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John D. Loeser, MD, Department Editor
Reviewed by John D. Loeser, MD
Advances in Pain Research and Therapy (Vol. 22), B. Bromm & J. F. Desmedt, (Eds.), New York, Raven Press, 1995, $99, 584 pages, ISBN 0-7817-0322-0
This volume derives from the symposium, "From Nociception to Pain," which was held August 27-29, 1993, in Beaune, France. The symposium was a satellite of the International Association for the Study of Pain (IASP) Congress in Paris, and many of the participants had presented their research at that and prior congresses and other meetings. Almost all of the research has also been published in peer-reviewed journals. The more than 2-year delay in publication contributes to the reader's sense of dj vu.
The book features nice printing and binding and good illustrations. The index is adequate. The price is relatively high, but this is the modern way. The review articles and original papers focus on the role of the human brain in processing nociceptive information. Some of the chapters relate to animal models, but this is clearly a book about our brains. However, the 36 chapters seem to focus on correlates rather than attributes of the cognitive processes. Imaging metabolic activity is probably just as informative as tracing impulses through the fiber tracts of the nervous system. Evoked potentials and electroencephalograms have been with us a long time; cognitive processes are still best described phenomenologically. The promise of anatomy and physiology remains in the future, as it was throughout the 20th century.
Several chapters seem particularly useful to me. Wallenstein et al. point out the need for assessment of mood as well as pain severity and etiology in the evaluation of analgesic drugs. Mood has both internal and external determinants. Those who focus their studies on the nociceptive processes to the exclusion of affect and environment are not likely to capture much of the variability in humans. The field of PET imaging is rapidly expanding; the several chapters in this book are informative, even though many papers have been published in the past 2 years, and it is still not clear what is really being imaged. Bromm's review of consciousness, pain, and cortical activity is superb. Tasker provides a good review of human microelectrode recordings. Gybels and Kupers provide a good review of deep brain stimulation, but I remain concerned about the true outcomes, because so many of the clinical trials have major methodological flaws.
Some of the chapters are weak. I was particularly taken aback by Bernstein's "Pain in Polyneuropathy," which is full of conventional wisdom and lacking in new information. Although there are peripheral nerve histopathologic changes in polyneuropathy, there are many reasons to doubt that the pain is due to these changes being "...abnormally interpreted by the central nervous system" (p. 393). There is now abundant evidence that central plasticity follows peripheral injury. The pain can be-and, I would argue, probably is-generated within the central nervous system. Line labeling is not a good concept. Treatment recommendations for polyneuropathy are devoid of studies of efficacy, and I wonder why they should be recommended as if they were known to be helpful.
In conclusion, this is a useful volume for someone interested in the problem of the role of the human brain in the perception of pain. It can serve as a starting point for an in-depth review of the literature on a specific topic. However, in many of the faster moving areas, it is already out of date. This volume carries on the tradition of this series of publishing useful volumes for pain researchers and clinicians.
John Loeser is professor of neurological surgery and anesthesiology and director of the Multidisciplinary Pain Center at the University of Washington in Seattle.
