Pain Medicine: A Comprehensive Review. By P. Prithvi Raj, M.D. St. Louis, Mosby, 2003. ISBN: 0323014704. Pages: 430. Price: $89.95.

It is a pleasure to see a new edition of this comprehensive pain medicine review, as the first edition received widespread acclamation among pain specialists, fellows, and residents. The authors’ goal is to provide a concise but comprehensive review of the latest theories and modalities available in pain medicine that have practical value in daily pain practice. They deserve congratulations in fulfilling their mission.

This edition encompasses a total of 430 pages covering 36 chapters in 6 parts. Current practice includes a wide spectrum of approaches to care. While some practitioners choose the conservative end of this spectrum, others tend to be more invasive. One of the strong points of the second edition is the collaboration of 72 different pain medicine authorities that represent a variety of views. Despite the numerous authors, the style, message, and flow of the book have not been jeopardized. For example, the chapter on neuropathic pain clearly describes and differentiates central versus  peripheral nervous system pain and briefly explains the main characteristics of each pathologic condition. It also touches on a range of therapeutic options, from conservative approaches such as acupuncture and physical therapy for phantom limb pain, to invasive interventional techniques such as gasserian ganglion block for trigeminal neuralgia.

The book begins by introducing the basics of pain medicine to the reader and smoothly builds up his or her knowledge of acute and chronic pain syndromes, evaluation and investigation of pain patients, and modalities of pain management. The majority of chapters are equipped with highly informative tables and schematic illustrations that summarize each chapter reliably, but the paucity of fluoroscopic imaging is a limitation. Visualization of the actual fluoroscopic images could have been of great assistance for readers in addition to the well-described theoretical points of interventional pain management techniques. Inclusion of fluoroscopic views could have made the book more powerful.

Although the breadth of coverage is for the most part admirable, it is perhaps inevitable in such a diverse field that some topics receive incomplete coverage. For example, spinal cord stimulators originally were designed for management of the reflex sympathetic dystrophy and neuropathic pain. Currently, the indications for spinal cord stimulators have expanded to include conditions such as failed back surgery syndrome, inoperable peripheral vascular disorders, ischemic heart disease, and others. Unfortunately, this book does not quench the thirst of an enthusiastic reader to learn the basics of spinal cord stimulators and their indications, placement, and complications. However, deficiencies such as this are few.

Chronic pain management is a complex and delicate matter. A large number of patients live with years of suffering and disappointment. Long-term suffering and work-related issues may make certain individuals litigious. Therefore, medicolegal issues are becoming more prominent in pain medicine, and they must be properly addressed. That is why part 6 (special situations) of this book is an invaluable addition. It focuses on economics of pain medicine, pain medicine and the legal system, ethical issues in pain management, and other sensitive areas that are crucial for a successful practice.

In summary, this is a priceless review book for your library no matter the level of your knowledge and training. As a resident, you can review this book quickly to get an idea about the daily practice of pain medicine. As a pain fellow, you can use this book to summarize your readings before sitting for the boards. As a practicing pain specialist, you are simply obligated to own all of Dr. Raj’s works!