Publications
APS Bulletin • Volume 10, Number 5, September/October 2000
Resource Reviews
John D. Loeser, MD, Department Editor
The Pain Clinic Manual
Reviewed by John D. Loeser, MD
S.E. Abram & J.D. Haddox, Lippincott Williams and Wilkins, Philadelphia, 2000, 480 pages, $45 (softcover) ISBN 0-7817-1253-X
This is a good book. It is significantly bulked up from the first edition and is packed with useful information. It is written in outline style; this does not appeal to me, but some may like the simple, one thought per sentence fragment. Some of the chapters are very brief, others more extensive. Many have a small reference list. Many of the anesthetic procedures are illustrated, but nothing else is. Useful tables are inserted where appropriate. All aspects of pain management are covered, with an emphasis on the importance of diagnosis and comprehensive management. Psychological issues are addressed.
However, as a neurosurgeon, I am appalled by the errors in the chapter titled ”Neurolytic Blocks and Other Neuroablative Procedures for Cancer Pain.“ Pages 388–389 contain more inaccurate neurosurgical information than I have ever seen in one place. I doubt that sympathectomy has utility for cancer pain. The risk of neurological complication after cordotomy is well described and is small; probably less than many neurolytic blocks. ”Uncontrolled trials“ should be used to describe all neurolytic procedures, not just those done by surgeons. Commissural myelotomy is well described to relieve pain below the region of loss of pain and temperature, and all of its effects cannot be ascribed to cutting spinothalamic decussating fibers. Cingulotomy, which is mysteriously a subheading of myelotomy, clearly does not lead to ”high psychologic morbidity.“ In fact, the reverse has been conclusively shown by Teuber and McCorkle and Ballantine. Pituitary ablation does not work better for prostate or breast metastases than other types of neoplasm. Spinal cord stimulation in patients with cancer pain is rarely warranted or effective. Periaqueductal stimulation does not release endorphins; that was an artifact caused by the ventriculography material. Microvascular decompression of cranial nerves is never done for cancer pain.
So, with the above exception, I strongly recommend this book as a good starting point for students, residents, or pain fellows who need a brief summary of the things that happen in a multidisciplinary pain clinic. Its brevity allows the reader to quickly get an overview of a wide array of topics.
John D. Loeser is professor of neurological surgery and anesthesiology at the University of Washington in Seattle.