Edited by J. Antonio Aldrete, M.D., M.S. Col. San Rafael, Mexico, Editorial Alfil, 2010. Pages: 718. Price: $390.00.
For those of us who practice pain medicine, arachnoiditis is a dreaded and potentially debilitating complication that is universally feared. Arachnoiditis, a neuropathic disease with a multifactorial etiology, is caused by chronic, nonspecific, insidious inflammation of the arachnoid mater and intrathecal neural elements. The constellation of symptoms produced by arachnoiditis may not be readily apparent to the inexperienced practitioner and may be dismissed as malingering. Aldrete and his contributors have assembled a comprehensive text that examines the subject matter in great detail from both a clinical and a basic science perspective, providing the interested learner a plethora of details and facts about this unfortunate condition.
The initial chapters examine the historical presentation and significance of the disease as well as a detailed review of the gross anatomic and ultrastructural components of the spine and corresponding neural components. As a history buff, I have always been interested in the early contributions to our specialty and Aldrete provides meticulous recognition of past scientists and researchers who have contributed to the knowledge of this disease. In fact, many of the chapters begin with a brief historical review pertinent to the topic. The basic science chapters are a bit dry but necessarily detailed for those pursuing a thorough understanding of the critical anatomic factors involved in the development of arachnoiditis. For pain practitioners preparing for certification examinations, the text offers a relatively easy to read review of the inflammatory cascade and basic review of the neurophysiology of pain transmission.
The text quickly shifts focus to the clinical components of arachnoiditis. Discussion begins with examination of noninterventional causes of the disease. Again, the text is detailed and the literature review exhaustive and current. The authors examine interventional etiologies of arachnoiditis, including both surgical and anesthesia/pain medicine-related topics. As an interventional pain physician, I found the section dedicated to injection-related causes to be quite interesting and daunting at the same time. Many of the illustrations revealed the high-risk nature of our practice and just how thin the line between success and complication can be. I admit I wondered about performing my next epidural steroid injection—but quickly overcame my fear. The two most important sections of the book are the ones devoted to diagnosis and treatment. Arachnoiditis remains difficult to diagnose and, despite our best efforts, even more difficult to treat. The author is careful to illuminate the fact that arachnoiditis does not present like other neuropathic syndromes and that the physician must have a high incidence of suspicion. Aldrete provides a reasonable framework of treatments and medications within which to work and even provides a section on preventive measures and well-being. However, the text does not readily discuss the role of opioid analgesic medications in the treatment of this condition. Basically, the author states that there is no role for this class of medication in the treatment of this neuropathic pain syndrome. Although the role of opioid analgesic medications in neuropathic pain remains controversial, the unrestricted condemnation of this class of medication seems harsh.
Most of the text is written by Aldrete himself but there are several contributions from practitioners well known in the pain medicine community. Most chapters are well written and fairly easy to read. One common occurrence throughout the text is the presence of spelling and grammatical errors that make it difficult at times to grasp what exactly the author intended to convey. Fortunately these errors are a minor distraction from an otherwise well-written book. For those who routinely perform interventional procedures related to the spine, Aldrete and his contributors have assembled a very useful and thorough reference text.