Surgical Management of Pain

Burchiel KJ, Ed. Surgical Management of Pain. 2nd Ed. Thieme; 631 pp; 208 ill; $279.99

Surgical Managment of Pain--Kim J. BurchielThis comprehensive book is aimed primarily at neurosurgeons, but the various clinical pain syndromes that are covered may present to different medical specialists and to primary care providers well before reaching a neurosurgeon. Although the title is Surgical Management of Pain, substantial portions of the book cover pharmacologic and other nonsurgical methods of pain management. Thus, the book may be useful to a range of medical practitioners.

The first section consists of 3 chapters covering the neuroanatomy and physiology of pain mechanisms, including the pathophysiology of neuropathic pain. The next section consists of 9 chapters on approaches to assessment of the pain patient, pharmacologic management, management by anesthetic techniques, and multidisciplinary management. There is a chapter on pain treatment for the dying patient.

The next large section consists of 17 chapters, mostly in groups of 2, covering specific pain diagnoses and their nonsurgical management. Topics covered include back pain, craniofacial pain, trigeminal neuralgia, other cranial neuralgias, and postsurgical and posttraumatic neuropathic pain. There are chapters specifically covering posttherapeutic neuralgia, complex regional pain syndromes, cancer pain, and postoperative pain.

After laying this extensive foundation in the first half of the book, the book gets to describing surgical procedures for the various pain diagnoses. There are 27 chapters covering such techniques as spinal cord stimulation, peripheral nerve stimulation, intrathecal therapy, and ablative procedures. There is extensive discussion of techniques for surgical treatment of trigeminal neuralgia and other cranial neuralgias, with 10 chapters in that section.

Back and neck pains are probably the most common pain problems to be considered for surgical management. Chapters covering back and neck pain are scattered through the different sections of the book. These chapters cover anatomy, pathophysiology, pharmacologic management, physical therapy and modalities employed by the physical therapist, and surgical intervention. The book does not cover in detail the variety of major surgical procedures applied to the spine for decompression and fusion. There are chapters discussing invasive techniques aimed strictly at pain that do not involve surgical decompression or fusion; these chapters cover such topics as facet blocks and spinal cord stimulation.

The book includes descriptions of a number of older surgical procedures that are currently not often done; however, in one of the Editor’s Comments, Dr. Burchiel states that “pain surgery, like all of medicine, can sometimes be needlessly trendy.” One stated purpose of the book is to help protect older techniques from oblivion so that they remain available to appropriately selected patients.

The final section is composed of 3 chapters on new directions. These chapters cover functional imaging, evidence-based practice, and translational research. The chapter on functional imaging of pain should interest the neuroradiologist, with discussions on the uses of PET, functional MRI, and pattern analysis. The chapter on evidence-based practice is a remarkable iconoclastic discussion of the current milieu of pain medicine, including the 2011 Institute of Medicine report on the need for more attention to pain. The chapter offers reasoned challenges to aspects of the current industry of pain management, and the Editor’s Comment says the chapter is “perhaps the most important chapter in the book.”

The chapters are well-organized and well-illustrated, with diagrams and radiographic images. The table of contents includes a list of videos; the back cover of the book states that the videos are available online, but the reviewer could not find any reference in the book regarding how to access the online videos. Some chapters survey their topics touching on the high points, but not going into exhaustive detail. These chapters expose the reader to the topic, but detailed understanding will require delving into the reference lists. Most chapters are extensively referenced. Each chapter ends with an Editor’s Comments section that provides perspective on the particular topic and the editor’s opinion on the current status of some of the techniques. These comments also point out the interrelationships between some chapters. The majority of the disorders covered in this book have multiple treatment options, and the Editor’s Comments on the work of the large number of contributors to the book are particularly valuable in providing insight and perspective.

Overall, this is a very useful book for any of a variety of specialists interested in treatment of pain. Many of the surgical procedures rely heavily on radiographic localization; these aspects of the book will particularly appeal to the neuroradiologist. The descriptions of anatomy, physiology, nonsurgical treatment, and surgical treatment provide a thorough overview of pain management.

Surgical Management of Pain
Editorial Office • American Journal of Neuroradiology @TheAJNR

The American Journal of Neuroradiology (AJNR) publishes original articles pertaining to the clinical imaging, therapy, and basic science of the central and peripheral nervous system, including but not limited to the brain, spine, head and neck, interventional procedures, techniques in imaging and intervention, and related educational, socioeconomic, and medicolegal issues.