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Reviews of Educational Material  |   May 2004
Pain: Current Understanding, Emerging Therapies, and Novel Approaches to Drug Discovery.
Author Notes
  • Medical College of Wisconsin, Milwaukee, Wisconsin.
Article Information
Reviews of Educational Material
Reviews of Educational Material   |   May 2004
Pain: Current Understanding, Emerging Therapies, and Novel Approaches to Drug Discovery.
Anesthesiology 5 2004, Vol.100, 1332. doi:
Anesthesiology 5 2004, Vol.100, 1332. doi:
Pain: Current Understanding, Emerging Therapies, and Novel Approaches to Drug Discovery.  By Chas Bountra, Rajesh Munglani, William K. Schmidt. New York and Basel, Marcel Dekker, 2003. Pages: 968. ISBN: 0824788656. Price:$225.
In the preface to this new compendium of pain science, the editors state that the book is designed to offer the latest in current knowledge on pain mechanisms, assessment, and treatment. Further, it is intended as a multi-authored resource book for academic and pharmaceutical researchers. These are worthy goals for several reasons. Although potentially problematic issues regarding the intentions and transparency of commercial research must be recognized, pharmaceutical laboratories have become a major venue for basic and applied research in pain, and their role is central in the translational process of drug development. Half of the authors of this book are industry employees, and a clear industry slant is evident in the editors’ acknowledgment of the importance of research pragmatics, such as model validity, clinical trial planning, cost-effectiveness of research, and the need to find drugs that are not only effective but are also superior to those currently marketed.
A second potential strength of this format is the opportunity to read updates from expert authors. Here, the book is only inconsistently successful. On pathogenic processes, for example, excellent summaries are provided on sympathetic involvement in pain by Baron and Janig, visceral pain by Wesselmann, and the role of neurotrophic factors by Mendell. These are concise but complete and are solidly based in cited research. For other chapters, it is hard to discern the intent of the authors. Chapters on human and animal models of pain are very brief and incomplete, not providing the detailed examination that would be a key resource to researchers. Regarding clinical conditions and treatments, the usefulness of chapters also varies widely. A review of migraine by Goadsby quickly brings one up to speed on current thinking on this topic, but a 6-page summary of acute trauma and postoperative pain is far too brief to be helpful. Oddly, a full 9-page chapter is allocated to a questionnaire survey of patients’ response to pulsed radiofrequency, an uncertain treatment for back pain. The book hits its stride in a lengthy series of capsule reports on various drug categories. Of note, for example, are chapters on novel opioids by Porreca and Hruby, vanilloids by Basbaum et al.  , neurotrophic factors by Mendell, and α2-adrenergic agonists by Lavand’homme and Eisenach. These and other tightly focused synopses offer the reader a good jump forward in understanding the applied pharmacology of numerous potential and current therapeutic agents.
One of the challenges in creating a multi-authored text is directing the efforts of a large crowd of contributors, in this case 141 of them. For this book, however, there was no apparent effort to link the content of the individual chapters in any clear way, so each brief chapter stands alone and repetition is extensive. Evidently, not all authors were timely in their submissions. As a result, publication was delayed and few chapters have any citations past 1999. Research on pain is dramatically expanding, as illustrated by an exponential increase in the number of MEDLINE entries on pain from 3,632 in 1982 to 14,171 in 2002. Therefore, the lack of recent references in this book is a serious defect, which was only partly repaired by adding a “Further Readings” section at the end.
Pain is a vastly broad and complex topic. Other than investigators needing a quick launch into a particular pharmacologic issue, most readers would optimally benefit from an integrative approach that provides a framework for the progressively more detailed theories and observations that are emerging from modern research. There is just too much to take in. Although the book includes thoughtful analytical pieces, such as those on pain categorization and the interaction of processes leading to neuropathic pain, a critical perspective is not apparent overall. The result is that the whole is not greater than the sum of the parts.