Surgical Management of Pain
To an anesthesiologist who practices pain control and management, Burchiel’s book presents this endeavor with realism and pragmatism.
Surgical Management of Pain is well organized, with broad coverage not only of surgical approaches to pain management but also of nonsurgical and pharmacologic methods of pain control. In fact, the general evaluation of pain and the nonsurgical management of pain are so well presented that the title of the book perhaps does it some injustice. There is also an unusual emphasis on the role of allied-health professionals in the management of pain. The list of well-known contributors to the book reads like a Who’s Who in the field of pain management. They join in presenting a comprehensive approach, a variety and divergence of opinions, and actual experiences from situations encountered in practice. Each chapter is punctuated by boxes highlighting pearls that effectively emphasize the essence of each topic and includes a commentary by another authority, who not only provides another opinion or perspective on the topic but also expands on it and sometimes offers a divergent opinion or frank disagreement, making it plain that in many aspects of pain management, consensus is lacking or opinions are unequivocal. The chapters are also generally well documented, with up-to-date citations of works that are essential for a multidisciplinary study of the management of pain. The complications and aftereffects of surgery for pain are well presented, with coverage of the incidence of treatment failure or recurrence of the original pain. The resulting discomfort in such cases is emphasized, especially in the case of patients with prolonged or permanent neurologic deficits. It is extremely important for patients to have reversible pain control so that they will experience the sequelae of the surgical treatment. The book is not perfect. Several authors make an insufficient distinction between the pain due to cancer and chronic pain of non-neoplastic origin. I would also have appreciated a discussion of the timing of therapy: When should practitioners stop a nonsurgical method of pain control and resort to surgery, especially in cases involving cancer and other causes of intractable pain? The chapter on the use of controlled substances should have covered after-care procedures and the potential for drug abuse and misuse. This excellent book will interest anyone treating pain and pain syndromes, regardless of their specialty and regardless of whether they see patients whose primary symptom is pain or other patients. The material will be of value to those of all levels of expertise, from students to generalists, surgeons, and anesthesiologists and those who specialize in the day-to-day management of difficult, recurrent, and intractable pain. Benjamin M. Rigor, M.D.
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