Robert W. Baloh - Sciatica and Chronic Pain: Past, Present and Future

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In Sciatica and Chronic Pain: Past, Present and Future , Professor Baloh addresses a common, universal problem directly related to mans upright posture. As such, it has afflicted man since prehistoric times. Our understanding of sciatica and pain has evolved over time. Modern imaging has contributed greatly to our appreciation of the relationships of nerve roots contributing to the sciatic nerve and the importance of adjacent structures of bone, cartilage, and disc. Our understanding of the phenomenon of pain and its physiology and chemistry is perhaps less complete. Management of patients with sciatica and chronic pain still poses a major challenge. Surprisingly, few have attempted to address this important problem.

Our perception of pain and response to pain is very individual and differs widely among people. Sciatica and Chronic Pain: Past, Present and Future delves into different aspects of pain from neural networks, neural transmitters, and genetic viewpoints and provides us with a glimpse of how various factors may interact to make us perceive pain. This book also provides a concise yet complete guide to the management of patients with sciatica. It explores the multifaceted approach to management of chronic pain from many viewpoints, including of course the pharmacological and surgical, as well as less orthodox approaches to pain. As such, it should be of interest to a wide audience, including students, physicians, as well as patients.

The historical perspectives are not only of interest but allow us to infer that our understanding of pain mechanisms will expand with current and future research, no doubt leading to even better methods of pain management.

I noticed a burning pain in my right buttock one Sunday morning. Since I frequently injured myself during my weekly tennis match on Saturday, at first I was not concerned. I tore my rotator cuff in the past and after surgical repair I could only play once a week without reinjuring the shoulder. But the pain gradually got worse and I noticed occasional sharp pains shooting into the outside of my right leg. I thought the pain might be coming from my hip possibly arthritis of the hip since my father had severe arthritis of the hip as he got older and I am a big believer in genetics. But when I saw the orthopedic surgeon who repaired my rotator cuff tear, he could not find anything wrong with my hip. We agreed that the pain was probably sciatica due to arthritis in my back and that I should lay off tennis and take ibuprofen as needed for the pain.

The goal of the book is to provide a concise overview of sciatica and chronic pain. I have a longstanding interest in the history of medicine and I use historical context to set the stage for understanding new concepts. As in all areas of neuroscience and medicine, there is a jargon that goes with the field. I have attempted to minimize the impact of the jargon on understanding new concepts by defining terms as they are introduced. Charts, figures, and tables help clarify new concepts. Finally, three patients with sciatica and chronic pain are followed serially throughout the book to illustrate important concepts discussed in the text.

I thank my neurology colleagues Melissa Spencer and Leif Havton for reviewing early drafts of the book and providing helpful comments. I want to particularly thank Rick Batzdorf for his helpful suggestions and for writing the Foreword to the book. I thank Julie (Juhyun) Kim for drawing several of the figures and her patience in getting them just right. Julie is a nurse practitioner at Mount Sinai Hospital in New York and a talented young medical illustrator. My wife, Grace, provided helpful suggestions and constant support. Finally, I want to thank Michael Griffin and Richard Lansing at Springer for helping me get the book together.