The Essence of Analgesia and Analgesics

Abstract

Edited by Raymond S. Sinatra, M.D., Jonathan S. Jahr, M.D., and J. Michaels Watkins-Pitchford, M.D. New York, Cambridge University Press, 2011. Pages: 550. Price: $99.00.In 2011, the pain specialist has numerous medication options available to treat a variety of chronic pain conditions. Cataloging the extensive array of medications available is daunting. The Essence of Analgesia and Analgesics concisely encapsulates these advances in pain medications into a single comprehensive, portable text. The book provides a useful reference that reviews the current advances in medications in an easy-to-use format without the sheer volume of a formal reference text. This book is an excellent complement to the medication sections of larger texts, such as Bonica's Management of Pain . The book will be helpful for any anesthesiology resident or pain medicine fellow in training.The Essence of Analgesia and Analgesics does more than just catalog medications: it offers a unique and refreshing review of the molecular basis of pain and its relationship to clinical pharmacology. The discovery of μ-opioid receptor polymorphisms and their clinical relevance is a key element of the future of pain medicine treatment. The interindividual genetic differences regarding specified pain medications, their interaction with receptors, and their metabolism have set future directions for pain treatments. The book not only discusses these unique genetic advancements and their relationship to pain physiology but also places these elements within a clinical context.Sinatra et al. skillfully walk the reader through pain physiology and the clinical relevance of numerous pain medications. Although multiple authors have contributed to the text, the editors ensure that the flow and format unify the text in seamless fashion. The book reviews conventional treatments along with the latest advances and concludes by describing the most novel medications and plausible drug targets for the future.The book is partitioned into 12 sections, with the first section describing pain pathophysiology. The remaining sections deal with a number of different medication classes, ranging from opioids to N-methyl-D-aspartate receptor antagonists. Some sections of the book include chapters with readily applicable practical information, such as understanding when to perform a neuraxial procedure in a patient who is anticoagulated.Chapters that review a specific medication are typically structured to include the drug's mechanism of action in addition to its metabolism, indications versus contraindications, common doses, and treatment advantages versus disadvantages. The chapters are outlined with elegant schematics of receptor physiology, medication tables for ease of comparison, and relevant clinical discussion regarding each of the medications reviewed.One of the limiting factors of the book is a defined approach to the use of medications presented for specific pain conditions. Often a chapter may allude to a medication's use for a particular pain condition, but data or specific practice techniques on its use are lacking. Some chapters have more information than others in this context. There is also a paucity of evidence-based guidelines to guide pain clinicians to effective medication choices for specified pain conditions.Another critique pertains to the chapters that describe opioid medications and related treatments. The discourse surrounding the appropriateness of chronic opioid management for patients in chronic nonmalignant pain has been increased to a national discussion of great importance. In order to educate our future physicians appropriately with respect to responsible opioid prescribing, these chapters should have a complementary section to describe strategies that have been employed to reduce the risk of abuse, addiction, and diversion. The pharmacology of opioids in a clinical setting should not be discussed without providing the clinician the context to make appropriate decisions regarding responsible opioid-prescribing practices.Despite these major critiques, there are many interesting novel sections to the book. The 12th section of the book is of particular interest, describing new and emerging therapies in wonderful detail, with more than 20 chapters dedicated to the topic. Chapters discussing intranasal ketamine, inhaled fentanyl, morphine-6-glucoronide, transdermal buprenorphine, and tamper-resistant opioids are nothing short of engaging and succinctly written.The Essence of Analgesia and Analgesics provides practicing clinicians and physicians in training with an excellent guide to navigate the current state of affairs in analgesic pain management, and also highlights the trajectory of future pain medications. The authors have not only met the demands of the practicing clinician but also exceeded them in developing a comprehensive, portable text dedicated to guiding pain management specialists through the multiplicity of medication choices available to treat their patients.