First edition. Carol A. Warfield; ed. 552 pages. New York: McGraw-Hill; 1993. $79.00.

The scientific study of pain has led to innovations in the practice of medicine, including patient-controlled analgesia, improved palliative care of patients with advanced cancer, and simple monitoring of the adequacy of pain management on the hospital ward by asking patients to rate their pain on a 0 to 10 or verbal descriptor scale. Progress in scientific understanding of pain mechanisms and control will increasingly require physicians to keep abreast of developments in the principles and practice of controlling pain and restoring function.

Although the compact size and price (for a textbook) of Principles and Practice of Pain Management might make this text appealing to the general internist or family physician interested in the evaluation and management of pain, the preface states that "this text is specifically intended for the pain specialist". In Part I, there are competent and well-written chapters on the pathophysiology of pain (Dubuisson), pain measurement (White), and pain psychology (Turk, Rudy, and Boucek). However, at 49 pages this section is too brief to give the general internist, let alone the pain specialist, an adequate introduction to pain mechanisms and assessment.

The chapters in Part II cover headache and orofacial, neck, chest, low back, abdominal, pelvis, perineal, joint, extremity, and foot pain. While useful material is presented in several of these chapters, there are deficiencies reflecting broad problems in the scientific and clinical underpinnings of the evaluation and management of pain patients. These chapters typically present considerable information on differential diagnosis, but the reader is usually not informed of which conditions are common and which are rare. Information on prognosis is also lacking. Like many textbooks in medicine, it is unclear when diagnostic and treatment recommendations reflect the opinion of the author and when they are based on rigorous scientific evidence. Not all of the chapters address therapy, but those that do tend to discuss a range of treatment options with an optimism that is not consistently substantiated by scientific evidence. Widely used diagnostic and therapeutic modalities that have been suspected or proven to be worthless are not identified, and little concern is expressed for the relative costs of alternatives. Unfortunately, these deficiencies reflect general shortcomings in medical approaches to pain management more than specific shortcomings of this text.

The third part of the text discusses common painful syndromes such as sympathetic dystrophies, cancer pain, the myofascial syndrome, and peripheral neuropathies. In general, these chapters provide brief overviews of their selected topics. The concluding section of the text is a series of chapters on forms of pain therapy such as systemic pharmacologic approaches, nerve blocks, stimulation-induced analgesia, and behavioral therapy. Most material in these chapters would interest the pain specialist more than the general practitioner.

Any text that stimulates the interest or enhances the abilities of general internists to keep abreast of developments in pain medicine is useful. Practicing clinicians and medical students would be well served by perusing several of the available textbooks on pain medicine to see which best meets their needs and interests. The careful shopper would be wise to look at the second edition of John Bonica's The Management of Pain (Lea and Febiger; 1990), a comprehensive standard against which other pain medicine texts can be judged.