Core Topics in Pain. Edited by Anita Holdcroft, M.B., Ch.B., M.D., F.R.C.A., and Sian Jaggar, B.Sc., M.B. B.S., F.R.C.A. Cambridge, United Kingdom, Cambridge University Press, 2005. Pages: 345. Price: $70.00.
Core Topics in Pain seeks to provide the reader with a comprehensive and easy-to-read introduction to the many facets of pain management. This aim is confirmed in the forward written by Douglas Justins, M.B. B.S., F.R.C.A. (Consultant in Anesthesia and Pain Management, Department of Anesthesia, St. Thomas Hospital, London, United Kingdom).
With a number of publications already available, is a new guide, such as this, needed to provide an important contribution for the key target group identified as anesthetic trainees and their counterparts (residents) in North America and to become an essential book for this readership?
In respect of United Kingdom trainees, for whom the pain management–related content of standard anesthesia texts can be inadequate, reliance may be placed on reviews published by the Royal College of Anesthetists or in monthly add-on journals. Core Topics in Pain covers all subject areas listed for the Royal College of Anesthetists competency-based training (for the Certificate of Completion of Training), but wider reading would be required for those undertaking higher pain training. For North America, in a similar way, the book broadly covers the content outline of the American Society of Anesthesiologists' Joint Council on in-training examinations, but not the pain medicine examination specifications of the American Board of Anesthesiology.
Any publication such as this, with a disparate target readership (also a first reference for nonanesthetic health professionals), however, always faces a difficult task in striking the right balance between dearth and surfeit, and it is therefore hardly surprising to find that in this case, topic coverage ranges from the comprehensive to the superficial. The problem is, perhaps, compounded by the multiple-author format, and the almost inevitable associated delays in the editorial process are the reason why some contributions are fresher than others and few recent references are to be found. An indication as to the specialism and affiliation of the chapter authors, as is usual practice in publications of this sort, would have been helpful. Style, of course, varies, and related topics are left unconnected; why the text is so divided into parts and sections is not entirely clear. So the test of this book has to be whether it does enough for the key target group and, in addition, is helpful as a valuable first reference for other health professionals.
Basic science in part 1 is comprehensive, covering the syllabus for anesthesia trainees and residents with respect to pain mechanisms and pathways, but is too complicated for many other health professionals.
Part 3, dealing with pain in the clinical setting, is something of a curate's egg. Both “Epidemiology of Pain” and “Pain Progression” in section 3a are superficial, whereas “Analgesia in the Intensive Care Unit” (while insufficient for the American Board of Anesthesiology) is not. Chapter 17, “The Chronic Pain Patient” (the subject of most of the book), would sit better in part 2. “Post-operative Pain Management in Day Case Surgery” receives superficial consideration, and why this has been separated from “Post-operative Pain” in the next section (chapter 24) is unclear.
Pain syndromes (really more accurately described as painful disease states) are covered in section 3b, mostly as in similar texts. Acute pain, particularly postoperative pain management, deserves a separate section, as does cancer pain, which receives too superficial a coverage and could usefully be conjoined with palliative care (chapter 48). Chapter 20 (neuropathic pain) deals with too much altogether and is probably insufficient for the American Society of Anesthesiologists.
The role of evidence (part 4) is, of course, important, but in pain medicine in particular, we appropriately emphasize individual patients and their response to treatment; every prescription is a clinical trial with n = 1.
The overview of chronic pain (section 5a, chapter 32) in part 5 would have been better at the start as a general introduction. Multidisciplinary team working (chapter 33), which is the generally accepted way forward, receives superficial coverage. Chapter 35, “Regional Nerve Blocks,” should be expanded and properly retitled “Interventional Pain Medicine.”
The consideration of pharmacology in section 5c introduces confusion (opioids and codeine, nonsteroidal antiinflammatory agents rather than drugs), and too many drugs are covered in too superficial a way under one chapter (antidepressants, anticonvulsants, local anesthetics, antiarrhythmics, and calcium channel antagonists in just 5 pages) and another for cannabinoids and “other agents” (4 pages). The index enables the content overall to be easily accessed.
Standard texts have an increasingly difficult time to be fresh. For pain management, the International Association for the Study of Pain–Core Curriculum 2005 (including up-to-date references) and Acute Pain Management: Scientific Evidence 2005 from the Australian and New Zealand College of Anaesthetists are examples of freely available Internet assets for anyone with an interest.
The first edition of any work is difficult to get right, and therefore, any criticisms should be considered in a positive light as the authors prepare their second edition. The stated concerns notwithstanding, such would be worthwhile. So to return to the test: My trainees find the book good in parts but not of a sufficiently uniform standard with dearth and surfeit evident. It will be helpful as a valuable first reference for other health professionals who can dip in; likewise, a number of chapters are useful for the clinician not in exclusive pain medicine practice. Access this text in your library and recommend that your trainees have a close look at the second edition when it appears.
Glan Clwyd Hospital, Rhyl, Denbighshire, United Kingdom. apjlake@aol.com
