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Interventional Pain Management: Image-Guided Procedures with DVD |  |
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Interventional Pain Management: Image-Guided Procedures with DVD | |
The book begins with a theory that is meant to explain pain as a human process and that is supplemented by an up-to-date, detailed analysis of the anatomy, physiology, and pharmacology of the pain system. Since the spine is the most common origin of pain, it is gratifying to see an excellent review of the functional anatomy of the spine. More interventions are directed to the spine than anywhere else in the body, so understanding spinal abnormalities and how they can produce pain is of great importance to clinicians. The use of diagnostic blockade in spinal disease is also well covered. The development of long-acting narcotic compounds has redirected attention to the pharmacologic management of pain. The chapter on this topic is brief but thorough and is followed by a general assessment of how the whole patient must be cared for if interventions are to be useful. Anyone in the field of pain management can read the first part of this book to advantage, and anyone who is treating patients for pain should do so.
The second part of the book relates to the evaluation of patients who have pain. It is a good summary but is not sufficiently detailed. The chapter on diskography is useful, and there is a chapter on spinal endoscopy. However, these chapters suffer from the same problem that weakens general articles in the literature: the techniques are described in detail, but their diagnostic value is not substantiated. The predictive or diagnostic value of diskography and endoscopy remains to be proved, and both procedures are associated with serious complications and add substantially to medical costs. The same can be said for differential nerve blocks in the evaluation of chronic pain. The authors of the chapter on this topic make a classic error, which is to equate the response to local injection of placebo with a psychogenic mechanism. This assumption is simply not valid. A chapter on placebos would have improved the book substantially.
The third part of the book, a how-to manual, describes a broad spectrum of interventional procedures for the management of chronic and acute pain. The chapters on the pharmacology of local anesthetics and neurolytic agents should be required reading for anyone using these interventions. The remaining chapters in this part of the book are superb descriptions of procedures. Some of these chapters outline straightforward interventions, well established in practice, with much documentation; others describe techniques for which outcomes have not been clearly established.
The principal shortcoming of the book is the lack of documentation of the outcomes for many of the procedures described. For example, intradiskal electrothermal annuloplasty is described in great detail, but only single paragraphs deal with the indications and outcomes of the procedure. The failure to document outcomes affects the entire field of pain management, particularly with respect to many percutaneous interventions. As a manual of procedures, this is a superb book, with detailed and well-illustrated descriptions of every form of nerve block and percutaneous intervention. The lack of a discussion of outcomes does not detract from its usefulness. However, the authors are obviously ``believers,'' and readers unfamiliar with the techniques do not learn about the reservations that many hold about some procedures.
The chapters on implantable devices for the stimulation of the nervous system are a valuable addition. The extensive documentation in the field of neurostimulation provides an excellent example of how outcomes research should precede and follow the introduction of any new technique.
This up-to-date, detailed, and authoritative book provides a superb reference for the techniques of various blocks and percutaneous interventions used in pain management. Deficiencies in the discussions of approaches to diagnosis, indications for procedures, and outcomes of procedures do not detract from its great practical value.
Don M. Long, M.D., Ph.D.
Copyright © 2001 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS. (From the New England Journal of Medicine, August 2, 2001) --This text refers to an out of print or unavailable edition of this title.
Review
"This is a very valuable addition to the few well-written books relating to interventional pain management. It is an excellent resource for the trainee as well as for practicing interventional pain physicians."-Anesthesia & Analgesia, review of the previous edition.
