Textbook of Pain

The fourth edition of the Textbook of Pain reflects the evolution of Pain Medicine over the years. As in other editions of this landmark book, the editors have brought together an erudite commentary of 102 authors in addressing the science and philosophy of pain. The authorship is clearly international and multispecialty. This registration of thought gives an invaluable view of pain that knows no geographic boundaries and lacks the bias that can occur when one specialist tries to write as if a member of another basic science or clinical discipline. Indeed, the editors acknowledge that they have made no attempt to homogenize the writing style nor, more importantly, the opinions or comments in the individual chapters by such a diverse group of knowledgeable individuals. Many authors are recognized authorities in the field and/or on the topic on which they have written. Anesthesiologists will be well served by this book as it will widen their knowledge base about “pain” and do so without the distraction of the regional anesthesia/analgesia focus so prevalent in other texts. The editors have consolidated some of the topics, offering a reduced number of chapters (68), yet there is still adequate coverage of pain overall (the page total is increased). The text remains comprehensive and contemporary in content. The reader’s understanding is enhanced by the chapter architecture, the organizational style of the text, and the use of summary statements in most of the chapters. Twenty-five percent of the text is devoted to basic science and physical and psychosocial mechanism considerations. The realistic interdigitation of physical and psychological realms of “pain” is consistently emphasized. The series of chapters on pain measurement are a valuable subsection of the text, as this aspect of pain medicine continues to be one of the most difficult to realize in clinical practice. This pertinent section is expanded from recent editions, and the chapter on pain studies in humans is crucial material for all clinicians. The Clinical States midportion (almost 50% of the pages) addresses the necessary disease states and sources of pain that are encountered in clinical practice. Anesthesiologists commonly see patients with chronic low back pain, cancer pain, and chronic regional pain syndrome, each of which is addressed with a chapter devoted to the topic. The editors are to be credited with including updated material on such new-age topics as chronic pelvic pain, spinal cord injury pain, gender differences in pain, and pain associated with end-of-life issues. The therapeutics section, again, deals with the expected modalities for pain management in a forthright manner. The chapter on spinal cord and brain stimulation techniques is of high quality, as is the one on the placebo response, and both appropriately emphasize the necessary selection of patients. Anesthesiologists will find this textbook lacking in extensive discussions about therapeutic regional anesthesia and analgesia techniques, but multiple other sources of such information are available to those needing that material. The chapter on therapeutic trials contains fundamental material that will be of interest to most clinicians and helps to elevate one’s appreciation of how hard it is to conduct scientifically honest research that results in valid outcomes. Pain management is a distinct and growing aspect of clinical anesthesia practice. The clinician needs access to educational resources that encompass the many components of pain medicine. Textbook of Pain fulfills such a need in assimilating the individual interpretations of a diverse collection of reputable authors into a well organized and useful text. The page total has been increased appropriately, yet there is a economy given that the writing is not wordy. The tables and illustrations are supplementary to the text, and not mere restatements. There is a small color plate section, and the chapter on the imaging techniques for pain is very interesting. The bibliography for most chapters is thorough (superb in some cases) and generally up to date. The enduring emphasis on pain being viewed at all times in the evaluation and treatment phases as a biopsychosocial disease is consistently presented and maintains the appropriate contemporary focus.