The bias of the book is perhaps toward invasive techniques rather than pills and chat -- what doves might call "psychiatry with needles." This raises the specter of a double standard, because whereas the evidence of the efficacy of drugs (e.g., tricyclic antidepressants for neuropathic pain) is reasonable, we do not have equivalent evidence of the efficacy of many of the nerve-block techniques. I found the book reasonably comprehensive but uncritical. The clinical question is often, "Are pills or needles better in this condition?" But when pills and needles are discussed in separate chapters, the book ducks the important compare-and-contrast question.
Good discussions of chronic pain are presented in the chapters on myofascial pain and "sympathetically maintained pain." Both syndromes involve problems of definition, but both present real clinical challenges. No one who treats patients with these syndromes would say that life is simple for them, and the relevant chapters in this book reflect the reality.
We use textbooks differently at different stages of our careers. Those starting out in pain management and looking for a one-stop textbook on pain should check this one out. Seasoned campaigners who need to look up rare problems and rare solutions, which they perhaps knew about once but have now forgotten, should keep looking.
Reviewed by Henry McQuay, D.M.
Copyright © 1998 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
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