The Essence of Analgesia and Analgesics

Abstract

R. S. Sinatra, J. D. Jahr, J. M. Watkins-Pitchford . ( eds ) Cambridge University Press , 2011 , ISBN 9780521 144506 , 550 pp . , Price £65.00 This is a very comprehensive text aimed at healthcare professionals who optimise pain control in anaesthesia, intensive care, cancer medicine and chronic pain settings and accordingly is a practical and useful guide for a wide audience. The book is just over 500 pages and comprises an initial section (70 pages) covering pain definitions, with the rest of the book going into the individual analgesic agents. The first section has chapters on specific areas such as neuropathic pain and multimodal analgesia. There are excellent diagrams detailing pain receptors and the molecular basis of pain pathways. The main body of the book is then divided into sections detailing the classes of analgesic agents in the typical format of opioids, NSAIDS, local anesthetics, etc. Each section is further divided into short chapters on each agent. This structure ensures that information on each agent is easily accessible. The information is highly detailed, referencing the evidence base for most of the text. There are also useful chapters on troubleshooting epidurals, and anticoagulation and regional anaesthesia. As a pharmacology text for trainees, however, the pharmacokinetics and pharmacodynamics do not have sufficient detail. This is an excellent reference text for regular analgesics and adjuncts such as antidepressants and muscle relaxants, but it also includes an entire section on new and emerging analgesics. Whereas many texts on analgesic agents may contain a paragraph on newer agents, here we have 24 (short) chapters on agents such as cannabinoid agonists, local anaesthetic bone paste and inhaled fentanyl. This is an American textbook with over 140 contributors. One obvious omission from the UK standpoint is diamorphine from the opioid section, and there is no chapter on alfentanil. There are also references that aren’t necessarily useful in the UK, such as FDA categories (e.g. pharmaceutical pregnancy categories). Management of pain in any setting is challenging to get right and a thorough understanding of the mechanisms and agents is paramount. This book provides a very useful reference to the many agents at our disposal, their benefits and side effects, and would be an excellent text to have to hand.