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question, which is a shame because correct answer structure
is crucial to getting the maximum marks from the available
knowledge in the limited time allowed.
There are 143 sample SAQs presented, these being
divided into four parts: clinical anaesthesia, critical care
medicine, anatomy and regional techniques, and pain
medicine and analgesia. The structure of the book is perplex-
ing as it does not seem to mirror the Intermediate Level
Training Curriculum to which all final FRCA questions have
to be mapped. It has deliberately omitted basic science
SAQs, yet included an entire section on anatomy and region-
al techniques. The decision to include some areas of the cur-
riculum in great detail while omitting others somewhat
contradicts the laudable aim of the book which is to
expose candidates to the range of topics used in the SAQ
paper.
Each question is presented in a clear and consistent way,
and indicates the number of marks available for each section
in a way similar to the real SAQ paper where percentage
breakdown is used. There then follows a brief description of
the aims of the question. The model answers are extensive
and structured, being correctly divided into approximately
the same proportions as the mark allocations. Some
answers contain excessively long lists of bullet points, for
example, the initial management of a perioperative death
(Part 1, Chapter 1, Q27), attracting 13 marks, has a list of
25 bullet points in a seemingly random order. This approach
makes reading the answers pretty heavy going, but the lack
of prioritization or systematic approach also makes remem-
bering the answers more challenging. In places the
answers do not appear to quite match the question, a
common reason for scoring badly in the examination, for
example, when the question asks about criteria for admission
to an intensive care unit (ICU) (Part 2, Q11) then broad state-
ments about the problems of ICU admissions do not gain
marks. The book contains many helpful line diagrams, quite
correctly included to act as an aide-memoire for the
answers rather than as a template for drawings in the exam-
ination. Another stated aim of this book is to provide model
answers for SAQs about recent guidelines and areas of
topical interest. These topics are well covered throughout
all sections of the book, making this a useful current resource
for examination candidates.
The authors are to be commended for producing such an
extensive and up-to-date source of practice SAQs. Sadly, it
does not cover all the topics that a candidate may face in
an SAQ paper. As a result, I think it would make a useful add-
ition to the trainee’s room of an anaesthetic department for
those less-busy nights on call, but an individual wanting to
buy a single book to help them to practise SAQ papers
must be aware that not all topics are covered.
A.B. Lumb
Leeds, UK
E-mail: andrew.lumb@leedsth.nhs.uk
doi:10.1093/bja/aer455
332
Book Reviews
Essentials of Pain Medicine, 3rd Edn. H. Benzon, S. N. Raja, S. Liu,
S. M. Fishman and S. P. Cohen (editors). Published by Elsevier,
Philadelphia, USA. Pp. 664; indexed; illustrated. Price £185.
ISBN 978-1-4377-2242-0.
The editors, and the long list of contributors, of this concise
book are drawn entirely from North America with the vast
majority from the USA. As stated in the brief preface, in
addition to a complete revision of all chapters, the editors
have deleted previous material related to regional and neur-
axial anaesthesia, and added chapters of relevance, particu-
larly to the practising American pain clinician, including the
use of ultrasound, and DSM mental disorders of relevance
to pain medicine.
The book is split into nine sections; the first three sections
offering basic science, clinical evaluation and examination,
and pharmacology. Subsequent sections cover all therapeut-
ic aspects including perioperative pain management. The
largest section is composed of chapters dedicated to specific
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chronic pain syndromes. There is a section on interventional
techniques, and one each on cancer and neural blockade.
Chapters end with succinct summaries or conclusions
where appropriate, and, in some chapters, key points. The
breadth of this book’s endeavour appears to be wide, but
not at all at the expense of depth and detail.
The book presents a state-of-the-art of current American
practice with the result that some chapters are essentially re-
dundant for non-American readers, for example, a chapter
on legal and regulatory issues in pain management.
A particular selling point of this book is that purchase of
the book allows access to an online version. This produces
some immediate benefits, including the placement of all
references online, reducing the number of printed pages con-
siderably and adding to the book’s ease of use as a reference
tome. Online, it functions as a full electronic version of the
book, with easy and straightforward navigation, and very
usefully incorporates word-search.
The word-search facility draws up all related sections of
the text in short form, which can of course be expanded by
a click of the button. Search of the word ‘pain’ drew up
more than 1500 entries, ‘magnetoencephalography’ just
one. The references in the online text link to Pubmed for
readers who wish to purchase the complete article. Frustrat-
ingly, however, the references are numbered in the text, but
not in the reference section—which makes it difficult to
match one with the other—a serious flaw which limits the
ease of use in this respect.
The book opens with a section which essentially serves
as a refresher course on the physiology of pain processing
at the peripheral and spinal cord level. This is succinct and
up-to-date. The next section focuses on evaluation of the
pain patient and includes a very useful chapter on spinal
imaging, with lots of magnetic resonance imaging scan
appearances of common spinal pathologies which is
useful as a quick, although selective, overview. It also
includes a chapter on determination of disability, but it is
Book Reviews
only two pages long, and written with a focus on providing
medical evaluation with respect to US social security
administration. This important topic deserved more, and
its treatment here will have limited application outside
the USA.
Clinical pharmacology is well represented, with a chapter
on drugs in myofascial pain disorders, which includes evi-
dence of efficacy—well conceived and useful. As might be
expected, a particular strength of the book is material
related to interventions, and as an example the chapter on
transforaminal epidural injection of steroids does not disap-
point. Although the chapter is not an exhaustive step by
step guide, it is a co-ordinated account with discussion of ra-
tionale, anatomy, technique, complications, and outcomes,
and is commendable. It is one of many in the section
‘Chronic Pain Syndromes’, which is the section of most rele-
vance to the busy practising pain clinician and is very good
overall. There is a separate section on Interventional Techni-
ques, with whole chapters devoted to procedures of un-
proven worth, for example, intradiscal electrothermal
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annuloplasty, discography, and also less controversial and
accepted techniques such as intrathecal drug delivery and
spinal cord stimulation. These chapters are useful summaries
for the generalist, but are not sufficiently detailed for the
specialist. In contrast, the section on Nerve Blockade (8
chapters) could be a succinct standalone text, although
with an emphasis on landmark and stimulation techniques
more than ultrasound guidance.
Despite the American emphasis, the book serves as an
excellent revision tool for advanced level pain trainees,
and CPD tool for consultants, aided by brief and concise
chapters. I have no doubt that many readers will find
themselves using the online version more than the
printed book.
N. Plunkett
Sheffield, UK
E-mail: nick.plunkett@sth.nhs.uk
doi:10.1093/bja/aer456
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333