Gregory T. Carter, MD, MS, Consulting Editor

This is also the first volume of the Clinics where we are adding, in response to our readers’ requests, an additional component of evidence-based medicine. An article is featured in this issue on “Discogenic Low Back Pain,” arguing that there isn’t much evidence that steroid epidurals have shown convincing benefit for this entity. In turn, Elsevier Clinical Solutions, Evidence-Based Medicine Center elected to include an article on “Epidural Steroid Injections for Radicular Lumbosacral Pain – A Systematic Review,” to also show that the evidence is insufficient.

Among the other esteemed authors is Dr Sucher, Director of the EMG Labs of Arizona Arthritis & Rheumatology Associates, who has done excellent work in the area of grading the severity of carpal tunnel syndrome (CTS) and developing methods for doing so. While most of us tend to use latencies as a guide, this can be misleading, and using other criteria, such as low amplitudes or conduction block and denervation, may be very useful. Drs Sucher, Nazarian, and Schreiber then give us a treatise on emerging, novel treatment strategies for CTS.

Dr Kamen, of the MossRehab Outpatient Center, and Dr Feeko, give us a comprehensive guide of opioid therapy, taking into consideration all available evidence from preclinical and clinical work. This includes excellent review of the safety and tolerability profile of opioids, pointing out that the adverse event profile varies greatly between opioids. Methods of using these agents to optimize the tolerability profile, especially regarding central nervous system and gastrointestinal effects, are provided.

Drs C. Smith and Bevelaqua give an excellent review of Parsonage-Turner syndrome in the context of neuropathic pain and Dr Saulino provides us with a thorough review of the challenges in treating spinal cord injury pain, which can often be refractory to conventional treatment and presents particular challenges to physicians and patients. This article reviews chronic spinal pain pathophysiology and the mechanisms whereby spinally administered analgesics may modify chronic pain as well as guidelines on the use of agents for nociceptive, neuropathic, and mixed pain.

Drs Greis, Marino, and Freedman review the management of complex regional pain syndrome, one of our biggest clinical challenges. They offer directly usable, clinically practical treatment paradigms.

The latter portion of this volume is rounded out with a thorough article by Drs Mallow and Nazarian on greater trochanteric pain syndrome, followed by a comprehensive review of hemiplegic shoulder pain by Drs Vasudevan and Browne. Dr Gerwin reviews the challenging topic of assessing myofascial pain syndrome, followed by a discussion from Drs Borg-Stein and Iaccarino on management strategies. Dr Kahan provides us with an excellent overview of cancer pain; the volume concludes with two articles discussing various aspects of low back pain. This includes an outstanding treatise on failed back surgery syndrome by Dr Shapiro, followed by a comprehensive discussion of the role of epidural steroid injections for radicular lumbosacral pain by Drs Shamliyan, Stall, Goldmann, and San-Lincoln.

I also want to thank each and every one of these distinguished authors, most especially Dr Schreiber, for their hard work and outstanding contributions to this issue of the Physical Medicine and Rehabilitation Clinics of North America . I believe this is a very comprehensive presentation of the management of a most challenging population of patients. This issue of Physical Medicine and Rehabilitation Clinics of North America gives us directly applicable and useful advice on how to treat these patients, making a sublime addition to the series.