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Book Reviews
November 2003

Atlas of Common Pain Syndromes

Author Affiliations


Arch Neurol. 2003;60(11):1652. doi:10.1001/archneur.60.11.1652-a

Steven D. Waldman, MD, JD, 335 pp, with illus, $85, W. B. Saunders Co, New York, NY, 2002.

The treatment of pain is controversial in the United States. Professor Waldman authors a series of books on the subject, from the point of view of an anesthesiologist. This book is very practical and helpful. However, it is not perfect. It begins with a brief overview of the diagnostic criteria for many painful conditions, particularly in the head, spine, and limbs. It then gives information about treatment, including, in each case, instructions on how to inject the painful joint, bursa, near-tendon or near-nerve; many will be relived to see that the book manages to leave out the euphoriant and highly addictive OxyContin, preferring morphine elixir or methadone. Many will be amazed to see that so many parts of the body can be injected with a local anesthetic and methylprednisolone so quickly, routinely, repeatedly, and with such apparent assurance that the patient will be helped; it is reminiscent of the line in Samuel Shem's The House of God to the effect that there is no place in the human body that cannot be reached with a strong arm and needle. This "how-to" manual is unencumbered by a single reference, let alone therapeutic trials or efficacy/side effect studies. The novice's enthusiasm should be tempered by instances of misplaced anatomy, such as interchanging medial and lateral indications; also, before trying it at home, the novice may also want to seek an expert's opinion before plunging a needle through the pulsating aorta to perform a transaortic celiac plexus block for chronic pancreatitis (usually reserved for pancreatic cancer). Neurologists will be hurt that the work of Asa Wilbourn is ignored and that the double-crush syndrome, which he carefully debunked, has risen again throughout the upper and lower limbs. They will also note the lack of influence by Jose Ochoa and Raul Verdugo, with a return to the thought that burning pain means reflex sympathetic dystrophy, which will be cured by sympathetic block. The book is not meant to be read from cover to cover, which makes it seem very repetitious. One will find this reference useful to look up pain by anatomical region; review the most common diagnoses and their criteria; and find treatment recommendations, including any potential injections (except for Janet Travell's trigger-point injections in muscle).