Pain Medicine and Management: Just the Facts. Wallace MS, Staats PS, eds. New York: McGraw-Hill, 2004. ISBN 0-07-14118-28. 379 pages, $54.95.
Subspecialty certification in pain management is now available for diplomats of the anesthesiology, neurology, physical medicine and rehabilitation, and psychiatry boards. Pain Medicine and Management: Just the Facts is a text designed to prepare the reader for taking the certification exam. This 379-page study guide consists of 70 chapters presented in an easy to read format to assist in examination preparation and to function as a quick reference for evaluating painful conditions. The index is well laid out with major topics and subtopics listed. The bulleted format makes reading this text easy, but at times limits the completeness of the chapters. One weakness of this text is that there is not an abundance of figures. In particular, several image-guided interventional techniques are described in a stepwise fashion in table format without helpful figures. As with any compilation text, there are several areas of overlap among the sections, but these just serve as reinforcement of the various processes outlined, which is beneficial in a study aide.
The text is divided into nine sections ranging from test preparation, through patient evaluation and treatment to evaluation of disability. Section I is a single chapter devoted to test preparation and planning. It provides a brief content outline of the Pain Medicine Certification Examination Content Outline of the American Board of Anesthesiology and touches on general study techniques.
Section II provides a succinct review of the physiology of nociceptive and neuropathic pain and is especially complete in its presentation. Section III reviews the evaluation of the pain patient from history and physical examination through diagnostic testing. The chapters describing electromyography, nerve conduction studies, and quantitative sensory testing will be of particular benefit to the anesthesia-based pain physician, who might not perform such diagnostic testing in his or her practice, yet is responsible for such knowledge in the certification examination.
Analgesic pharmacology is discussed in section IV. In addition to the typical systemic analgesics, sodium and calcium channel antagonists and various other analgesic adjuncts are included within this section. The use of tables to present the properties of these medications provides a quick reference guide for clinical situations. While published before the controversy that has enveloped COX-2 inhibitors, the authors do mention the higher incidence of serious cardiovascular events with rofecoxib.
Section V reviews management techniques of acute pain, including patient-controlled analgesia, regional anesthetic techniques, and continuous perineural catheters. Tables describing dosing guides and side effect profiles are included. This section includes examples of standing orders from the author’s institution that aid in establishing an acute pain service. Of particular benefit are the intrathecal analgesic algorithms and the discussion of the potential complications.
Section VI is dedicated to regional pain syndromes, with reviews of diagnostic strategies and therapeutic option for pain syndromes on an anatomic basis. The authors again have used both algorithms and tables to facilitate reviewing the differential diagnosis of the regional pain syndromes. These representations are especially beneficial in the chapters describing headache and abdominal and pelvic pain. However, the tables occasionally have too much information, which may prompt the reader to skip or merely glance at the text.
Section VII is devoted to chronic pain management. These chapters outline diagnostic feature and therapeutic options for pain states related to cancer, complex regional pain syndrome, and fibromyalgia. In addition to reviewing interventional techniques, discussion of biopsychosocial factors and physical therapy approaches to chronic pain syndrome are presented. With up to 15% of the certification examination covering topics of pain in the geriatric, pediatric, and pregnant populations, these chapters are of particular interest.
Section VIII describes special techniques in pain management, including neurolytic and ablative procedures. Chapters on complementary and alternative medicine, acupuncture, and prolotherapy are discussed. This is another area where the anesthesia-based pain management physician would benefit significantly in exam preparation, as these topics are not generally covered. Also this section discusses some of the controversial pain topics, including discography, intradiscal electrothermal annuloplasty, nucleoplasty, and lysis of adhesion. Each topic is presented with minimal bias and with supporting literature. The inclusion of the various neurosurgical techniques of pain management is likely solely for academic and test preparatory reasons, as it is unlikely that anyone sitting for the pain management certification examination would be performing these procedures.
Section IX pertains to disability evaluation. The most significant part of this chapter provides a foundation for using the guides of the American Medical Association to impairment and disability, as well as describing some of the issues surrounding return to work. There is a chapter reviewing medical and legal evaluations, which are often excluded from interventional pain management texts.
In summary, Pain Medicine and Management: Just the Facts is a comprehensive evidenced-based review text suitable for the certification examination. Independent of the reader’s medical discipline or training level, this text provides a foundation for the multispecialty approach to pain management.