Pain in Infants, Children, and Adolescents, 2nd Edition.

Abstract

Mayo Clinic, Rochester, Minnesota. mauck.william@mayo.eduPain in Infants, Children, and Adolescents, 2nd Edition.Edited by Neil L. Schechter, Charles B. Berde, Myron Yaster. Philadelphia, Lippincott Williams & Wilkins, 2003. ISBN: 0-7817-2644-1. Pages: 892. Price: $145.Pain is a critical public health issue that has generated considerable scientific and clinical interest of late. Unfortunately, many obstacles to its proper management remain, including gaps in our knowledge of human neurobiology, the role of social, cultural, psychological, and emotional influences in the pain experience, and simple practical problems such as how to best quantify pain, to name a few. These problems are especially pronounced in the pediatric population, and for many years there was a dearth of good clinical information available to those caring for children with pain. The first edition of Pain in Infants, Children and Adolescents , published in 1993, was a monumental step in compiling, in a single reference, the best available information and treatment for pediatric pain. The 2nd edition of this text further improves on this excellent reference.The format of the 2nd edition remains unchanged from the first. The book is organized into three distinct sections. The first 150 pages outline a basic scientific foundation of pain theory, including such topics as developmental neurophysiology, pharmacology, assessment and measurement of pain, cultural and psychological influences, and a historical perspective of pediatric pain management. The 2nd section addresses specific treatment strategies, including pharmacologic, physical, interventional, and psychological. The last section is divided into chapters pertaining to specific pain problems. This organization provides a logical flow of general principles followed by specific treatments. It also, as the editors point out, leads to a significant amount of redundant information, but I did not find this distracting.Added topics from the first edition include new chapters on clinical pharmacology and long-term consequences of pain in neonates, which rounds out the basic science section. The chapter dealing with the pain-associated disability syndrome concisely summarizes the approach to this difficult problem and is a welcome addition. Not to be taken as a “how-to” reference, the new sedation chapter focuses on general sedation concepts and includes a useful table outlining common procedures and sedation strategies. A much-needed chapter-expansion of nonconventional analgesics addresses commonly used medications for neuropathic pain such as antiepileptics, membrane stabilizers, and α-2 agonists. The palliative care chapter has been more fully developed to include additional end-of-life issues in addition to traditional pain control.Most of the chapters are very well written, easy to read, and concise. This is especially true of those covering the neurobiologic basis and developmental neurophysiology of pediatric pain. Other publications cover these topics in greater detail, but the information provided in this text is very clinically relevant. This is further demonstrated by the dosing charts and tables available for local anesthetics, opioids, nonsteroidal antiinflammatory drugs, and continuous epidural infusions. More detailed information on specific topics can be accessed by using the annotated bibliography available in each chapter. However, some of the diagrams for the regional anesthetic techniques could be improved in quality and quantity. There are helpful discussions pertaining to the techniques, but I recommend referring to a text or atlas on regional anesthesia for better three-dimensional illustrations.Overall, the 2nd edition of Pain in Infants, Children and Adolescents continues to provide a comprehensive approach to pediatric pain management. A number of written texts deal with specific pediatric pain issues, including acute, cancer, spine, procedural, gynecologic, and headache pain, but I am not aware of any other that attempts, with such success, to cover the subject so completely.