Pain

Abstract

Pain: Nociceptive and Neuropathic Mechanisms with Clinical Correlates. Vol 15, No 2 of Anesthesiology Clinics of North America, M. S. Wallace, J. S. Dunn, T. L. Yaksh, eds. Philadelphia: WB Saunders, 1997, ISSN 0889-8537, 242 pp, $106.00 annual subscription for four issues. The stated goal of this quarterly monograph is twofold: first, to present to the practicing anesthesiologist the basic pharmacology and physiology of acute and chronic pain processing, and second, to discuss a selection of clinical pain states in which these principles can be applied to produce clinical benefits. At the outset, the editors state their approach to dividing preclinical and clinical information each into two sections, which reflects their view that most clinical pain states should be thought of as a composite of two different mechanisms. These mechanisms are tissue injury, such as is observed postoperatively, and nerve injury, such as is observed with diabetes or herpes zoster. The editors proceed to present abundant examples that most clinical pain states reflect contributions from both mechanisms and lie along a spectrum in which one or the other mechanism predominates. Thirteen chapters have been contributed by well known authors in the field. The book begins with a brief but interesting chapter on nociception, followed by chapters on the basic pharmacology and physiology of acute pain processing and on clinically useful drugs for perioperative analgesia. The remainder of the first half of the book provides clinical examples in which acute nociception predominates: burns, arthritis, musculoskeletal injury, sickle cell disease, and pancreatitis. The contribution of neuropathic pain to chronic postburn pain is acknowledged. Yaksh and Chaplan's chapter on neuropathic pain is a concise, timely summary of much recent work in this rapidly progressing area. Those who read it will have a better grasp of the complexities of the basic mechanisms of allodynia and the general organization of postnerve injury processes. The remainder of the second half of the volume presents thorough discussions of conditions in which neuropathic pain figures prominently: pain after mastectomy or thoracotomy, acute zoster and postherpetic neuralgia, "reflex sympathetic dystrophy" and causalgia, diabetic neuropathy, and spinal cord injury. Of the latter group, the discussions on zoster and causalgia are comprehensive yet fresh looks at topics about which much has been written. The final two chapters, which should be of interest to all pain clinics, deal with diabetic neuropathy and its sequelae and post-spinal cord injury pain states. Although all chapters and references are current, one wonders why recent advances in spinal drug delivery for spinal injury pain were not mentioned in that chapter (as they are in the discussion on reflex sympathetic dystrophy and causalgia). In summary, this issue of Anesthesiology Clinics in North America is a timely work that carefully balances a discussion of the basic physiologic mechanisms of pain and the application of this knowledge to treatment of selected pain states. The editors should be commended for their efforts in condensing the vast amount of research data and clinical experience that has accumulated in this young field. William Guptill, MD Daniel Carr, MD Department of Anesthesia; New England Medical Center; Boston, MA 02111