Atlas of Anesthesia, Volume VI: Pain Management (CD-ROM). Edited by Ronald D. Miller (series) and Stephen E. Abram, M.D. (volume). New York, Churchill Livingstone, 1999. Price: $195.00.

Books on CD-ROM are becoming more popular, but it is uncertain as to their usefulness for the average physician. Just like books that are purchased solely to be reference sources in anesthesiology libraries, CD-ROM books may find their way to the back of the compact disk stack. Everyone in medicine knows how to find a topic in a book: one manually flips through the table of contents and the index to locate the information. However, with a CD-ROM, another layer of knowledge, effort, and equipment is added. One needs a computer and must know how to load and retrieve the program. Once at the title page, navigation through the virtual pages involves more than licking a finger to turn a page.

With these differences in mind, I evaluated the pain management volume (VI) of the Atlas of Anesthesia  series with respect to content and the ease by which one can access the information.

First, be sure that you have the minimum system requirements. In reviewing these parameters, anyone with a computer, IBM-compatible or Macintosh, should be able to use this disk. The instructions are easy to follow, and the program installs under “Programs,” listed as “Cm” for Current Medicine. Clicking on the “Volume 6” bar produces the table of contents, which comprises 15 chapters. The chapter titles include (1) “Peripheral Mechanisms of Pain Perception”; (2) “Mechanisms of Pain Processing”; (3) “Mechanisms and Management of Neuropathic Pain”; (4) “Acute Postoperative and Posttraumatic Pain Management”; (5) “Back Pain”; (6) “Sympathetically Maintained Pain”; (7) “Visceral Pain”; (8) “Clinical Diagnosis and Treatment of Headache”; (9) “Cancer Pain Management”; (10) “Spinal Cord Stimulation”; (11) “Psychological Assessment and Therapy in Pain Management”; (12) “Organization of Pain Management in the Clinical and Workplace Settings”; (13) “Physical Rehabilitation in Chronic Pain Syndrome”; (14) “Outcomes Assessment in Pain Management”; and (15) “Acute Herpes Zoster and Postherpetic Neuralgia.”

From the table of contents, one can access the subheadings in each chapter and go directly to that page. As an example, “Chapter 5—Back Pain” has a subheading titled “Sacroiliac Pain.” Clicking on that line produces the text about this topic. Most of the contents are arranged in such a way that a picture or graph appears, followed by explanatory text. These figures are too small to view without enlarging them. An additional feature allows one to split the screen into halves or thirds so as to follow the text while viewing the visual aid. “Pop-ups” are highlighted words or reference numbers that reveal an explanation or citation when clicked. This feature is useful if one wishes to immediately write down the reference citation for further reading.

As with all software programs, there are various toolbar options that allow for bookmarking certain areas, writing notes in the “columns,” searching the entire text for key words, and printing certain aspects of the written text.

Chapters 1–3 are particularly well-written by established investigators who are involved with pain mechanism research. Chapters 4–10 involve clinical topics that provide more than a survey treatment but less than a textbook review of each condition. The pictures enhance the understanding of the text explanation, which is written in “Hemingway” style, i.e. , with an economy of words. Chapters 11–13 provide concise and informative overviews of the psychologic components of pain management, the administrative organization of pain clinics, and rehabilitation of patients with chronic pain, respectively. In Chapter 14, outcomes assessment is a chapter that defines terms and outlines how one begins evaluating treatment outcomes clinically. The chapter title is unintentionally misleading, in that it does not provide evidence in support of using one pain treatment approach versus  another. The last chapter, which deals with herpes infection and pain, is particularly strong in the explanation of its pathogenesis but correspondingly weak in describing a multidisciplinary approach to therapy. For this condition, various treatments have been tried with varying degrees of success. A mere mention in table form of these treatments would help the reader to seek esoteric approaches for specifically difficult cases.

I had a few problems with the navigating, which I considered minor. I could not get the scrolling wheel on the mouse to advance the text. Instead, I had to use the arrow to click on the advance text bar located to the right of the screen. Some of the historical references in German were displayed as gibberish because of the difference in alphabet characters. Finally, the small images above the text must be enlarged to be viewed because one cannot get a sense of the picture’s content from the standard view. Therefore, virtually every picture must be enlarged and evaluated by the reader. One can split the screen and scroll the enlarged pictures along the text, which makes this task more tolerable.

Overall, this CD-ROM will be useful to those who are comfortable with new technology, travel frequently with a desktop computer, or wish to carry around a library of CD-ROM “books” in compact form. Unlike traditional book reference activity, obtaining information from CD-ROM requires some additional training and access to computer terminals. Finally, one should not mistake this CD-ROM for a complete reference source that deals with all aspects of pain. It serves more as a practical reference to the average pain physician engaged in daily clinical practice.