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Botulinum toxin type A in pain management

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    Botulinum toxin type A in pain management. By martin k childers (Pp 127, US$24.95). Published by Demos Medical Publishing, New York, 1999. ISBN 09663422-2-4

    Even when just glancing through this book the reader will be put on guard. There are two spelling errors and misalignments in the table of contents, inclusion of dystonia as a component of the upper motor neuron syndrome (page 56), confusion between dysphasia and dysphagia (twice on page 122), and a bizarre format of the references which show journals variously printed in italics or abbreviated, and with haphazard pagination. But if these are specific examples, the book as a whole is a mishmash that includes a summary of neuromuscular and autonomic physiology pitched at a sixth form level; a review of myofascial pain syndromes oddly singling out three specific conditions (the piriformis, pronator teres, and thoracic outlet syndromes); a chapter dealing with spasticity and dystonia (including contact information on how “to find a movement disorder specialist in your area”); and a chapter on equipment and injection techniques including EMG studies to localise the motor end plate, “ . . .home to the neuromuscular junction”, and 14 drawings of various injection sites around the body in which x marks the spot. A chapter entitled Obtaining reimbursement, which means from “third party payers”, can happily be skipped by those outside the United States, although readers will note that the cost of botulinum toxin is curiously omitted. Botulinum toxin may alleviate the pain seen in spasticity and dystonia, but the mechanisms by which it does so have not been established. I suggest that those interested in learning the practical aspects of managing patients would be wise to look elsewhere for guidance. This is particularly important because, as the author acknowledges, the toxin is not licensed for pain relief. Those interested in theoretical aspects will certainly need to look elsewhere. In my view this book cannot be recommended.

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