Publications
APS Bulletin • Volume 12, Number 4, July/August 2002
Resource Reviews
John D. Loeser, Department Editor
Interventional Pain Management (2nd ed.)
Reviewed by David S. Goodman, MD
Steven D. Waldman (ed.), Philadelphia, W.B. Saunders, 2001, 754 pages, $159 (hard cover), ISBN 0-7216-8748-2
This is the second edition of a text originally published in 1996 and edited by Alon Winnie and Steven Waldman. Nineteen new chapters have been added and many other chapters revised in this new addition that increases the number of pages to 754.
There are six sections: Anatomy and Physiology of Pain, Evaluation of the Patient in Pain, Neural Blockade and Neurolytic Blocks, Neuroaugmentation, Spinal Administration of Opioids and Other Analgesic Compounds, and Neurosurgical Techniques in the Management of Pain.
The first section, Anatomy and Physiology of Pain, remains essential reading for the student of pain management. It contains the revised chapters “Toward a New Concept of Pain for the New Millennium” and “Receptors at the Spinal Cord Level: The Clinical Target.” There are unchanged chapters including “Functional Anatomy of the Spine” and “Anatomy and Pharmacology of the Pain Processing System” that are identical to the 1966 edition.
The second section, Evaluation of the Patient, contains two new chapters, “Rational Use of Laboratory Tests in the Evaluation of the Patient in Pain” and “Discography in Clinical Practice.” Although the chapter on discography provides a good review of the anatomy and technique, it provides only minimal discussion of the controversy surrounding its clinical relevance. Unlike the rest of the chapters, only 12 articles are referenced for this complex subject. The chapters on electrophysiology and radiological imaging remain excellent reviews.
The third section, Neural Blockage and Neurolytic Blocks, has undergone the most significant revisions, with 11 new chapters. Many of the new chapters are brief, two-page descriptions of specific diagnostic nerve blocks such as thoracic paravertebral, thoracic sympathetic, suprascapular, spinal accessory, vagus, and phrenic nerves. Waldman has published some of these chapters previously in Atlas of Interventional Pain Management in 1998. This section is the largest in the book, containing 358 pages. Its subject matter is the heart of an interventional textbook. Chapters such as “Local Anesthetics in Clinical Practice,” “Atlantooccipital and Atlantoaxial Injections in the Treatments of Headache and Neck Pain,” “Sphenopalatine Ganglion Blockage,” “Stellate Ganglion Block,” “Percutaneous Epidural Neuroplasty,” “Lumbar Sympathetic Nerve Block and Neurolysis,” “Celiac Plexus and Splanchnic Nerve Blocks,” “Subarachnoid Neurolytic Blocks,” and “Facet Block and Neurolysis” are classics. However, there is significant overlap of subjects between multiple chapters. There are excellent discussions of the anatomy, diagnosis and treatment of facet joint pain but they are located in two nonadjacent chapters with different authors. Additionally, there are outstanding reviews of neurolytic blocks using alcohol, phenol, cryoneurolysis, and radiofrequency but they are spread over three chapters. Discussion of the treatment of pain in the trigeminal nerve distribution is reviewed in five chapters. For the beginning student, such diversity of thought may be confusing although experienced practitioners may appreciate it. Future editions might consider consolidating such important aspects of pain management.
The fourth section remains unchanged, but the fifth section contains two new chapters: “When All Else Fails: A Role for Implantable Pain Management Devices” and “Spinal Administration of Nonopiate Analgesics for Pain Management.” The latter is an intriguing look at potential future intrathecal medications for neuropathic pain.
The sixth section, Neurosurgical Techniques in the Management of Pain contains four new chapters, “Percutaneous Laser Discectomy,” “Intradiscal Electrothermal Annuloplasty,” “Percutaneous Vertebroplasty,” and “Chymopapain Chemonucleolysis.” Most of these chapters are rather brief, secondary to the limited outcome studies from these new noninvasive treatments for discogenic pain. “Chymopapain Chemonucleolysis” is a good review of a technique that has gone out of favor. The standout chapter in this section is “Percutaneous Cordotomy.” It is a complete review of the anatomy, indications, technique, complications, and outcome studies. Surprisingly, the lead chapter “The Role of Neurosurgery in the Management of Intractable Pain” is only a cursory discussion of surgical techniques. Future editions should expand upon these valuable neurosurgical treatments that can offer patients significant pain relief. It also would improve the utility of the text if outcomes data for all of these procedures were reviewed.
In spite of these flaws, “Interventional Pain Management” is the premier textbook on this subject. It broadly covers the topic from the basic science of pain anatomy, physiology, and pharmacology to nearly every interventional technique known. Many of the authors are leaders in their field, including Ronald Melzack, Tony Yaksh, Gabor Racz, Prithvi Raj, Michael Stanton-Hicks, and Alon Winnie. Most chapters have some discussion of the efficacy of their stated technique. A treasure of this book lies in the extensive references that permit the student of the subject to review the original articles and to formulate his own opinion. This book should be required reading for every pain management physician whether a resident, fellow or experienced practitioner. It is a book that will not remain on your shelf long, but will become dog-eared from constant use, only to be replaced, I hope, by the third edition.
David Goodman is acting assistant professor of anesthesiology at the University of Washington in Seattle.