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BJA Book Reviews

question, which is a shame because correct answer structure Essentials of Pain Medicine, 3rd Edn. H. Benzon, S. N. Raja, S. Liu,
is crucial to getting the maximum marks from the available S. M. Fishman and S. P. Cohen (editors). Published by Elsevier,
knowledge in the limited time allowed. Philadelphia, USA. Pp. 664; indexed; illustrated. Price £185.
There are 143 sample SAQs presented, these being ISBN 978-1-4377-2242-0.
divided into four parts: clinical anaesthesia, critical care
medicine, anatomy and regional techniques, and pain The editors, and the long list of contributors, of this concise
medicine and analgesia. The structure of the book is perplex- book are drawn entirely from North America with the vast
ing as it does not seem to mirror the Intermediate Level majority from the USA. As stated in the brief preface, in
Training Curriculum to which all final FRCA questions have addition to a complete revision of all chapters, the editors
to be mapped. It has deliberately omitted basic science have deleted previous material related to regional and neur-
SAQs, yet included an entire section on anatomy and region- axial anaesthesia, and added chapters of relevance, particu-
al techniques. The decision to include some areas of the cur- larly to the practising American pain clinician, including the
riculum in great detail while omitting others somewhat use of ultrasound, and DSM mental disorders of relevance
contradicts the laudable aim of the book which is to to pain medicine.
expose candidates to the range of topics used in the SAQ The book is split into nine sections; the first three sections
paper. offering basic science, clinical evaluation and examination,
Each question is presented in a clear and consistent way, and pharmacology. Subsequent sections cover all therapeut-
and indicates the number of marks available for each section ic aspects including perioperative pain management. The
in a way similar to the real SAQ paper where percentage largest section is composed of chapters dedicated to specific

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breakdown is used. There then follows a brief description of chronic pain syndromes. There is a section on interventional
the aims of the question. The model answers are extensive techniques, and one each on cancer and neural blockade.
and structured, being correctly divided into approximately Chapters end with succinct summaries or conclusions
the same proportions as the mark allocations. Some where appropriate, and, in some chapters, key points. The
answers contain excessively long lists of bullet points, for breadth of this book’s endeavour appears to be wide, but
example, the initial management of a perioperative death not at all at the expense of depth and detail.
(Part 1, Chapter 1, Q27), attracting 13 marks, has a list of The book presents a state-of-the-art of current American
25 bullet points in a seemingly random order. This approach practice with the result that some chapters are essentially re-
makes reading the answers pretty heavy going, but the lack dundant for non-American readers, for example, a chapter
of prioritization or systematic approach also makes remem- on legal and regulatory issues in pain management.
bering the answers more challenging. In places the A particular selling point of this book is that purchase of
answers do not appear to quite match the question, a the book allows access to an online version. This produces
common reason for scoring badly in the examination, for some immediate benefits, including the placement of all
example, when the question asks about criteria for admission references online, reducing the number of printed pages con-
to an intensive care unit (ICU) (Part 2, Q11) then broad state- siderably and adding to the book’s ease of use as a reference
ments about the problems of ICU admissions do not gain tome. Online, it functions as a full electronic version of the
marks. The book contains many helpful line diagrams, quite book, with easy and straightforward navigation, and very
correctly included to act as an aide-memoire for the usefully incorporates word-search.
answers rather than as a template for drawings in the exam- The word-search facility draws up all related sections of
ination. Another stated aim of this book is to provide model the text in short form, which can of course be expanded by
answers for SAQs about recent guidelines and areas of a click of the button. Search of the word ‘pain’ drew up
topical interest. These topics are well covered throughout more than 1500 entries, ‘magnetoencephalography’ just
all sections of the book, making this a useful current resource one. The references in the online text link to Pubmed for
for examination candidates. readers who wish to purchase the complete article. Frustrat-
The authors are to be commended for producing such an ingly, however, the references are numbered in the text, but
extensive and up-to-date source of practice SAQs. Sadly, it not in the reference section—which makes it difficult to
does not cover all the topics that a candidate may face in match one with the other—a serious flaw which limits the
an SAQ paper. As a result, I think it would make a useful add- ease of use in this respect.
ition to the trainee’s room of an anaesthetic department for The book opens with a section which essentially serves
those less-busy nights on call, but an individual wanting to as a refresher course on the physiology of pain processing
buy a single book to help them to practise SAQ papers at the peripheral and spinal cord level. This is succinct and
must be aware that not all topics are covered. up-to-date. The next section focuses on evaluation of the
pain patient and includes a very useful chapter on spinal
A.B. Lumb
imaging, with lots of magnetic resonance imaging scan
Leeds, UK
E-mail: appearances of common spinal pathologies which is
useful as a quick, although selective, overview. It also
doi:10.1093/bja/aer455 includes a chapter on determination of disability, but it is

Book Reviews BJA
only two pages long, and written with a focus on providing annuloplasty, discography, and also less controversial and
medical evaluation with respect to US social security accepted techniques such as intrathecal drug delivery and
administration. This important topic deserved more, and spinal cord stimulation. These chapters are useful summaries
its treatment here will have limited application outside for the generalist, but are not sufficiently detailed for the
the USA. specialist. In contrast, the section on Nerve Blockade (8
Clinical pharmacology is well represented, with a chapter chapters) could be a succinct standalone text, although
on drugs in myofascial pain disorders, which includes evi- with an emphasis on landmark and stimulation techniques
dence of efficacy—well conceived and useful. As might be more than ultrasound guidance.
expected, a particular strength of the book is material Despite the American emphasis, the book serves as an
related to interventions, and as an example the chapter on excellent revision tool for advanced level pain trainees,
transforaminal epidural injection of steroids does not disap- and CPD tool for consultants, aided by brief and concise
point. Although the chapter is not an exhaustive step by chapters. I have no doubt that many readers will find
step guide, it is a co-ordinated account with discussion of ra- themselves using the online version more than the
tionale, anatomy, technique, complications, and outcomes, printed book.
and is commendable. It is one of many in the section
‘Chronic Pain Syndromes’, which is the section of most rele- N. Plunkett
Sheffield, UK
vance to the busy practising pain clinician and is very good E-mail:
overall. There is a separate section on Interventional Techni-
ques, with whole chapters devoted to procedures of un- doi:10.1093/bja/aer456

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proven worth, for example, intradiscal electrothermal