Handbook of Pain Relief in Older Adults, Second Edition

Gloth III FGM, ed. Handbook of Pain Relief in Older Adults, Second Edition. Humana Press 2011, 210 pages, $109.00.

This handbook is a collection of 14 chapters written by leading experts in the field of pain management. It provides useful information and new guidelines for the often challenging task of managing persistent pain in older adults. Chapters cover a wide range of topics related to the physical as well as the psychological components of pain, and their management. Include topics range from “Spirituality as an adjunct to Pain Management” to “The Politics of Pain: Legislative and Public Policy Issues”. Of particular relevance to the Radiology audience is Chapter 9, “Interventional Strategies for Pain Management.”

This chapter is divided into nine sections:

  1. Pathology of Pain
  2. Nerve Blocks/Neurolysis
  3. Electrical Stimulation of Spinal Cord and Peripheral Nerves
  4. Spinal  Drug Delivery
  5. Epidural Steroids
  6. Intrathecal Therapy
  7. Vertebroplasty and Kyphoplasty
  8. Intradiscal Electrothermal Annuloplasty and Nucleoplasty
  9. Botox Use in Blocks

The first section starts with a brief description of the pathophysiology of pain. The following chapter deals with the various nerve blocks and gives a brief description of their uses in various pain syndromes. The section also goes on to include a brief description of common methods of nerve destruction. Diagrams and radiographs are included to demonstrate the placement of the needles for the nerve blocks. Unfortunately, those are not well annotated.  The X-rays and images are not of good quality. Electrical nerve stimulation of spinal cord and peripheral nerves are described, and the results of several relevant studies included, showing the efficacy and limitations of these devices. Further subsections in this chapter deal with the use of epidural steroids in treating radiculopathy related to herniated nucleus pulposes.  Several current studies are touched upon.

Intrathecal therapy and the use of pharmaceuticals to influence the behavior of neurotransmitters are touched on, citing various studies and their results. Included is an algorithm for the titration of intrathecal analgesics, which is of useful practical application to those using it. Vertebroplasty and kyphoplasty is touched on briefly, and gives the results of a multicenter trial on the benefit of these procedures.

Intradiscal Electrothermal Annuloplasty and Nucleoplasty is a minimally invasive technique to treat radiculopathy.  This relatively new procedure is briefly described and some early results of clinical outcomes provided. This section also outlines the “Spinal Wand” technique which is another method of MILD (minimally invasive lumbar decompression) being used. The final subsection deals with using Botox to treat pain related to excessive myofascial spasm.  Results of recent studies are detailed and their contraindications and a few potential side effects discussed.

Overall, this is a well organized presentation on the current techniques available to treat pain syndromes and their strengths and weaknesses. The subject matter is covered in its breadth rather than in its depth; and the reader may want to consult more detailed texts on the subject.

References are current and refer to relevant recent studies and articles on the subject.

This chapter would give an interested reader an overview of the common techniques available and their relative strengths and weakness.


Handbook of Pain Relief in Older Adults, Second Edition