Print Share

Library

APS Bulletin • Volume 8, Number 4, 1998

Resource Reviews

John D. Loeser, MD, Department Editor

Pain Mechanisms and Management

Reviewed by Margaret R. Byers, PhD

S.N. Ayrapetyan & A.V. Apkarian (Eds.), IOS Press/Ohmsha, Amsterdam, Tokyo, Washington, DC, 1998, 390 pages, $88, ISBN 90-5199-306-4

This book presents papers from the International Symposium on Pain held in Nagorno-Karabakh Republic (NKR) and the Republic of Armenia in September 1996. This most unusual scientific meeting was the first to be held in the newly renovated amphitheater in Stepanakert (the facility received damage from more than 700 aerial bombing attacks during the war for independence from the former Soviet Union) and was sponsored by the Human Rights Alliance as well as scientific societies, foundations, and governments.

The program included not only papers and discussions of the molecular and cellular mechanisms of pain at peripheral, spinal and supraspinal levels, and clinical issues, but also included papers on the medicinal plants of Armenia and Karabagh, natural anti-inflammatory and immunomodulatory molecules in plants and animals, and the challenge of pain management in war and disease when resources are severely limited. The latter topic had special significance since thousands of people had died or had been wounded in the recent conflict, and some surgeries in the nearby main health center of NKR still had to be performed without anesthesia because of a lack of necessary drugs. The irony for the meeting participants of observing such operations within days of hearing lectures on the fine details of opiate pharmacology, computed tomography technology, and mechanisms of general anesthesia must have been extreme.

This extraordinary meeting took place and produced 38 papers for this book through the leadership of Professors S.N. Ayrapetyan, A.V. Apkarian, and Jean-Marie Besson and with the sponsorship of Catherine Porter, president of the Human Rights Alliance; the U.S. NIH; Naval Research Office; Gulbenkian Foundation in Portugal; British MRC; International Pharmacology Society; International Biophysical Society; National Academy of Science in Armenia; IASP; IBRO; Monsanto Company; and the Lebanese government. The plenary discussions are presented in full and are especially interesting due to the many thoughtful and challenging questions by Professors J.M. Besson, A.V. Apkarian, P.D. Wall, P.W. Reeh, S.A. Eaton, A.I. Basbaum, N.E. Saad, K.J. Berkley, D. Lima, V. Amassian, S.A. Jabbur, Z. Seltzer, and others. A few of the papers were submitted by authors who were unable to travel to NKR, and those of C. Advokat, T.L. Yaksh, W.D. Willis, Y. Shir et al., and P. Lebrun et al. appear to be in this category.

The symposium had six sections. The first, "Metabolic Regulation of the Neuron," considers aspects of neuronal membrane molecular composition and function under conditions of swelling, ischemia, and axonal transport fluctuation or in relation to molecular regulation of vesicular trafficking and release. The second section, "Peripheral and Spinal Cord Physiology," is the strongest section of the book and concerns molecular mechanisms driving hyperalgesia in various model systems; actions of opiates, NSAIDs, or local anesthetics in preventing hyperalgesia; inflammation-driven changes in peptide diffusion in the dorsal horn and in expression and internalization of the NK1-receptor; peripheral and central morphine effects or lack of effects on specific spinal plasticity responses to inflammation; the use of Fos as a detector of neuronal activity changes; effects of NGF depletion or IL-1 receptor antagonist on hyperalgesia; thymulin modulation of cytokine release; mechanisms of preemptive analgesia; and an interesting discussion of the effects of diet on neuropathic pain in rats. The third section, "Supraspinal Physiology," reviews the role of medullary endogenous pain control from nucleus tractus solitarius, dorsal reticulum, and ventrolateral reticular formation; the roles of the basal ganglia, hypothalamus, forebrain, and cingulate cortex in nociceptive processing; and thalamic mechanisms and thalamocortical inhibitory networks. In the fourth section, "Pharmacology," there are papers on designing antinociceptive receptor agonists; on naturally occurring anti-inflammatory molecules such as the salicylic acids, flavinoids, tannins, phenylalkanoids, amides such as anandamide, and many other plant compounds; on the pro- and anti-inflammatory actions of capsaicin; and on the mechanisms of halothane oxidative stress and nitric oxide. The last two sections, "Social and Clinical Issues in Pain Management," plead for improvements in epidemiology, education, and pain medications for rescue forces during war and disasters, especially as they relate to recent experiences in Armenia.

The juxtaposition of pain treatment problems from disaster areas with treatments such as percutaneous radiofrequency neurotomy, cortisone and lidocaine blocks, and computed tomography underscores the wide range of clinical approaches used when conditions range from the luxuriously fortunate to the severely deprived. The editors and sponsors are to be congratulated on producing a most unusual meeting and book.

Margaret Byers is a research professor of anesthesiology and biological structure at the University of Washington in Seattle.

Reviewer content represents the opinion of the reviewer, not APS.

Please direct your suggestions for future Resource Reviews to John D. Loeser, MD, Department Editor, at jdloeser@u.washington.edu

Issue Index