Book Review

Pain Medicine: A comprehensive review

N Engl J Med 1996; 334:546February 22, 1996

Article

Pain Medicine: A comprehensive review
By P. Prithvi Raj. 571 pp., illustrated. St. Louis, Mosby, 1995. $49.95. ISBN: 0-8016-7998-2

New motives and new methods for controlling pain have recently emerged. Pain control is increasingly — and appropriately — seen as key to patients' quality of life and satisfaction with medical care. Pain is also recognized as a biologic cascade whose early treatment (or neglect) can have long-lasting consequences for body and mind. New drugs, delivery systems, and nonpharmacologic techniques make the control of pain in many settings a feasible goal. A distinct body of specialized knowledge, applied by growing numbers of clinicians whose practices emphasize the diagnosis and treatment of pain in itself to a greater degree than do existing specialties, is now recognized by medical establishments across the industrialized world. Several years ago, the American Board of Medical Specialties began awarding a certificate of added qualification in pain management to board-certified anesthesiologists who complete a one-year clinical fellowship in pain management and pass a written examination. Similar certification, also contingent on clinical training and successful completion of a written examination but not restricted to anesthesiologists, is now offered by the American Board of Pain Medicine.

The advent of “pain boards” triggered a demand for educational resources that is still being met. This book will do much to meet this need. I believe it to be the only book designed to prepare candidates for these board examinations. Its editor is a respected scholar, educator, and founding father of this young field. Many of the dozens of contributing authors have also labored on behalf of certification of this discipline. Their backgrounds mirror the specialties of those giving or taking the examinations. Anesthesiologists predominate, with participation from practitioners of internal medicine, neurology, nursing, pharmacology, occupational and physical therapies, and rehabilitation medicine. In a manner consistent with the clinical focus of board certification, this book emphasizes practical diagnosis and therapy, areas in which its authors and editor are authorities.

With more than 500 full-sized pages, this softcover book is neither a pocket synopsis nor a searching critique of current clinical practice. Its clear purpose is to help diligent readers pass their pain boards or answer pain-related questions well on general examinations in fields such as anesthesiology or rehabilitation medicine. The book is up to date, comprehensive, and replete with tables, illustrations, flow charts, and mnemonic devices. The few typographic errors I spotted were minor. Each chapter is followed by sample test questions, enhancing the book's practical value. A separate section at the end contains two sets of 75 questions each. I can comfortably assure our own clinical fellows in pain management that if they study this book and, for good measure, the annotated curriculum issued by the International Association for the Study of Pain, they will succeed. Later they can acquire and savor the classics cited herein by Bonica, Wall and Melzack, Ferrante and Vadeboncoeur, Raj himself, and contributing authors such as Patt and Stanton-Hicks, along with a handful of others, such as Cousins and Bridenbaugh and Fields — assuming they can actually ply their trade in an era increasingly hostile to specialists.

Daniel B. Carr, M.D.
New England Medical Center, Boston, MA 02111