New book on pain in peripheral nerve diseases

[Guest guest]

(Book review of new book on pain in peripheral nerve diseases, FYI) ~ G

Journal of Neurology Neurosurgery and Psychiatry

2002;73:210-211

© 2002 Journal of Neurology Neurosurgery and Psychiatry

BOOK REVIEW

Pain in peripheral nerve diseases

Edited by C Sommer (Pp 202, US$170.50).

Published by Karger, Basel, 2001. ISBN

3-8055-7268-9

Donaghy

Despite having a subspeciality interest in peripheral nerve disease,

often I am perplexed by patients with neuropathic pain. Yet pain is a

leading symptom of neuropathy, and the ability to manage it is essential

to the compleat neurologist. So I was delighted to have the opportunity

to improve my own understanding of neuropathic pain from this volume

edited by Sommer. Her experience in linking clinical and

experimental aspects of pain is a welcome thread running throughout this

volume.

We are reminded that so much of our knowledge of neuropathic pain

phenomena derives from American Civil War nerve injuries studied so

carefully by Weir-. Pain pathways are dealt with pragmatically

in standard anatomical and physiological terms. Gate control theory is

not even listed in the index, allowing simple thought about the self

evident modulation of pain transmission and perception. Cytokines

receive welcome attention; if tumour necrosis factor is not a

fundamental cause of pain, it may mediate the nerve injury resulting in

a pain state.

The various terms used to describe painful phenomena are covered

succinctly, and pain rating scales are introduced. The chapter on

mononeuropathies lacks extensive coverage of the newly introduced terms

‘CRPS I and II’ (complex regional pain syndrome). Many use these terms

now to replace reflex sympathetic dystrophy and causalgia because of

uncertainties about the part played by the autonomic nervous system in

generating the former of these two chronic pain states.

Those polyneuropathies responsible for neuropathic pain, and conversely

analgesia, are covered extensively and will be of particular value to

non-neurologists who manage pain. Hereditary motor and sensory

neuropathy uncommonly causes pain and merits less attention. More

attention could have been given to the awful burning foot syndrome that

can occur in nutritional neuropathies or to the vexatious question of

differentiating pain due to the neuropathy of HIV from that caused by

antiviral drugs. Morphometric differences underlying the hereditary

sensory and autonomic neuropathies provide an interesting perspective on

the anatomical transmission of pain and would have merited more

systematic coverage.

Neurologists should read Sommer’s excellent chapter on the treatment of

neuropathic pain. The useful information about the number you need to

treat so as to relieve pain satisfactorily in one patient endorses our

use of anticonvulsant drugs, sodium channel blockers, tricyclic

antidepressants, and dextromethorphan. Mexiletine, gabapentin, and

lamotrigine are useful in resistant states. Dr Sommer’s personal

experience shows through strongly in this chapter, which culminates in a

useful algorithm. This will be a useful book for pain clinicians and in

libraries, despite a swingeing price for only 202 pages.

[Guest guest]

Editor C Sommer says:

<< Hereditary motor and sensory neuropathy uncommonly causes pain and merits

less attention.>>

That's us, folks.

MERITS less attention?!?!?!

Too bad the author is ill-informed about this.

Kat

Seattle USA