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Atlas of pain injection techniques
  1. A Nicol

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Edited by T O’Connor, S Abram. London: Published by Harcourt Publishers Ltd, 2003, £49.99, hardcover, pp 141. ISBN 044306380X

Injections have a well recognised role to play in managing pain in many musculoskeletal conditions. Joint injections are commonly used now by a variety of medical practitioners from GPs to rheumatologists and orthopaedic surgeons. Muscle injections into myofascial trigger points are also gaining favour, with many practitioners now utilising both injections and dry needling techniques. This book therefore had great potential.

One major change in current practice with regard to injection techniques is that many are now “guided”. Ultrasound, fluoroscopy, and computed tomography are all used to aid the physician in the accurate placement of the needle, with the result that we more often refer a patient to a radiology department for a guided injection, which many of us used to do blindly.

The introduction, giving us an overview of the current thinking on pain transmission, is fairly in depth, but it cites no references to support many of its statements. If our understanding of pain has moved on recently, we ought to have access to the evidence base for the interested reader to follow up.

Unfortunately, for the majority of readers, this book will not be what they were expecting. Its stated aim was to provide a description of many of the basic regional anaesthetic tools and the common joint and muscle injections that may be of benefit to patients with persistent or severe pain. It does cover regional anaesthesia fairly well, particularly the chapter on autonomic blocks, but it really skims over the two chapters that most readers of this journal would open it for: joint injections and muscle injections.

The chapter on joint injection only addresses three joints, and all should now be carried out under radiographic guidance, so they are of academic interest only. The chapter on muscle injection also lacks any real detail and is essentially a summary of some of the myofascial trigger points that can be injected with local anaesthetic. The vast majority of soft tissue injections, most of which are performed for pain management, have been omitted, so the book lacks balance and the general appeal that the title suggested it may attract.

As an atlas, it is clear and structured, with good illustrations. The accompanying text is in bullet point format, so there is a lack of detail in some areas, but it is very easy to follow. I did like the appendix on dermatomes, which is an excellent pictorial view of human dermatomes in different anatomical positions—a useful addition to any aide memoir. Also, I was not sure why they needed to add a chapter on TENS in a book on pain injection techniques!

This book is therefore pitched very much at the anaesthetist involved in pain management or perhaps the radiologist doing a lot of guided injections. It does not offer much to the generalist in sports medicine other than an overview of some of the more specialist regional anaesthetic techniques available today.

Evidence basis10/20