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Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation Devi E. Nampiaparampil Online article and related content current as of April 20, 2009.

JAMA. 2009;301(11):1178-1179 (doi:10.1001/jama.2009.331) http://jama.ama-assn.org/cgi/content/full/301/11/1178

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BOOK AND MEDIA REVIEWS

according to the educational objectives developed by the author of the chapter. The book would have benefited from an overview chapter that discussed abuse more broadly, identified commonalities among the types of abuse, and summarized treatment options currently available to abused persons and their families. Last, any text that deals with the medical treatment of abused or tortured persons should acknowledge and include some discussion of secondary traumatization and the effect that dealing with abuse has on the health care practitioners themselves.

In summary, Emergency Care of the Abused is an easy-toread reference text about how to recognize and provide immediate medical treatment for different types of abuse. To our knowledge, it is the first of its kind to address the breadth of abuse issues that general practitioners, emergency medicine physicians, pediatricians, and others may encounter in their clinical practice. The intended focus, however, is solely on acute medical care. In not addressing mental health considerations for either the patient or the practitioner, it does not alert the practitioner to opportunities for prevention, early intervention, and short- and long-term treatment options. As such, it does not push clinicians to acquire a deeper understanding of their role in addressing a complex set of societal problems.

Melissa L. McCarthy, ScD Johns Hopkins University School of Medicine Baltimore, Maryland mmccarth@jhmi.edu Karin V. Rhodes, MD, MS University of Pennsylvania School of Medicine Philadelphia karin.rhodes@uphs.upenn.edu Financial Disclosures: None reported.

ESSENTIALS OF PHYSICAL MEDICINE AND REHABILITATION: MUSCULOSKELETAL DISORDERS, PAIN, AND REHABILITATION

By Walter R. Frontera, Julie K. Silver, and Thomas D. Rizzo Jr 2nd ed, 935 pp, $119.95 New York, NY, Saunders/Elsevier, 2008 ISBN-13: 978-1-4160-4007-1

WITH MORE THAN 175 CONTRIBUTING AUTHORS FROM A VAriety of specialties, Essentials of Physical Medicine and Rehabilitation is an excellent resource for clinicians interested in sports medicine, pain management, and inpatient physiatry. The majority of the text is devoted to musculoskeletal syndromes, with the rest divided between pain medicine and rehabilitation. The scope is expansive, covering topics as general as chronic kidney disease and as specific as corns. It is thorough in its listing and discussion of various orthopedic and neurologic disorders.

The topics presented, such as osteoarthritis, lumbar degenerative disease, rotator cuff tendinitis, and patellofemo1178 JAMA, March 18, 2009—Vol 301, No. 11 (Reprinted)

ral syndrome, are germane to primary care physicians. Because of the book’s clear and concise language, wellorganized chapters, and illustrative images, it would be a valuable asset to physicians working in the ambulatory care arena. The book likewise offers practical advice for common pain syndromes such as arthritis: “An occupational therapy evaluation . . . may identify difficulties with hand activities (e.g., due to hand [osteoarthritis]) and difficulties with donning and doffing of footwear (due to restricted hip range of motion). Adaptive equipment (e.g., reaching devices, sock donners, long-handled shoe horns, elastic shoelaces) may help maximize independence. . . . ” Essentials of Physical Medicine and Rehabilitation would be equally beneficial to sports medicine clinicians and primary care practitioners because of the depth and detail with which it presents each topic. Chapters are devoted specifically to claw toe, hammer toe, and mallet toe. Certain chapters explain which radiographic views to order when evaluating different injuries. For example, in a chapter on acromioclavicular injuries, the author writes that “A 15-degree cephalad anteroposterior view helps diagnose . . . separation between the acromion and clavicle. . . . ” The chapter on assessing wounds may be especially useful on the wards. Of note, the authors forego discussing electromyography.

The book skillfully integrates the perspectives of physiatrists as well as orthopedic surgeons on conditions that they may both address. Compared with its peer textbooks, this text delves more deeply into surgical treatment options. Multiple chapters discuss operative techniques for various musculoskeletal injuries, the usefulness of different types of hardware, and potential postoperative complications. The chapters on flexor and extensor tendon injuries are exceptional and provide descriptions of all the zones of injuries and their respective management algorithms.

The book is replete with useful and informative figures and radiological images. Even for rare syndromes such as Tietze syndrome, the authors provide ultrasonographic imaging of normal as well as enlarged costochondral joints to illustrate the foundation for patients’ pain symptoms. For office procedures, such as subacromial bursa injections, the authors illustrate the different directional approaches as well as the varying success rates with each approach. Excellent figures and descriptions are used to demonstrate how to perform a wide range of injections, including pronator teres injections and anterior interosseous nerve blocks.

The book clarifies some of the administrative issues surrounding disability. Unlike most textbooks in physical medicine and rehabilitation, it outlines the criteria necessary for patients to qualify for social security disability based on chronic pain. In addition, on page 601, the book describes “K levels,” which are “used by Medicare to determine an individual’s functional potential and thus to justify prosthetic components” for patients with lower limb amputations.

Although the text is generally comprehensive, some areas could be more robust. For example, there are no chapters ©2009 American Medical Association. All rights reserved.

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BOOK AND MEDIA REVIEWS

specifically dedicated to the controversies surrounding opioid therapy. In the chapter on postherpetic neuralgia, the authors write that “Studies of corticosteroids, anticonvulsants, opioids, antidepressants, and acupuncture . . . have not been found to reduce the severity of acute zoster symptoms or the incidence of postherpetic neuralgia.” No further information is given about these treatments, which may lead the reader to the conclusion that these medications are not useful. However, opioids and tricyclic antidepressants have often been considered the mainstays of treatment for both acute zoster and postherpetic neuralgia. Randomized controlled trials have suggested the efficacy of the anticonvulsants gabapentin and pregabalin,1,2 and both agents have received approval from the US Food and Drug Administration (2002 and 2004, respectively) for the treatment of postherpetic neuralgia. Also, the organization of the “Rehabilitation” section could be improved. For example, the chapters related to traumatic brain injury, spinal cord injury, and rheumatologic disease could have been grouped together.

Despite these minor limitations, the text achieves the difficult goal of satisfying the needs of generalists and specialists alike. Essentials of Physical Medicine and Rehabilitation is well written and well researched. It would be a valuable addition to the library of any physician treating sports injuries or chronic pain resulting from musculoskeletal or rheumatologic causes.

Devi E. Nampiaparampil, MD Division of Pain Medicine VA Hudson Valley Healthcare System Castle Point, New York Muscle and Nerve Pain Specialists, Ltd Chicago, Illinois devichechi@hotmail.com Financial Disclosures: Dr Nampiaparampil reported having served on a research advisory board for Elan Pharmaceuticals.

1. Rowbotham M, Harden N, Stacey B, Bernstein P, Magnus-Miller L; Gabapentin Postherpetic Neuralgia Study Group. Gabapentin for the treatment of postherpetic neuralgia: a randomized controlled trial. JAMA. 1998;280(21):1837-1842.

2. Dworkin RH, Corbin AE, Young JP Jr, et al. Pregabalin for the treatment of postherpetic neuralgia: a randomized placebo-controlled trial. Neurology. 2003; 60(8):1274-1283.

EVIDENCE-BASED DERMATOLOGY Edited by Hywel Williams, Michael Bigby, Thomas Diepgen, Andrew Herxheimer, Luigi Naldi, and Berthold Rzany 2nd ed, 723 pp, $300.25 Malden, MA, Blackwell Publishing, 2008 ISBN-13: 978-1-4051-4518-3

THIS HEFTY TOME, NOW IN ITS SECOND EDITION, STARTS WITH 14 chapters on the basis and meaning of evidence-based medicine and dermatology. These chapters have titles such as “The Field and Its Boundaries,” “The Rationale for Evidence-based Dermatology,” “The Cochrane Skin Group,” “Critical Appraisal of Pharmacoeconomic Studies,” and, most ©2009 American Medical Association. All rights reserved.

significantly, “How to Critically Appraise a Randomized Controlled Trial.” The chapters are clear and well written, with informative tables and line drawings printed in color. The text includes many pearls and useful data. References are pertinent and up to date. Unfortunately, the writing does have a whiff of defensiveness. As an example, the preface

by Williams starts by saying that “Evidence-based dermatology is no longer a dirty word in dermatology.” A more serene approach might have been more desirable.

Chapters 15 to 57 comprise the bulk of the book (approximately 600 pages) and cover a variety of clinical subjects, from acne to treatment of warts and from basal cell carcinoma to venous ulcers. A typical heading covers the definition and main features of the condition (in many cases with demonstrative clinical photographs); the main questions to be asked and the answers found in bibliographic searches; and extensive references. Key points are outlined in color in some chapters, and tables and line drawings are also included. Authors state when no significant data were found; for instance, “There are no data to support a role for azathioprine in psoriasis” (p 180).

We have no qualms with the concept of evidence-based medicine, or evidence-based dermatology, to be more exact.

The material is based on published data, but this is limiting in and of itself. A study may have been conducted that would support one theory or another, but without publication in an available journal, such evidence would be lost or perhaps ignored. Does this mean that there is no evidence for such a theory, or does it mean there is no written documentation?

Unfortunately, the quality of the chapters is uneven. This in part reflects the variability of the available published evidence, but intrinsic variation also exists in the authors’ work and choices of clinical topics. First, for example, hand eczema is considered and evaluated as a single item. The clinician cannot really evaluate, say, the role of oral immunosuppressants vs that of corticosteroids, taking together irritant contact dermatitis, allergic contact dermatitis, and hand dermatitis in atopics as a single subject of therapy. Some rather unusual and controversial definitions or statements are also presented; eg, “Eczema is, by definition, poorly defined erythema” (p 131).

Second, the same problem is also found in the chapter on leprosy, which states that “A biopsy of the skin lesion may help confirm the diagnosis, improve research, and allow culture of [Mycobacterium] leprae in mouse footpads; however, the sensitivity is poor, because biopsies can yield negative results despite obvious clinical signs” (p 442). Leaving aside the use of the word “may,” which should be avoided in a book on evidence-based practice, the seeming lack of proper evaluation of the role of biopsies in the diagnosis and classification of leprosy is a major shortcoming.

Third, the book’s definition of scabies as “an itchy immune hypersensitivity reaction to infestation of skin by the mite Sarcoptes scabiei” (p 463) would exclude crusted scabies or the nonitchy scabies seen sometimes in small children or certain other individuals.

(Reprinted) JAMA, March 18, 2009—Vol 301, No. 11

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