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Management of Acute and Chronic Pain.
  1. RAJESH MUNGLANI

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    Management of Acute and Chronic Pain. Edited by Narinder Rawal. (Pp 230). Published by BMJ Books, London 1998. ISBN 0-7279-1193-7.

    This book purports itself to be a comprehensive reference. Certainly the title would suggest so. However, it is clear that this is not a comprehensive text, but a book that is an update on particular timely topics in the field of pain medicine. There are sections on pain mechanisms with a chapter on the pharmacology of acute and chronic pain, and other chapters on postoperative pain, obstetric pain, and acute paediatric pain. There are three further chapters specifically on the management of chronic low back pain, cancer pain, and an overview of interventional pain techniques.

    Many of the authors are internationally known and this is perhaps the book’s strongest point—one does get a state of the art review and to this end I warmly welcome this book as an addition to the bookshelf to update a busy anaesthetist or pain specialist, though the chapters on chronic low back pain and cancer pain will also be of interest to those in other fields.

    The chapter on the anatomy and physiology of pain is excellent in that it has clear explanations and a number of very helpful diagrams. Unfortunately it fails to mention increasing understanding of the role of GABA in mediating analgesia within the spinal cord and furthermore does not mention some of the other neuroplastic changes which are well known to occur in chronic pain states such as central sprouting and phentypic switching.

    The chapter on pharmacology of acute and chronic pain again is well written, but unfortunately a lot of time is spent on non-steroidal drugs. There is a review of the adjuvant drugs such as antidepressants and anticonvulsants that are used in chronic pain, however one is left at the end with a sense of knowing about the drugs but not quite when to use them. There is no mention of the increasing use of gabapentin nor of other drugs that are sometimes used in chronic pain states such as clonidine and other sympatholytic agents or calcium channel blockers.

    The chapter on acute postoperative pain management is well written and informative as are the chapters on obstetric and paediatric pain. The chapter on chronic low back pain by Rauck is one of the best I have seen for some time. It is a comprehensive review of both acute and chronic low back pain. It is excellent as it also mentions treatments that are often performed outside the medical specialist arena. I was pleased to see in it the mention of some of the newly evolving techniques such as facet denervations, spinal cord stimulation, and disc denervation. It was a pity that the randomised control trials which have shown facet denervation to be an outstandingly useful technique in chronic low back pain were not mentioned. It was also a pity that the reference to the disc denervation procedure was to another text book rather than any original papers.

    The chapter on cancer pain management has been written by internationally known authors and is an excellent summary of the subject. In the section on interventional pain techniques the emphasis was on spinal cord stimulation, radiofrequency, and cryoneurolysis. Again this chapter has been written by an internationally well known author who concentrated on general overview of the techniques rather than a how to do it approach, which I think one would have to go to a bigger text for. In summary I think that this volume would make an excellent addition to the bookshelf of those involved in the treatment and management of pain.

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