Surgical Pain Management: A Complete Guide to Implantable and Interventional Pain Therapies, S Narang, A Weisheipl and EL Ross (editors)

Abstract

Surgical Pain Management has been edited by three pain specialists working at the Center for Pain Management at Brigham & Women's Hospital and Harvard Medical School. They coordinate a multidisciplinary team of 43 co-authors. Although most of them are anaesthetists and specialists in pain medicine by training, there are a significant number of neurosurgery specialists, psychiatrists, nurses, and a biologist. It is a direct reflection of what pain management is nowadays: a multidisciplinary effort where a common problem, chronic pain, is observed from very different perspectives to achieve the common goal of pain relief. Besides being a multidisciplinary effort, pain management has evolved into a highly specialized and sophisticated, almost independent subspecialty strongly related to anaesthesia. Knowledge and technology have significantly increased in recent years, giving clinicians opportunities to understand better what is going on with the patient with chronic pain, the mechanisms underlying chronic pain, and why some therapies work better than others. The introduction of more invasive techniques based on surgical intervention has significantly changed the scope in the pain clinic. More and more pain specialists require operating room time to conduct procedures involving implantation of devices or other interventional therapies. The book subtitle is A Complete Guide to Implantable and Interventional Pain Therapies. As far as I know, this is the first attempt to make available all approaches and technologies in invasive pain management, and it can be seen as a manual to explain all the different options and the widely accumulated experience of the authors available for the treatment of patients in the pain clinic. With its almost 400 pages, it covers several aspects of clinical management of chronic pain patients: from the organizational aspects of a pain center to a detailed list of chapters, each one describing a particular technique. The book has two parts and a total of 14 appendices. Part 1 is about the surgical pain management team and includes four chapters. Part 2 describes the different procedures in a total of 12 chapters. The 14 appendices cover much from official guidelines on aspects related to clinical practice, anatomy, physiology of cerebrospinal fluid, pharmacology, equipment, regulatory details, or surgical and device aspects. The first section deals with what could be considered organizational aspects, and the avid reader might want to skip it and go directly to the clinical aspects. It is important to highlight how relevant it is to select adequately and pick the indication for a particular technique, which is dealt with in this section. Is it adequate for the patient? Is the patient really ready to get the most benefit of the approach? How different is it to treat a terminal patient or a chronic persistent pain patient? How does the patient tolerate the therapies psychologically? What will the patient need after the procedure? What education should be given? All these aspects and more are essential to maximize the success of one such therapy, so it is worthwhile reading this section carefully before going deep into the clinical aspects of the book. Each chapter shows a detailed, concise and summarized display of information that makes it quite easy to get to the bottom line. The chapters contain tables and figures that are taken directly from X-ray images similar to what the practitioner will find in the operating room. An interesting chapter covers the topic of anaesthetic management of patients requiring surgical pain control therapies, including a section on specific co-morbidities that emphasizes the chronic opioid user, a frequent finding in chronic pain patients. Also, the decision between sedation and general anaesthesia is discussed, which will depend mainly on the procedure and the prior condition of the patient. Some procedures require active collaboration of the patient, so minimal sedation would be the choice. This book covers a gap in the literature given the development that pain management has seen in recent years. It presents state-of-the-art techniques in a way that makes it easy to consult. It emphasizes the importance of the organizational aspects to make sure that, in the context of scarce resources and therapeutic alternatives, the right approach has been selected for the right patient. It will be of help for pain specialists and for those who are considering training in pain as a subspecialty. The book allows comparison of your practice with the way in which it is performed in a leading academic department. It will also be very useful for pain clinics establishing themselves in the area of interventional pain therapies.