Management of Acute and Chronic Pain, N. Rawal, ed. London: BMJ Books, 1998. ISBN 0-7279-1193-7, 231 pp., $47.37.
This book, one of the latest entries in the area of pain management, is edited by one of the well known authorities in regional anesthesia and acute postoperative pain management who has developed a unique model in the postoperative pain control practice. Ten other well known authorities in pain management and regional anesthesia have contributed to various chapters.
Chapter 1 focuses on neuroanatomy and the neurophysiology of pain perception in a clear, simplified, but comprehensive and up-to-date review. Chapter 2 deals with pharmacology of various groups of medications used to treat acute or chronic pain, including the pharmacology of opiates, nonsteroidal antiinflammatory drugs, local anesthetics, anticonvulsants, tricyclic antidepressants, and the GABA agonist baclofen. This chapter provides a very valuable entry-level review for residents starting their training.
Chapter 3 deals with postoperative pain management and starts with an introduction on the current status of unsatisfactory postoperative pain relief, barriers to effective postoperative pain relief, and the somatic as well as the psychologic sequelae of untreated postoperative pain. There is a slight redundancy between Chapter 1 and Chapter 3 regarding preemptive analgesia and pharmacology of postoperative pain management. The rest of the chapter is devoted to a very focused and comprehensive discussion on various methods of postoperative analgesia. Unfortunately, the author did not present the criteria for patient selection to various modalities of postoperative pain management. The chapter ends with a description of the organization of the postoperative pain management service, which is a unique model that deserves studying and adopting for better patient satisfaction and outcome after major surgeries. Finally, the author outlines the postoperative analgesia ladder and decision-making for using analgesic modalities in relation to various surgical procedures.
Chapter 4 deals with obstetric pain management and discusses the nature of pain during childbirth, concentrating on the role of regional analgesia in obstetrics in a practical and stepwise decision-making presentation. Complications of regional analgesic technique, such as postdural puncture headache, nausea, vomiting, the inferior vena cava compression syndrome, and their management are discussed. Alternative techniques, including combined spinal epidural analgesia, are also discussed.
Chapter 5 deals with pediatric pain, an area of pain management that is relatively deficient in the literature. The chapter discusses various scales used to assess children in pain, followed by a concise presentation of medication routes of administration and analgesic techniques that are commonly used to relieve pain in children. The section on strategies for postoperative pain management in children is invaluable, with a focused discussion that is essential for any practitioner who deals with pediatric patients.
Chapter 6 presents chronic back pain and starts with an outline of the epidemiology and magnitude of the financial impact of chronic low back pain in the United States and Europe. The author goes on to discuss several pathologic conditions that contribute to low back pain problems and how to evaluate and treat in a very focused yet comprehensive approach. There is also an emphasis on the lack of adequate prospective outcome studies.
Chapter 7 focuses on cancer pain management with a very nice summary on how to assess cancer pain, barriers of adequate cancer pain treatment, the use of opiate and nonopiate medication, and neurolysis techniques to control cancer pain. The author also discusses in a very informative and practical way how to initiate, titrate, and deal with the side effects of opiate therapy. The author also touches on the myth of addiction as an outcome of therapy.
Chapter 8 is a very nice overview of interventional techniques used for the management of intractable pain. Interspinal drug delivery systems are discussed in depth. Other interventional modalities, such as cryoablation, radiofrequency, peripheral nerve stimulation, and spinal cord stimulation, are also briefly discussed.
This is a comprehensive entry to acute and chronic pain management, which is recommended to pain management physicians who need to refresh their knowledge, and it would also be very useful to new residents in anesthesiology and fellows in pain management as their first exposure to the field.
Nagy A. Mekhail, MD, PhD
Pain Management Center; The Cleveland Clinic Foundation; Cleveland, OH 44195