Gary Stein, MD is an internist with The Permanente Medical Group in San Jose, California, where he is head of the Spine Clinic.

This book is a "must read" for all clinicians seeing patients who have back pain. The Back Pain Revolution covers most of the pertinent areas of interest to the student of back pain: medical history and physical examination, epidemiology, risk factors, natural history, the differences between physical impairment and disability, and psychological distress. The chapter discussing patient beliefs about back pain is an excellent summary of the many unspoken ideas patients bring with them to the examination room and how these ideas vary enormously among different cultures.

The Back Pain Revolution has changed treatment methods dramatically. We now encourage patients to remain active and to resume usual activities as soon as possible. Narcotics are used much less frequently and usually only for severe and acute pain. We have learned the power of the medical history and physical examination for making the diagnosis, and we appreciate the appropriate and more limited role of plain radiographs and advanced imaging techniques. We have a better understanding of pain as affecting and being affected by the central nervous system with insight into the diverse influences producing and sustaining pain. Dr Waddell and others have used the phrase "back pain as a biopsychosocial phenomenon" to summarize the diverse factors influencing pain perception. Above all, our inclination to cure by wielding a blade has been inhibited: A chance to cut is not necessarily a chance to cure. Indeed, the suffering that accompanies the patient with back pain is best treated with sincere concern and wise counsel. The tricyclic and tetracyclic antidepressant agents work well to improve sleep and pain tolerance. The selective serotonin reuptake inhibitors (SSRIs) and the newer antidepressants help patients when depression is prominent.

The last third of this book contains the clinical practice guidelines developed for governmental bodies in the United States, the United Kingdom, and New Zealand. These guidelines have served as models for the guidelines established by most Permanente Medical Groups.

In addition, the book contains "Information for Patients" that can be reproduced and given to them to help them understand that back pain is both musculoskeletal and neurological. This may be of help especially to patients who insist on knowing the precise anatomic location of the pain. These patients frequently request magnetic resonance imaging (MRI) to help find the pain even when MRI is not needed for diagnostic or therapeutic purposes. A request of this sort is based on long-outdated thinking; we must help our patients and, when need be, our colleagues, to understand the newer concepts of back pain. This well-written, easy-to-read, informative book does just that. Our patients with back pain will get well with the least possible pain and suffering if we appropriately obtain the medical history and conduct the physical examination, rule out dreaded disease, recognize those few conditions that surgery can predictably improve, and explain the problem to the patient in the way Dr Waddell explains it to us. This book is an interesting and important contribution about a very common problem.

Churchill Livingstone, $60; Edinburgh, New York;1999: ISBN: 0443060398.

"God Unmasked; the Full Life Revealed,"
by Ernest Lane, MD
Review by Albert Ray, MD

Albert Ray, MD, is Assistant Chief in the Department of Family Practice at Kaiser Permanente in San Diego and an elected Director of the Southern California Permanente Medical Group.

Dr Ernest Lane practiced medicine with the Northwest Permanente Medical Group for 17 years. After spending his lifetime as a healer of humans, Dr Lane has written God Unmasked; the Full Life Revealed, a treatise on the value of bridging the schism between science and religion. Dr Lane offers a series of compelling and logical arguments concerning 1) the existence of the spiritual self and 2) the importance of recognizing the bond between the physical, measurable realm of science and the intangible, incalculable world of the spirit. Skeptics as well as religious believers with a somewhat questioning outlook will achieve reconciliation by reading this book, which, contrary to my expectations, actually embraces "openness to doubt" as the cornerstone of spiritual development. And for unwavering believers, reading this book presents an opportunity to more fully contemplate--and thereby appreciate--the gift of faith.

As educated individuals, we are taught from an early age to be critical thinkers. The scientific and spiritual realms grow apart and seem to be at odds. Dr Lane portrays an existence where these entities are brought together under a central canopy that results in a more fulfilling life. Through exploration of the psychology of human behavior, the book asserts, a person can become aware of God's presence in the world. This awareness results in a change in mental outlook for the individual, who is rewarded with a more wholesome existence.

Dr Lane asserts that people must be committed to integrity, defined by its open door to doubt; indeed, acceptance of uncertainty is what allows a person to feel God's presence. In this way, not only is God unmasked but each of us comes to understand what we are really all about. Ultimately, this process allows us to comprehend what constitutes the essence of a fuller life for ourselves and for all the world.

With great creativity and sensitivity, Dr Lane unveils a compelling saga for those who seek a deeper understanding of human existence. A person must look beyond personal needs to find the key to deeper comprehension of the meaning of life and must learn the fine balance between detachment and engagement in order to navigate existence successfully.

This book was not written in a vacuum. Dr Lane has drawn from the rugged circumstances of his own personal history, combining it with more than 30 years of experience working in general medical practice. If you want to be challenged, read this book. The famous words, "God, reveal yourself; hide no more" do become a reality, and, within that reality, you will be able to experience greater understanding of self.

High Ground Publishing, $24.95. Montpelier, VT; 1998; ISBN O-9654915-2-8

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