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Interventional Pain Management

Ferrante, F. Michael MD

Book Review

Department of Anesthesia, Hospital of the University of Pennsylvania, Philadelphia, PA 19104-4283.

Interventional Pain Management, S. D. Waldman and A. P. Winnie. Philadelphia: WB Saunders, 1996, ISBN 0-72161-58741, 582 pp, $130.00.

It is becoming fashionable to refer to the invasive treatment of pain as "interventional pain management." To most practitioners, this implies the use of spinal cord stimulation, implantation of subarachnoid or epidural catheters with reservoirs or pumps, radiofrequency lesioning, cryoanalgesia, etc. This book discusses some of the aforementioned topics plus the more conventional regional analgesic and regional anesthetic topics such as occipital nerve block, glossopharyngeal nerve block, cervical plexus block, and stellate ganglion block. This book suffers in three areas: 1) it is not a definitive treatise on the major invasive and perhaps less popularized techniques (radiofrequency lesioning, cryoanalgesia, etc.); 2) differences in writing style and content detract from the book, in general; and 3) organization of topics is diffuse, requiring reference to multiple chapters in order to search for a particular topic (see below).

The book itself is organized into six parts that deal with anatomy and physiology, evaluation, neural blockade and neurolytic techniques, neuroaugmentation, spinal opioids, and neurosurgical techniques. These sections are then divided into 54 chapters. There are excellent discussions of neuroaugmentative techniques, including spinal cord stimulation and peripheral nerve stimulation, as well as excellent chapters on the use of spinal opioids. There are also excellent chapters on the use of neurolytic agents in clinical practice and cryoneurolysis.

Unfortunately, the book has certain problems, not least of all the title. The use of the term "interventional pain management" would perhaps imply exhaustive and definitive discussion of more arcane topics such as cryoneurolysis, radiofrequency ablation, and atlantooccipital and atlantoaxial injections. Anesthesiologists who are facile with performance of these techniques refer to themselves as practicing "interventional pain management" rather than more traditional "regional techniques." The juxtaposition of more traditional regional anesthetic and regional analgesic topics perhaps makes the title somewhat misleading in regard to the contents of the book, given the public's and practitioners' connotation of "interventional pain management."

The index is not "user friendly." Certain topics are difficult to trace to the appropriate pagination using the index. Because of the numerous authors, there are variabilities with respect to content organization as well as writing style. For instance, a topic commonly searched by pain fellows is the performance of cervical facet injections. In order to obtain information regarding cervical facet injections, one must look in the chapters on functional anatomy of the spine, radiofrequency techniques and clinical practice, and facet blocks. Within the chapter on facet blocks, the reader may find a discussion that would be relevant. Unfortunately, better descriptions of the technique do appear in other treatises.

Another problem inherent with the text is the sometimes superficial treatment of certain procedures. For instance, cervical nerve root block is discussed on two pages in the chapter on functional anatomy of the spine. Similarly, the book has no real discussion of the use of subarachnoid baclofen. Anesthesiologists are implanting pumps for baclofen administration for spasticity of both spinal and cerebral origins. It would be useful to discuss the drug and the paradigm for trial and insertion. Certainly, the book would be more valuable with more expansive discussion of techniques, the physiology and indications for performance of specific techniques, and graphics more illustrative of the techniques themselves. While the book is replete with copious figures, they are sometimes not as "user friendly" as one would hope.

In summary, this is a book that does have value. Some of the aforementioned chapters are indeed excellent discussions of their respective topics. Unfortunately, there has been a crying need for a definitive text on interventional pain management. This is a good text, but it could have been a great text. A definitive discussion of interventional pain management for the practitioner of pain medicine is still needed.

F. Michael Ferrante, MD

Department of Anesthesia

Hospital of the University of Pennsylvania

Philadelphia, PA 19104-4283

© 1996 International Anesthesia Research Society