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Anesthesiology:
doi: 10.1097/ALN.0b013e31827d4197
Reviews of Educational Material

Central Pain Syndrome: Pathophysiology, Diagnosis, and Management, Second Edition.

Cheng, Jianguo M.D., Ph.D.*; Ningegowda, Lokesh M.D.; Saeed, Pasha M.D.; Rosenquist, Rick M.D.

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Central pain syndrome is a neurological condition caused by damage or malfunction in the central nervous system. Management of central pain syndrome is extremely challenging for both patients and physicians alike because the extent of pain and the areas affected are related to diverse pathological conditions, including trauma, spinal cord injury, tumors, stroke, multiple sclerosis, Parkinson disease, or epilepsy. Pain is either localized to a specific part of the body or may affect the whole body. Burning pain is the most common symptom, but patients may also report symptoms, such as pins and needles, pressure, lacerating, aching, and extreme bursts of sharp pain. Pain is typically constant, may be moderate to severe in intensity, and is often made worse by touch, movement, emotions, and temperature or weather changes.
Since the first description of central pain after thalamic stroke in 1906 by Dejerine and Roussy, significant progress has been made in the neurological mechanisms, diagnostic methods, and therapeutic strategies for the treatment of central pain syndrome. Central Pain Syndrome: Pathophysiology, Diagnosis, and Management, Second Edition, is an extremely informative book that synthesizes the most up-to-date research advancements to guide clinical practice. On the basis of the success and reviews of the first edition published 5 yr earlier, the authors have updated the contents, expanded the scope, and completely reorganized the text in this second edition of the book.
There are several distinctive features of this book that expand its utility. First, it provides the fundamental knowledge and skills required to understand and diagnose central pain syndromes (sections 1 and 2). The authors have made it easy and interesting to navigate through the various elements of central pain and its diagnosis by using well-designed tables that capture the core of relevant studies. Second, evidence-based treatment strategies are presented in chapters that are highly synthesized, succinct, and easy to read (section 3). Patients are placed in the center of evidence-based practice and the focus is clinical application of high-quality research findings. Details of a large number of individual studies are clearly tabulated for easy reference. The book provides an excellent means to balance the need of clinicians to quickly grasp key points of important clinical topics and the desire of the inquisitory mind to critically assess the scientific merits of the evidence presented in the literature. Third, significant efforts to elucidate mechanism-based therapeutic interventions are made whenever possible. For this purpose, the pathophysiology of central pain syndromes (section 4) is discussed in the context of therapeutic interventions. Erroneous theories of central pain syndrome are challenged with clinical observations that are inconsistent, or incompatible, with these theories (Appendix). Fourth, in contrast to some books with many contributors, this book, written by two Italian authors with expertise in neuromodulation, maintains consistency in content, style, and format throughout and provides a coherent presentation of the current status of the understanding and treatment of central pain syndrome. For these reasons, we highly recommend this book to those who are interested in the management and/or research of central pain syndrome. As practicing pain physicians and investigators, we believe Central Pain Syndrome: Pathophysiology, Diagnosis, and Management is an outstanding book on this topic and provides the most comprehensive and updated information in the field. The authors are to be commended for this significant contribution to the field of pain medicine.
Jianguo Cheng, M.D., Ph.D.,* Lokesh Ningegowda, M.D., Pasha Saeed, M.D., Rick Rosenquist, M.D.
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*
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, and Cleveland Clinic Pain Medicine Fellowship Program, Cleveland, Ohio. chengj@ccf.org

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