Pain Medicine: Specialty Board Review.

Abstract

Acute Pain Service, The University of Texas Health Science Center at San Antonio, San Antonio, Texas. eckmann@uthscsa.eduPain Medicine: Specialty Board Review. By Salahadin Abdi, M.D., Ph.D., Pradeep Chopra, M.D., M.H.C.M., and Howard Smith, M.D. New York, McGraw Hill Professional, 2009. Pages: 512. Price: $64.95. ISBN-10: 0071443444. ISBN-13: 978-0071443449.The July 1, 2007, Accreditation Council for Graduate Medical Education program requirements for accredited pain medicine fellowships were aimed at improving the training in our subspecialty through the inclusion of structured multidisciplinary training and participation. Indeed, as our understanding of the complexity of pain has evolved, so have we realized that no single specialty or model holds all of the answers to comprehensive pain treatment. The enriched curriculum poses new challenges to educators and trainees alike as the learning curve is arguably steeper than ever before.Many candidates for board certification in pain medicine will have already studied for their core residency board examinations within the same fellowship year while also managing a busy schedule of clinical services, academic duties, and career searches. Candidates require board preparation materials that strike an efficient balance between being both high yield and comprehensive over multiple disciplines. Although few resources exist to meet this need, Pain Medicine: Specialty Board Review , by Abdi et al. is among the best efforts available to that end. The contributors to this book have backgrounds in anesthesiology, physical medicine and rehabilitation, neurology, and psychology.This board review is a 300-page question–answer book containing nearly a thousand test items organized into 15 chapters related to pain pathophysiology and management. Within each chapter is a self-test of multiple choice, true–false, or K-type style questions followed by an answer key that holds the bulk of the informative content. Most answers highlight the rationale behind the correct answer in less than 100 words, but certain important topics are expanded to include more background information. For example, an answer related to intrathecal catheter-tip granuloma has two pages of content. Conversely, a small number of questions are presumably straight forward enough to warrant no explanation.Testing of fundamental knowledge, such as anatomy, pain pathophysiology, pharmacology, and pain states, occurs mainly in the first half of the book. Although not necessarily organized by region, the anatomy chapter focuses foremost on the spine and the nervous system. However, relevant anatomy is tested indirectly in many other questions throughout the book. Significant attention is directed toward cellular mechanisms of pain (e.g. , neurotransmitters and receptors) and pathologic pain syndromes, such as central pain, phantom pain, craniofacial pain, headache, complex regional pain syndrome, radiculopathy, neuropathy, soft tissue pain, cancer pain, pelvic pain, and arthritis. Opioids are well covered, and nonsteroidal antiinflammatory drugs, antidepressants, anticonvulsants, and other medication classes are also explored.Middle chapters transition into the diagnosis and assessment of pain, where moderate attention is paid to signs, symptoms, electromyography, imaging, examination, and diagnostic injections. Psychometric scales are covered briefly. However, within these sections, there is significant interleaving of content on pain syndromes and pathophysiology.The latter half of the book is devoted to pain management techniques and practice considerations. Advanced interventions, such as intrathecal therapy, spinal cord stimulation, neurolysis, spinal augmentation, and provocative discography, are covered in detail, whereas there is modest discussion of complementary and alternative therapies. The interdisciplinary chapter presents topics on pain management in different patient populations (e.g. , geriatric, pediatric, critically ill, and pregnant) rather than featuring the application of multiple disciplines to treat pain. For such information, the reader should refer to the later chapter on rehabilitation. Behavioral, psychologic, ethical, and medicolegal aspects of pain medicine complete this book to ensure a well-rounded review.In my opinion, this excellent board examination review book is contemporary, informative, and useful. Busy physicians will appreciate a resource that allows interactive learning while also being relatively comprehensive and detailed. Although the content is not as strictly demarcated as the chapter headings suggest, it probably simulates the multidimensional nature of actual board examination questions. I believe that the focus of this book in a small way reflects the bias of the authors and of pain subspecialization in general—dominated by anesthesiologists (like myself) but having increasing integration with rehabilitation, neurology, psychiatry, and palliative care. Those areas are where review materials similar to this can expand in the future as the needs of our specialty change.Acute Pain Service, The University of Texas Health Science Center at San Antonio, San Antonio, Texas. eckmann@uthscsa.edu