succinct standalone text, although with an emphasis on landmark and stimulation techniques more than ultrasound guidance. Despite the American emphasis, the book serves as an excellent revision tool for advanced level pain trainees, and CPD tool for consultants, aided by brief and concise chapters. I have no doubt that many readers will find themselves using the online version more than the printed book.