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Media Watch
Media watch Neuropathic Pain: Physiology and Treatment Hansson PT, Fields HL, Hill RG, Marchettini P IASP Press, 2001 US$79, 288 pp ISBN 0 931092 38 8
If I begin this book review by alluding to the last two sentences of the volume, please rest assured that I read it and did not just skip to the end. However these last two sentences neatly capture the main strength of the work. Having summarised the near and far horizons of future work for neuropathic pain patients, two of the editors observe “Help for these patients will require close cooperation among clinicians, clinical scientists, and basic scientists.” This slim work of 264 pages succeeds in offering value for clinicians and scientists alike, and is written with a clear regard for clinical priorities. The preface tells us that book arose from two symposia but, rather than acting as a conference proceedings, was intended to be a review of research and clinical practice. A successful balance between research and clinical information is often difficult to achieve, with clinical needles bundled in research hay, but there is much here to capture the attention of clinicians. A thoughtful early chapter on the clinical perspective is followed by several chapters on science: sodium channels, cytokines, primary nociceptors, CNS mechanisms in peripheral neuropathy, tonic descending facilitation, and the sympathetic nervous system. There is a favourable impression of tight editing to keep the contributors focused, although a few unclear abbreviations have slipped in. From these chapters the scientist and clinician alike get an overview of some of the pathophysiology and mechanisms of
Robot: The Future of Flesh and Machines Rodney A Brooks Allen Lane, 2002 £16·99, 260pp ISBN 0 713995 01 7
Rodney Brooks has been called the “Self Styled Bad Boy of Robotics”. In the 1990s he gained this dubious honour by orchestrating a string of highly evocative robots from his artificial interligence Labs at the Massachusettes Institute of Technology (MIT), Boston, USA. First up there is Genghis, a six-legged robot that Brooks describes as “my most satisfying”—there is even a 12 page appendix describing exactly how it works. Then there is Cog, originated in 1993 in an attempt to approach Hal from the film 2001. With an arm and cameras for eyes it certainly has the look. But the cherry on the cake is most definitely Kismet, who with droopy eyelids and floppy ears, looks excruciatingly cute when responding to sounds. Could it even be exhibiting emotions? Brooks is clearly on his home patch when describing his robots and the words flow easily. The wearable computers of Thad Storner and Steve Mann (both once of MIT) are described, along with a
THE LANCET Neurology Vol 1 December 2002
pain. Most will benefit from a greater appreciation of mechanisms important in the generation of neuropathic pain, surely a prerequisite for designing and focusing effective treatments. The next few chapters cover treatment—antidepressants, anticonvulsants, antiarrhythmics, opioids, topical local anaesthetics, and CNS stimulation. These chapters may be particularly informative for clinicians, notably the clear data on numbers needed to treat. I see gabapentin increasingly used as a first line agent in neuropathic pain and note with interest that the number needed to treat to achieve 50% pain relief for amitriptyline is about 2·0 in several studies, but 3·8 for gabapentin. The chapters are extensively referenced and there is quite careful indexing, including figures and tables as well as text. While neatly illustrating how much we have learned about neuropathic pain, the book does not evade the gaps in knowledge that exist, both those easily filled and those perhaps unbridgeable. Clearly, we lack high quality efficacy data on some common drugs, particularly for central neuropathic pain, and further work is rightly suggested. However, acknowledged but not perhaps explored, is a far more fundamental and taxing difficulty. How useful can animal models be to study a subjective phenomenon like pain? The last chapter explores some of the reasons that central neuropathic pain remains daunting to treat, and reminds us that reorganisation plays a role in perpetuating such pain. So what of the final sentence that I alluded to at the start of this review? It reads “We hope that this volume will serve as an impetus for others to join the effort to understand and treat these patients”. On balance, with this readable and thought provoking summary, they have succeeded. Carolyn Young
chapter devoted to cochlea implants, heart pacemakers, and artificial legs. He also gives a good account of the research of Tom Knight and Ron Weiss, also of MIT, in making Escherichia coli cells into tiny robots. Even the work of Miguel Nicolelis is covered, whereby he used neural signals from owl monkeys to direct a robot arm in MIT, remotely connected via the Internet. Philip Kennedy, from Emory University in Atlanta has carried out some of the most amazing research in robotics by making use of human neural signals to operate a computer mouse. Yet this receives only a passing mention with Kennedy himself ignored completely. While Brooks indicates that forces from a robot arm will, in the future, be fed back to the owl monkeys to allow them to feel the force, he seems completely unaware that this has already been done successfully with humans. Although I have to admit, that wasn’t at MIT, so perhaps it doesn’t count. Brooks is unquestionably one of the leading researchers in the field of robotics, and for a coverage of his work, this book is a delightful read. But in terms of its billing as a vision of the future, it appears that Brooks is wearing bifocals that only allow him to look as far as the suburbs of Boston. Kevin Warwick
http://neurology.thelancet.com
519
For personal use. Only reproduce with permission from The Lancet Publishing Group.
If I begin this book review by alluding to the last two sentences of the volume, please rest assured that I read it and did not just skip to the end. However these last two sentences neatly capture the main strength of the work. Having summarised the near and far horizons of future work for neuropathic pain patients, two of the editors observe “Help for these patients will require close cooperation among clinicians, clinical scientists, and basic scientists.” This slim work of 264 pages succeeds in offering value for clinicians and scientists alike, and is written with a clear regard for clinical priorities. The preface tells us that book arose from two symposia but, rather than acting as a conference proceedings, was intended to be a review of research and clinical practice. A successful balance between research and clinical information is often difficult to achieve, with clinical needles bundled in research hay, but there is much here to capture the attention of clinicians. A thoughtful early chapter on the clinical perspective is followed by several chapters on science: sodium channels, cytokines, primary nociceptors, CNS mechanisms in peripheral neuropathy, tonic descending facilitation, and the sympathetic nervous system. There is a favourable impression of tight editing to keep the contributors focused, although a few unclear abbreviations have slipped in. From these chapters the scientist and clinician alike get an overview of some of the pathophysiology and mechanisms of
Robot: The Future of Flesh and Machines Rodney A Brooks Allen Lane, 2002 £16·99, 260pp ISBN 0 713995 01 7
Rodney Brooks has been called the “Self Styled Bad Boy of Robotics”. In the 1990s he gained this dubious honour by orchestrating a string of highly evocative robots from his artificial interligence Labs at the Massachusettes Institute of Technology (MIT), Boston, USA. First up there is Genghis, a six-legged robot that Brooks describes as “my most satisfying”—there is even a 12 page appendix describing exactly how it works. Then there is Cog, originated in 1993 in an attempt to approach Hal from the film 2001. With an arm and cameras for eyes it certainly has the look. But the cherry on the cake is most definitely Kismet, who with droopy eyelids and floppy ears, looks excruciatingly cute when responding to sounds. Could it even be exhibiting emotions? Brooks is clearly on his home patch when describing his robots and the words flow easily. The wearable computers of Thad Storner and Steve Mann (both once of MIT) are described, along with a
THE LANCET Neurology Vol 1 December 2002
pain. Most will benefit from a greater appreciation of mechanisms important in the generation of neuropathic pain, surely a prerequisite for designing and focusing effective treatments. The next few chapters cover treatment—antidepressants, anticonvulsants, antiarrhythmics, opioids, topical local anaesthetics, and CNS stimulation. These chapters may be particularly informative for clinicians, notably the clear data on numbers needed to treat. I see gabapentin increasingly used as a first line agent in neuropathic pain and note with interest that the number needed to treat to achieve 50% pain relief for amitriptyline is about 2·0 in several studies, but 3·8 for gabapentin. The chapters are extensively referenced and there is quite careful indexing, including figures and tables as well as text. While neatly illustrating how much we have learned about neuropathic pain, the book does not evade the gaps in knowledge that exist, both those easily filled and those perhaps unbridgeable. Clearly, we lack high quality efficacy data on some common drugs, particularly for central neuropathic pain, and further work is rightly suggested. However, acknowledged but not perhaps explored, is a far more fundamental and taxing difficulty. How useful can animal models be to study a subjective phenomenon like pain? The last chapter explores some of the reasons that central neuropathic pain remains daunting to treat, and reminds us that reorganisation plays a role in perpetuating such pain. So what of the final sentence that I alluded to at the start of this review? It reads “We hope that this volume will serve as an impetus for others to join the effort to understand and treat these patients”. On balance, with this readable and thought provoking summary, they have succeeded. Carolyn Young
chapter devoted to cochlea implants, heart pacemakers, and artificial legs. He also gives a good account of the research of Tom Knight and Ron Weiss, also of MIT, in making Escherichia coli cells into tiny robots. Even the work of Miguel Nicolelis is covered, whereby he used neural signals from owl monkeys to direct a robot arm in MIT, remotely connected via the Internet. Philip Kennedy, from Emory University in Atlanta has carried out some of the most amazing research in robotics by making use of human neural signals to operate a computer mouse. Yet this receives only a passing mention with Kennedy himself ignored completely. While Brooks indicates that forces from a robot arm will, in the future, be fed back to the owl monkeys to allow them to feel the force, he seems completely unaware that this has already been done successfully with humans. Although I have to admit, that wasn’t at MIT, so perhaps it doesn’t count. Brooks is unquestionably one of the leading researchers in the field of robotics, and for a coverage of his work, this book is a delightful read. But in terms of its billing as a vision of the future, it appears that Brooks is wearing bifocals that only allow him to look as far as the suburbs of Boston. Kevin Warwick
http://neurology.thelancet.com
519
For personal use. Only reproduce with permission from The Lancet Publishing Group.