James C. Eisenach, M.D., Editor

Textbook of Pain on CD-ROM. Third Edition. Edited by Patrick D. Wall and Ronald Melzack. New York, Churchill Livingstone, 1997. Price:$195.00.

The Textbook of Pain, editors Patrick Wall and Ronald Melzack, is one of a growing number of textbooks available on interactive CD-ROM. Because the text itself has been reviewed previously, this critique will focus exclusively on the Churchill Livingstone interactive software package and its usefulness for the pain practitioner. I should preface the review by stating that I am neither a novice nor an expert in the use of computers. I am, most likely, representative of most pain practitioners who rely on multiple software packages to accomplish daily administrative tasks but who have precious little time to sit in front of a computer and obtain “guru” status in their computer knowledge base.

Following the user-guide instructions, I found the installation process to be very straightforward and easy. For Windows-based personal computers, the minimum system configuration needed to use the CD-ROM is a 386, Intel-compatible processor, (although a 486 processor is strongly recommended), 4 MB RAM with at least a 4-MB swap file, Microsoft Windows 3.1 or higher, file sharing, 5 MB free hard disk space, and a CD-ROM drive. For the Macintosh, the minimum system configuration requires a 6XX20 processor or higher, 4 MB RAM (8 MB recommended), System 7 or higher, 5 MB free fixed-disk drive space, and a CD-ROM drive.

The format is identical to the other CD-ROM texts published by Churchill Livingstone, for example Miller's Anesthesia, fourth edition. Included in the interactive software are the Textbook of Pain and a MEDLINE database. The MEDLINE database includes a listing of all the references cited in the text and a substantial subset of articles pertinent to the pain field from the MEDLINE database produced by the National Library of Medicine. This database also contains a listing of all articles from key journals in the pain field for the past 5 years. Therefore, when reading the text, reference citations can be double clicked to display title, author, journal, and date. If a MEDLINE icon is present above the reference, clicking the icon opens the MEDLINE database to display the full abstract and details of the journal article, including a MEDLINE identification number. Unfortunately, the number of available abstracts was fewer than I would have anticipated. For example, in Chapter 1, only 185 of 305 references are linked to MEDLINE and have an available abstract. Inevitably, it seemed as though the abstracts that I was particularly interested in were unavailable.

Having a MEDLINE resource with only articles pertinent to pain is an advantage, however this CD-ROM only contains articles current to the end of 1996, limiting its function as a consolidated pain reference database. Those of us who perform regular literature searches are often in need of the most current articles, making a dated MEDLINE database of limited usefulness.

The text and MEDLINE are equipped with a powerful search engine called the “query” function. Using the query function, key words, authors, titles of sections, among other things, can be retrieved. The query function has a bit of a learning curve, however. For example, if interested in finding information about a multiword topic, e.g., cervical cancer, typing in these two words will yield 23 “hits.” However, a hit is any paragraph that contains both the word cervical and the word cancer, highlighting multiple sections that discuss cancer in conjunction with cervical nerve injury, cervical node biopsy, cervical spine pathology, among others. To find text that specifically discusses cervical cancer necessitates entry of the text in quotes. The search engine will then yield hits with the desired phrase. Although it could be argued that this method of searching is becoming standard, the User Guide and tutorial lacks discussion of this issue, whereas many other basic computer skills are discussed in great detail.

The software also has the capability of allowing one to “highlight,”“bookmark,” or make notes in any area of the text, customizing the text in much the same way one would with a conventional textbook. The query function can also be used within in this customized text, allowing one to narrow the search or return to these particular premarked sections very easily.

Customer service for this product was poor. Calls placed on multiple occasions provided only an answering machine. Several days after leaving a message, the service call was returned, but this was clearly not the prompt customer service that I have experienced with other software vendors.

Is the Textbook of Pain Interactive CD-ROM worth purchasing? I believe the digital CD-ROM format provides several advantages over the paper version. First, portability is much more convenient. Carrying the CD-ROM between computers is far less burdensome than lugging the heavy, 1,500-page text. Second, the robust search engine provides virtually instant access to every word within the text. Third, accessing reference by mouse clicks is much easier and faster than thumbing though the pages to the back of the chapter. However, I am certain that this CD-ROM will not replace the Textbook of Pain on my bookshelf at work. The CD-ROM version is limited by the amount of information that can be displayed on the computer screen. Despite poor portability, I also still enjoy the reverence inspired by the crisp, clean pages of a reputable textbook. The limited MEDLINE function will only be used for viewing references within the text because it is far less robust that an on-line MEDLINE link. Finally, poor customer service bedevils a sometimes nonintuitive user interface. Everyone knows how to use a book.

Dawn J. Schell, M.D.

Director; University of Maryland Pain Center; Baltimore, Maryland 21201