Book Review

Differential Diagnosis of Acute Pain by Body Region

N Engl J Med 1993; 329:972-973September 23, 1993

Article

Differential Diagnosis of Acute Pain by Body Region
By Stanley L. Wiener. 845 pp., illustrated. New York, McGraw-Hill, 1993. $65. ISBN: 0-07-070177-6

Ouch! A textbook devoted entirely to the diagnosis of pain? Weiner's is just such a textbook, and it is a stunning, welcome addition to the library of medicine.

Dr. Wiener defines acute pain as pain that is “new and never experienced before,” “so severe and disabling that relief is sought,” and sufficiently alarming for the patient to seek medical attention. A unique taxonomy of pain according to body region gives the clinician rapid and easy access to the complete range of diagnostic possibilities.

Virtually all pain syndromes described in this book are classified into one of seven body regions. These regions are covered in chapters that more specifically localize the patient's symptoms. For example, the facial region has chapters on eye, ear, nose, face, mouth and lip, and throat pain.

Each chapter begins with an extensive list of possible diagnoses for the causes of pain in that particular body region. Within these lists are hierarchies of cause ranging from the most common to the unusual. Following this diagnostic list is a clear and concise summary that mentions each of the diagnostic possibilities. This summary is followed by a table of disease incidence that tabulates the common, uncommon, and rare causes of pain; it is based on the author's clinical experience and on information available from a review of the medical literature.

At the front of the book is a remarkable set of shaded line drawings that show graphically where the patient hurts. Under each drawing in this rogues' gallery is listed the chapter in which the causes are discussed. The line drawings, summary, and disease-incidence table make this textbook as user friendly as the author hoped. The reader can simply locate the drawing that corresponds to the area of the patient's pain, turn to the appropriate chapter, and use the summary to determine quickly whether the symptom fits the causes discussed in the chapter. A concise discussion of each pain syndrome follows the summary and incidence table.

Diseases and syndromes that cause pain in different or overlapping regions are mentioned in each chapter, making the chapters independent modules. For example, all three chapters on chest pain contain a discussion of chest-wall pain and esophageal pain. The length of each discussion is generally tailored to the frequency of the particular cause. Some discussions are reprinted in their entirety. This redundancy is an appealing feature since it assures the reader of completeness. Mysteriously, the book does not contain cross-references to material in other chapters.

The references for each chapter are extensive and very current. The majority of the journal references are from the late 1980s, although important older works are also noted.

Differential Diagnosis of Acute Pain by Body Region is a pleasant surprise. This textbook brings together some of the best attributes of computerized data-base management -- for example, ease of referencing -- with a masterly synthesis of clinical information. Equally important, Wiener's style is eminently readable and clear. Everyone who picks up this book will wonder why no one has organized information about pain this way before. All providers of primary care for adults, including office-based, clinic, and emergency room physicians, will find this textbook a very useful addition to their daily reference libraries.

Max Michael, III, M.D.
Cooper Green Hospital, Birmingham, AL 35233