Atlas of Uncommon Pain Syndromes. S. D. Waldman (ed.). Saunders, Elsevier: Philadelphia, USA, 2003, 256 pp; indexed, colour illustrations by C. H. Duckwall ISBN: 0-7216-9372-5; Price £74.99
This book aims to help the pain clinician diagnose some of the most challenging painful conditions. It is also a review tool for the USA Pain Management Certification examinations, and includes International Classification of Diseases (ICD)-9 codes to ensure proper billing and reimbursement. It is designed to complement the Atlas of Common Pain Syndromes, also edited by Dr Waldman.
The book is divided into 13 sections, and each is subdivided into 4-8 chapters, describing 71 pain syndromes in total. The sections start with headache pain syndromes, facial pain, and it then moves down the body, incorporating brachial plexus, upper limb, chest, abdomen, lumbar spine, pelvic pain and lower limb. The author has chosen pain syndromes that are unusual but obvious diagnoses that tend to elude the physician at first meeting. They are not rare or exotic diseases, and are intended to be within the remit of all practising pain clinicians. For instance, the first chapter on ‘Headache pain syndromes’ includes ice pick headache, chronic paroxysmal hemicrania, sexual headache, cough headache, headache associated with temporal arteritis and post-dural puncture headache.
Each chapter describes the clinical syndrome, signs and symptoms, investigations, differential diagnoses, treatment, complications and side effects, and clinical pearls. This latter section is intended to provide practical, and sometimes hard-to-find, information on how best to care for patients suffering from the described condition. Each chapter is accompanied by an excellent anatomical drawing, an emotive coloured picture of a sufferer, a copy of an X-ray or scan, if relevant, and a diagram of a nerve blocking technique, if appropriate. The standard of the illustrations is very high, and the anatomical drawings, often superimposed on a body form, are particularly helpful.
The text is repetitive, but it does allow the reader to use the book as a reference point for a single disorder without having to find other sections. It is written in a didactic fashion, and the treatment sections do not refer to any evidence base for outcome measures or efficacy. There are no references to the worldwide literature, or acknowledgements to any other authors who may have contributed to the book.
The clinical syndromes are well described, together with the type of pain, and its exacerbating and ameliorating factors. The reader is offered differential diagnoses for the purpose of exclusion and there is advice about which questions of importance to ask, e.g. a past history of sexual abuse in a patient with prostadynia. Thorough investigations are recommended to an extent that reflects the differences between medicine in the USA and the UK, although British readers would do well to take note of these recommendations. There is much for us to learn from these sections. Treatment options tend to be repetitive, e.g. the use of gabapentin and amitryptiline is described in many chapters, and cyclooxygenase-2 (COX-2) inhibitors are exclusively recommended as non-steroidal anti-inflammatory agents. Psychological evaluation and intervention is frequently mentioned as a modality to take place concurrently with interventional treatment, which may not be feasible in some countries. Nerve blocks are described clearly and with excellent drawings which would enable the reader to reproduce the treatment without difficulty.
Complications and pitfalls are cleverly stated in a dogmatic way. There may be other complications unknown to this author, but we are not invited to consider this option. The clinical pearls are an individual view of the pain problem, and give pragmatic advice emanating from a great deal of experience. Many of the syndromes described, e.g. supraspinatus tendonitis, Paget's disease of the bone, pes anserine bursitis, bunionette pain, may be seen in a rheumatology clinic, so this book could be of interest to a wider audience.
I would recommend this book as a reference source to help the busy physician diagnose and treat some of the more challenging pain presentations, and to learn about the existence of some little known conditions such as ‘devil's grip’ and ‘Eagle's syndrome’. Unfortunately, the treatment recommendations are not evidence based and one might disagree with some of the information offered. Nonetheless the book offers pragmatic advice to the doctor who is trying to make sense of an unusual clinical pain presentation, and the illustrations are of very high quality.