Book Review

Acute Pain: Mechanisms and Management

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

Article

Acute Pain: Mechanisms and Management
Edited by Raymond S. Sinatra, Allen H. Hord, Brian Ginsberg, and Linda M. Preble. 636 pp., illustrated. St. Louis, Mosby-Year Book, 1992. $74. ISBN: 0-8016-4677-4

We have seen a boom in the subspecialty of pain management over the past several years, and now great interest has developed in the area of acute pain. There is a tremendous need for a reference work that specifically addresses the needs of patients with acute pain. Dr. Sinatra and his colleagues have done a wonderful job with the first textbook dedicated to just this purpose. The scope of the book ranges from pain mechanisms through pharmacologic and nonpharmacologic management for both adults and children to the information needed in starting and maintaining either a university-based or a community-based acute-pain service. Some of the most difficult acute-pain problems are addressed, such as opiate dependence, major organ failure, and concomitant chronic pain. Each of these problems has particular physical and psychological features that bear on routine treatments for acute pain. The only groups of patients not addressed are patients with cancer who have acute pain of new onset or acute pain superimposed on chronic pain.

The chapters on pain mechanisms are well organized and clearly explain the intricate neurophysiology involved in the processing of pain and its clinical implications. All currently used treatment methods are well described, with attention to their advantages and disadvantages, criteria for the selection of patients, clinical techniques, equipment and monitoring, and outcomes data. The liberal use of diagrams and treatment algorithms is very helpful. Few questions about the routine treatment of acute pain are left unanswered.

Those most likely to benefit from this textbook include all physicians and health care providers involved in an acute-pain service or directly responsible for patients who have acute or postoperative pain. The book is written in a way that is technical enough to be interesting to the physician but also useful to other health care professionals. Therefore, Acute Pain will undoubtedly become the chief reference work for all acute-pain practitioners. There is no other textbook of its kind.

The book has other strong points. Although this is a multiauthored work, the text flows well and thus is easy to read, to the credit of the editors. A myriad of recent references at the end of each chapter provides sources of further in-depth information. The extensive index allows for easy access to information on specific issues presented in different chapters. The list of contributors does lack some of the original leaders in both the basic science and the clinical management of acute pain. That aside, the multidisciplinary background of the contributors is commendable.

In summary, I think the editors have contributed an excellent first reference textbook in the field of acute-pain management. Any physician caring for surgical or medical patients with acute pain will find this book useful. All acute-pain specialists will undoubtedly want this textbook for their individual and hospital libraries. Acute Pain is a much-needed reference and will be greatly appreciated by private practitioners and academicians alike.

Cheryl L. Dixon, M.D.
University of Florida College of Medicine, Gainesville, FL 32610-0254