Pain Management for the Practicing Physician. Edited by Gordon A. Irving and Mark S. Wallace. New York, Churchill Livingstone, 1997. Pages: 330. Price:$49.95.
When I started my career in pain medicine 20 yr ago, there was scarcely a chapter about the topic, let alone a textbook. Today, with the rapid growth of interest in the field of pain medicine, the practitioner is faced with an often difficult choice of pain texts.
Pain Management for the Practicing Physician provides a succinct but comprehensive collection of information regarding the treatment of painful syndromes. The text starts with a very useful glossary of pain terminology. Section 1 includes four chapters about the anatomy, physiology, and pharmacology of pain. Section 2 provides a “cook-book” reference about how to treat 23 painful syndromes, including headaches, herpes zoster, lower back pain, pediatric pain, reflex sympathetic dystrophy, and spasticity. Algorithms are presented for each diagnosis in a chart format, with step-by-step instructions about how to proceed in treating each condition. Recommendations proceed from plan A to plan B to plan C, and so on, and end with “referral to pain specialist.” The text then offers numerous approaches that the pain specialist might use during such a referral. Also included are pertinent case studies to clarify the use of the algorithms.
Although section 2 provides the major bulk of the text, section 3 offers a review of the psychologic aspects of pain management, including a very useful chapter with algorithms about opioid detoxification.
Section 4 discusses acupuncture, physical therapy, and transcutaneous electrical nerve stimulation, and section 5 consists of a chapter regarding the future of pain medicine.
I do have a few criticisms. Although the “Reflex Sympathetic Dystrophy” chapter states that a sympathetic block is routine in the diagnosis of reflex sympathetic dystrophy, it completely leaves blocks out of the algorithm, suggesting use of a number of pharmacologic manipulations and even acupuncture and coping skills before neural blockade. I also thought the acupuncture chapter to be rather meager.
Although the authors clearly state that this text is intended to provide non-pain specialists with guidelines for pain treatment and for referral to a pain specialist, I believe this text would be an excellent resource for those training in a pain fellowship program and also for anesthesia residents during their pain rotation. The cost of $50 is what I would consider to be quite reasonable for a text for such purposes.
Carol A. Warfield, M.D.
Associate Professor of Anesthesia; Harvard Medical School; Chief, Division of Pain Medicine; Beth Israel Deaconess Medical Center; Boston, Massachusetts
