Essentials of Pain Medicine and Regional Anesthesia. By Honorio T. Benzon, Srinivasa N. Raja, David Borsook, Robert E. Molloy, Gary Strichartz. Philadelphia, Churchill Livingstone, 1999. Pages: 504. Price: $69.00.

John C. Rowlingson, M.D., University of Virginia Health System, Charlottesville, Virginia.

Trying to contain the “essentials” of pain medicine and regional anesthesia in 500 pages of text is a prodigious effort. To approach this monumental task, Dr. Benzon has recruited a team of anesthesia-based coeditors (well-known or of expectant renown), and they have integrated the contributions of 76 additional scientific and clinical authors, giving a genuinely multidisciplinary emphasis to the final product. Approximately 130 pages are devoted to each of the following topics: pain medicine, evaluation and diagnostic tests, pharmacology, treatment options for chronic pain; chronic pain syndromes; and local anesthetics and nerve blockade. Postoperative pain management and cancer pain are 30 pages each. The stated purpose of the book is to serve as an “up-to-date, concise and authoritative discussion of the essential topics in pain medicine and regional anesthesia.”

How well are these goals met? The 1999 copyright date is only an estimation of the contemporary purport of the material. In this book, the reader will learn something new or have knowledge reaffirmed by every chapter. Examples of pertinent concepts that one might view as new-age include: the use of pain psychologists to assess the appropriateness of referred patients for chronic opioids or invasive procedures; the daily use of opioids in patients with chronic, noncancer pain; an algorithm to aid in the diagnosis of complex regional pain syndrome; the acknowledgment that there is a controversy regarding preemptive analgesia; and the reality that the determination of physical disability is an administrative issue, whereas psychologic disability really is based on clinical indices. The writing style is clear, focused, and specific. The bibliography for most chapters is admirably short, and many have but a few references older than 1990 (allowing for some of the classic articles). The book does not try to compete with recognized textbooks on regional anesthesia but does recreate a distillation of such information, which has value for the complete novice or anyone looking for quick guidance.

The chapters are truly concise. The brevity, though, highlights the editorial group’s understanding that clinicians are furiously busy. In pursuit of a kernel of information during a hectic day in the pain center or the operating room, one does not always have time to wade through page after page of text. Satisfaction comes in getting to the heart of the sought-after matter efficiently. The setup of this text surely fulfills that pursuit. Perhaps some of the chapters are so short that they could have more practically been associated with other relevant material, but the consistency of the writing combined with the approach taken to formatting the text helps to direct one’s attention effectively. There is a germane bibliography on each topic (and in some chapters a further reading list) at the end of even the briefest chapter. The text is complimented by an appropriate number of useful tables and figures—many of them reproductions from more classic sources. The index is helpful in directing one’s query to the relevant material and is refreshingly thorough for a book of this type. Although not all authors are established experts in the area of pain medicine or regional anesthesia, one senses the oversight of the professorial editorial group in achieving relevance as well as economy of the written word.

At $69, I truly believe the book is a bargain. The targeted approach to material about pain medicine and regional anesthesia is a valid one for the current time. Overall, the information is accurate, and the contemporary bibliographies contain references one can actually access. We have needed a concise informational source in pain medicine, but many that have set out to provide this have fallen short of the goal because of excessive brevity or the discovery that the topic grows larger when the effort is more complete. Benzon et al.  have come the closest of any to date. This book will appeal to students of any specialty for whom pain medicine, let alone regional anesthesia, is of interest. This is a book for residents of any professional persuasion who ask, “what informational resource can I use as I approach (and endure) my rotation through the acute and chronic pain services?” In addition, it will serve as a primer and a refresher to many practitioners with differing levels of experience because it fulfills the purpose of providing up-to-date information in a ready, albeit intentionally superficial, manner. The interplay of written text and figures is visually efficient, and the text is free of how-I-do-it entries so that one gains a generic application of the information presented.

Some might conclude that this book presents pain medicine as teasingly simple. However, these veteran editors stress the need for patients to be evaluated adequately for regional anesthesia and pain medicine. For regional anesthesia, they encourage technical precision and intellectual preparation regarding the risks, benefits, complications, and applications of the techniques of regional anesthesia and analgesia. For pain medicine, they urge creating a differential diagnosis and then a diagnosis on which multidisciplinary treatment can be based. They valiantly provide enough information to point the clinician in the direction of diversified treatment, not just toward the needle-based techniques. The essential themes of pain medicine and modern regional anesthesia are contained in this book.