Associate Professor of Anesthesia; Harvard Medical School; Chief, Division of Pain Medicine; Beth Israel Deaconess Medical Center; Boston, MassachusettsPain Management for the Practicing Physician. Edited by Gordon A. Irving and Mark S. Wallace. New York, Churchill Livingstone, 1997. Pages: 330. Price:$49.95.When I started my career in pain medicine 20 yr ago, there was scarcely a chapter about the topic, let alone a textbook. Today, with the rapid growth of interest in the field of pain medicine, the practitioner is faced with an often difficult choice of pain texts.Pain Management for the Practicing Physician provides a succinct but comprehensive collection of information regarding the treatment of painful syndromes. The text starts with a very useful glossary of pain terminology. Section 1 includes four chapters about the anatomy, physiology, and pharmacology of pain. Section 2 provides a “cook-book” reference about how to treat 23 painful syndromes, including headaches, herpes zoster, lower back pain, pediatric pain, reflex sympathetic dystrophy, and spasticity. Algorithms are presented for each diagnosis in a chart format, with step-by-step instructions about how to proceed in treating each condition. Recommendations proceed from plan A to plan B to plan C, and so on, and end with “referral to pain specialist.” The text then offers numerous approaches that the pain specialist might use during such a referral. Also included are pertinent case studies to clarify the use of the algorithms.Although section 2 provides the major bulk of the text, section 3 offers a review of the psychologic aspects of pain management, including a very useful chapter with algorithms about opioid detoxification.Section 4 discusses acupuncture, physical therapy, and transcutaneous electrical nerve stimulation, and section 5 consists of a chapter regarding the future of pain medicine.I do have a few criticisms. Although the “Reflex Sympathetic Dystrophy” chapter states that a sympathetic block is routine in the diagnosis of reflex sympathetic dystrophy, it completely leaves blocks out of the algorithm, suggesting use of a number of pharmacologic manipulations and even acupuncture and coping skills before neural blockade. I also thought the acupuncture chapter to be rather meager.Although the authors clearly state that this text is intended to provide non-pain specialists with guidelines for pain treatment and for referral to a pain specialist, I believe this text would be an excellent resource for those training in a pain fellowship program and also for anesthesia residents during their pain rotation. The cost of $50 is what I would consider to be quite reasonable for a text for such purposes.Carol A. Warfield, M.D.Associate Professor of Anesthesia; Harvard Medical School; Chief, Division of Pain Medicine; Beth Israel Deaconess Medical Center; Boston, Massachusetts