Atlas of Pain Management Injection Techniques.  By Steven D. Waldman. Philadelphia, WB Saunders, 2000. Pages: 400. Price: $140.00.

The goal of this text, which contains 245 illustrations, is to serve “. . . as a ‘how-to-do-it guide’ to aid the practicing physician in promptly diagnosing and treating the myriad of musculoskeletal pain syndromes of their patients seen in clinical practice.” Each of the 110 chapters discusses a pain problem with a corresponding injection technique. Topics range from temporomandibular joint pain to metatarsalgia pain syndrome. Each chapter starts with the proper billing code (CPT-2000) and contains five sections: Indications and Clinical Considerations, Clinically Relevant Anatomy, Technique, Side Effects and Complications, and Clinical Pearls. An illustration is included for each technique.

Strengths and weaknesses of this approach can be illustrated by an example, the chapter about temporomandibular joint (TMJ) pain. The Indications and Clinical Considerations section gives a brief overview of the location and characteristics of TMJ-associated pain in one paragraph. The Clinically Relevant Anatomy section describes the anatomy of the joint in a single sentence and then tells us that internal derangement of the disc may cause TMJ-related pain. The Technique description and the corresponding illustration are also lacking in detail. In the Side Effects section, we are warned that the region around the TMJ is highly vascular, increasing the risk of hematoma formation, and that accidental facial nerve block may occur, but neither the narrative description nor the illustration reveals enough about the adjacent anatomy to help us understand how to avoid these complications. The final Clinical Pearls section is a rapid-fire attempt to cover the myriad causes of pain in the area of the TMJ. The coverage is so cursory and the anatomic details are so few that I do not believe the inexperienced reader could either understand what TMJ joint pain is or how (and, more importantly, when) to perform TMJ injection.

To be fair, the author states at the outset that this is a how-to guide; there is no reason to expect anything more than a brief description of each pain syndrome. Practitioners in various disciplines use many of the injection techniques routinely. There is no other available source that brings together descriptions of common pain syndromes and the typical injection techniques for conditions such as tennis elbow, de Quervain tenosynovitis, slipping rib syndrome, piriformis syndrome, plantar fascists . . . the list goes on. The concept behind this atlas is valuable, but it lacks enough essential information to be useable as a stand-alone reference. Given that the atlas advocates the use of local anesthetic and steroid combinations, a key omission is a discussion of the risks, benefits, and available preparations of these two groups of drugs. There are no data given to help the reader understand how and when to use the injection techniques in a rational way; indeed, there is not a single reference in the atlas.

The overall impression is that the book represents a catalog of superficial information about injecting virtually every bursa, muscle, joint, ligament, and small peripheral nerve in the human body, but with information and diagrams lacking enough anatomic detail to guide practitioners. If this book serves, as is my opinion, to promote the indiscriminate use of injections techniques, then it does a disservice to the evolving field of pain medicine. The concept of assembling information about common injection techniques in one compendium is valuable, but a true opportunity was missed to review the scientific literature and prepare a rational guide that incorporates the best available evidence for using these injection techniques. At $140, one’s money would be better spent on a good atlas (or two) of human anatomy.