James C. Eisenach, M.D., Editor

The Management of Chronic Pain-Second Edition. Edited by A. W. Diamond and S. W. Coniam. Oxford University Press, Pages: 178. Price: $56.00.

This second edition Drs. Diamond and Coniam is intended, as described in the preface of the first edition, as a textbook of "how to handle the clinical problems that will confront the workers in a Pain Clinic." The book is directed toward an audience of "those who are starting work in a clinic as consultants, to those training in pain management, and to those whose curiosity is driving them to ask precisely what a pain clinic does." Toward these goals, the authors have produced a valuable introductory textbook concerning the clinical management of chronic pain. In 175 pages, this textbook reviews most of the common clinical problems managed by physicians in a pain clinic. The text is written clearly and organized logically into 11 chapters.

The first three chapters provide general descriptions of the development and philosophy of pain clinics in the United Kingdom, of pain perception, and of assessment of the patient in pain. The remainder of the text discusses various clinical pain problems and therapeutic approaches in the management of chronic pain. The final chapter is a summary of concise clinical protocols for several common clinical presentations, including back pain, body wall pain, pain in malignant disease, neurogenic pain, head pain, and complex regional pain syndromes. The information presented in the text is sparsely referenced, which readers may find problematic, particularly in the chapter about pain perception in that much of the factual information presented is not supported by references from scientific literature.

This text would appear to be most appropriate for clinical practitioners in the United Kingdom or Europe and potentially somewhat less so for those in the United States with regard to the availability of recommended pharmacologic agents. Although many of the medications recommended are commonly available and used throughout the world, readers in the American population occasionally will be scrambling to find a medication available in the United States that is similar in pharmacologic activity or that is commonly referred to by another name. Another notable consideration for readers of this book is the bias toward primarily noninvasive multidisciplinary management. Little information is provided regarding the appropriate use of neural blockade procedures and other more-invasive pain management techniques, including spinal cord stimulation, and implanted drug administration systems largely are ignored. Readers seeking information about the application of invasive management approaches largely will have to seek this readily available information from other sources.

In the context of a concise, introductory textbook reviewing the multidisciplinary management of common chronic pain syndromes from the perspective of two notable clinicians in the United Kingdom, this book serves as an interesting and easily accessible resource. Although not intended as a comprehensive textbook about pain management, the authors provided a concise and practical introduction to the clinical management of common chronic pain syndromes.

James C. Crews, M.D.

Associate Professor; Department of Anesthesiology; Wake Forest University School of Medicine; Winston-Salem, North Carolina; E-mail: jcrews@bgsm.edu