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Principles and Practice of Pain Medicine, 2nd ed.

Section Editor(s): Elison, NorigSchaefer, Michael MD

Book and Multimedia Reviews: Media Review

Professor and Vice-Chairman Department of Anesthesiology and Intensive Care Medicine Charité-Universitätsmedizin Berlin Berlin, Germany

Principles and Practice of Pain Medicine, 2nd ed. Warfield CA, Bawa ZH, eds. New York: McGraw-Hill, 2004. ISSN 0-07-144349-5. 938 pp. $99.00.

The second edition of Principles and Practice of Pain Medicine edited by Warfield and Bajwa presents a comprehensive review of pain medicine. The editors have recruited a group of distinguished leaders each representing different disciplines within the field of pain medicine. The editors extended their concept of the first edition which contained chapters such as basic pain knowledge, pain by anatomical location, pain syndromes and pain therapies. The second edition also contains novel chapters such as evaluation of pain, chronic pain and administrative and legal affairs. A special emphasis has been made on a multidisciplinary perspective to educate readers independent of their individual background and training.

This textbook can be used like a reference book that provides much valuable information on every aspect of pain. The book gives insights into mechanisms, diagnoses, and treatment strategies of specific pain syndromes. However, similar to other textbooks on the market, the book does not provide a practical step-by-step guidance for people who are clinically involved with pain patients. The text is mainly explanatory and gives less hands-on information on how to establish a diagnostic strategy or how to develop a specific treatment plan. A more didactic presentation highlighting important aspects and providing more detailed information would be helpful. At the end of each chapter, a short summary that emphasizes the aspects that should have been learned is not always presented. There is some overlap between chapters. For instance, the pharmacotherapy of pain is covered in all chapters of part IV (pain by anatomical location), part V (pain syndromes), and part VI (pain therapies).

The book starts with a historical perspective of pain research. The first part covers the scientific basis re biology, anatomy, and physiology of pain. The chapters are well written. However, some are not up-to-date—e.g., figures for the nociceptive pathways are not presented and certain aspects are described in great detail (e.g., nerve growth factors) while other aspects are missing.

The second part covers the topics “general principles and evaluation.” Particularly interesting and well written is the chapter about “outcome measurements in pain medicine.” The note about specific Web sites is very helpful. The chapter on the radiologic evaluation of spinal diseases is very good. The chapters on “Functional Magnetic Resonance Imaging” and “Diagnostic Injections for Spine Pain” could be improved with more and better illustrations.

The third part describing the psychological evaluation and treatment of chronic pain is new. Particularly, the chapter on the psychotherapeutic management of chronic pain is excellent. Rather than remain on a theoretical explanatory level, this chapter outlines treatment possibilities, is case orientated, and summarizes the important aspects at the end. The chapter on consulting the difficult pain patient is not structured, scratches just the surface, and falls short of providing information. The chapter on chronic pain management programs has only a very short paragraph about treatment.

The fourth part covers pain by anatomical location. Chapters 17 through 24 deal with the epidemiology, assessment, differential diagnosis, and treatment of the various forms of headaches. The chapters on the pathophysiology and common headache syndromes are short and leave many aspects uncovered. The chapters on the epidemiology of headaches and chronic daily headache are clearly written and structured, and very informative. The chapter on facial pain lists all the pathological forms of neuralgia. However, the text just touches the surface and does not provide in-depth information and treatment strategies. The chapter on neck pain is excellent, providing helpful information on taking history, physical examination, and treatment plans. At the end of the chapter on low back pain a very helpful table lists all clinically relevant examination tests and explains them. The illustrations in the chapter on facet syndrome do not provide hands-on information on how to perform a facet block. The chapter on failed back surgery syndrome lacks information on special management programs. The chapter on pain management in rheumatologic disorders mainly covers pharmacotherapy, citing important clinical trials, but fails to give final recommendations. In contrast to the chapter on opioids for nonmalignant pain that gives a more critical appraisal of the use of opioids, the chapter on rheumatologic disorders describes opioids in a very positive light and does not point out limitations of opioid therapy, such as cognitive deficits, lack of functional improvement, and others, particularly in the elderly population. The chapter on extremity pain provides a very comprehensive list of pain syndromes,. However, the text remains explanatory and provides only little information on what to do. The chapter on abdominal pain explains nicely the differential diagnosis of abdominal pain, but again, provides only little information on treatment strategies. In this respect, the chapter on pelvic pain is much more helpful.

The fifth part deals with the various pain syndromes. Throughout this part, the chapters are excellent, clearly structured, and well written, providing much valuable information. The chapter on preemptive analgesia is very intriguing and well written. A final summary statement at the end of each paragraph dealing with the different classes of drugs to prevent sensitization would have been helpful. The chapter on acute pain management in adults is short and lacks several important aspects. The chapter on assessment and treatment of pain in sports injuries is excellent in the way it describes a systematic approach of these patients. Cancer pain is covered in chapters 44 through 47. The chapter on anesthetic interventions in cancer pain, which is very good, could have been improved with more figures. That a chapter on pain in HIV and AIDS is included is excellent and brings the long time neglected pain of these patients to the attention of the clinicians. The chapter on fibromyalgia is short and does not mention the recent improvements in the understanding of this pain syndrome. This reviewer appreciates that pain in children is covered in separate chapters 53 through 56. They are excellently written, illustrated, and easy to read. The chapter on abdominal pain could be more structured and give more hands-on information about possible treatment strategies. Similarly important is the chapter on pain in the elderly.

The sixth part refers to pharmacologic treatments, nerve blocks, and complementary as well as physical therapy treatments. The chapter on opioid pharmacotherapy is very comprehensive. However, the text does not give practical information on treatment with opioids, such as special aspects of transdermal opioid application, opioid rotation, relationship of oral, intravenous and spinal applications, drug prescription, and criteria for patient/doctor agreements for chronic opioid use. Sometimes the information provided is not updated, e.g., in table 58-3 on page 595: “fentanyl is the only opioid currently available for transdermal administration.” The separate chapter on opioids for nonmalignant pain is very informative, well written, and gives a critical appraisal of opioid use. The chapter on epidural steroid injections gives much practical information, but omits the controversy about outcome parameters. The chapter on intra-articular injections and facet blocks is well written and clearly outlined, with excellent illustrations. In contrast, the illustrations in the chapter on peripheral nerve blocks as well as in the appendix are not very helpful. The chapter on neuromodulation for pain could have been improved with case reports and illustrations of typical patients with spinal cord stimulation. The chapter on cryoanalgesia and radiofrequency is also excellent. The chapter on physical medicine and rehabilitation is very practically orientated and helpful.

The last part provides new information on administrative and legal issues of pain. The topics of chapters 80 through 87 are all very intriguing and important for pain specialists in private practice as well as hospital-based pain facilities. The glossary is somewhat short; however, the index is excellent.

All together, this is an excellent, comprehensive textbook on all aspects of pain and is recommended for physicians in all specialties who deal with pain patients. What could be improved is an easier to read format, clearer illustrations, and information on assessment and treatment strategies presented in a more practical manner.

© 2005 International Anesthesia Research Society