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Atlas of uncommon pain syndromes. second edition.

Atlas of Uncommon Pain Syndromes. Second Edition. S. D. Waldman. Saunders Elsevier; Distributor: Elsevier Australia -, Tower 1, 475 Victoria Avenue, Chatswood, NSW 2067; $150.00; pp. 220x280 mm; pp. 330; ISBN: 978-14160-5284-5.

An atlas is a book of maps and this book seeks to lay out the features of many uncommon pain syndromes in an easy pictorial form. It closely follows the format established in its companion volume Atlas of Common Pain Syndromes, and includes a further hundred or so pain syndromes, grouped according to body region. Each two- or three-page entry comprises a description of the clinical syndrome, a coloured drawing of a typical patient illustrating where the pain is felt, one or more MRI scans and a list of relevant signs and symptoms, investigations, differential diagnoses, treatment options, complications and side-effects and lastly some clinical pearls. From post-dural puncture headache (not an uncommon pain syndrome where I practise) to Parsonage-Turner Syndrome (brachial neuritis) to fibulocalcaneal pain syndrome (sprained ankle), most structures that could give rise to pain as a result of degeneration or over-use are mentioned.

The problem with this book is that it depicts clinical practice as a procedurally-based but totally evidence-free zone. There are no references and no comment on the likely efficacy of the treatments recommended, with only occasional lip-service to the concept of a multidisciplinary approach to management of complex problems. The book is very repetitive and recommends non-steroidal anti-inflammatory drugs, the application of heat or cold, and local anaesthetic and steroid by local or epidural injection for practically every musculoskeletal and a few surprising visceral pain syndromes. The descriptions of injection techniques are vague and presumably directed at North American "office" practice, totally ignoring the benefit and availability of ultrasound and radiological guidance. The MRI scans are not necessarily relevant to the text and the "clinical pearls" are not particularly profound.

I think the key to this book lies in the preface to its companion where the author mentions the need to round out the skill sets of the various specialties involved in the treatment of pain. For those with a background in anaesthesia, musculoskeletal medicine is new territory and a list of syndromes which should be considered as part of the differential may be helpful. For this reason the book may have a place in the departmental bookshelf but it in no way represents a guide to current practice of pain medicine in Australasia.


Adelaide, South Australia
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Author:Slattery, P.
Publication:Anaesthesia and Intensive Care
Article Type:Book review
Date:Mar 1, 2009
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