James C. Eisenach, M.D., Editor.

Interventional Pain Management. By Steven Waldman and Alon Winnie. Philadelphia, W.B. Saunders. Pages: 594. Price:$130.00.

This is a multi-authored textbook edited by two well known interventional pain management specialists. The topics are based on the popular Interventional Pain Management Meetings sponsored by the Dannemiller Memorial Education Foundation, coordinated by one of the textbook editors. It consists of 54 chapters and contains more than 800 illustrations (photographs, tables, line drawings). The book is logically organized into six parts, consisting of 7 chapters on anatomy and physiology, 6 chapters on patient evaluation, 25 chapters on neural blockade, 5 chapters on neuroaugmentation, 7 chapters on spinal analgesia, and 4 chapters on neurosurgical techniques. Overall, the book is reasonably well referenced, well illustrated, and well indexed, making it a user-friendly text.

This book would best be described as a technical manual, instructing the reader with generous use of quality line drawings and radiographs accompanied by a reasonably detailed text. Although regional anesthesia and interventional pain management techniques are not ideally taught or learned from textbooks, this book provides a reasonable starting point. A majority of the 54 chapters were useful to excellent, whereas only 7 chapters would fit into the categories of poor or useless. For those interested in discussions on Radiofrequency Blockade and Celiac Plexus Blocks, these chapters were particularly thorough and well done. I would, however, caution the neophyte pain practitioner that the chapter on radiofrequency lesioning ascribed greater efficacy to the technique than actually exists in clinical practice. The excellent chapter on Functional Anatomy of the Spine is recommended reading to anyone just getting started in the area of spinal injection therapy, because it provides a nice overview of the role of injections for spinal axis pain. Other particularly strong chapters include Patient Selection Criteria for Spinal Cord Stimulation and two chapters on anatomy and pharmacology of the pain processing system, although these chapters do not have much to do with interventional pain therapy, per se. Unfortunately, a few important topics or techniques were either left out of the text (e.g., intrathecal baclofen therapy, trigger point injections) or discussed only briefly (discography), while other topics of little significance received more extensive coverage (e.g., ganglion impar block).

A review would not be complete without a few criticisms. There were a few annoying inconsistencies that could have been taken care of with closer editorial scrutiny. For example, several authors stated in their chapters that destructive nerve blocks have little or no place in contemporary treatment of noncancer pain, and the chapter on radiofrequency blockade insinuated significant efficacy for this neurolytic technique to treat a wide variety of noncancer pain problems. After reading the book, the reader is left somewhat confused as to the role of neurolytic nerve blocks in contemporary pain management. Similarly, the chapter on psychologic testing admonishes the reader that “placebo administration for the purpose of distinguishing between organic and psychogenic pain is not recommended.” The next chapter follows with an extensive discussion on the value of placebo injection during the conduct of differential neural blockade. The five chapters on spinal cord stimulation and the seven chapters on spinal analgesia resulted in significant redundancy, and each of these sections could have been condensed into one or two chapters.

The authors targeted this book as a clinically oriented reference aimed at trainees and practitioners who are either beginning their practice or have only dabbled in pain management and are interested in becoming more involved in pain management. It is not a reference source for basic pain theory, pain mechanisms, and management of specific pain syndromes. I do not agree with the editors' contention that, previously, there did not exist a “unified text in interventional pain management,” because there are at least 3–4 other textbooks on the market similar to this book in their intent, breadth, and scope.

In summary, this is a very good book and, when supplemented with appropriate references on basic pain theory, specific pain syndromes, and multi-disciplinary pain management concepts, would be a valuable resource for trainees or the beginning pain practitioner. It will not be of much value to the seasoned practitioner who already owns one of the other major pain management or regional blockade textbooks. At the suggested price of $130.00, it is a bit pricey, and is no doubt reflective of the numerous illustrations (including 39 full-color prints).

Tim Lamer, M.D., Department of Anesthesiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, Florida 32224.