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British Journal of Pain

[3 followers] Follow
Full-text available via subscription

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ISSN (Print) 2049-4637 - ISSN (Online) 2049-4645
Published by Sage Publications

[700 journals]

Trauma
- Authors: Cox; F.
  Pages: 65 - 65
  PubDate: 2013-05-16T23:37:53-07:00
  DOI: 10.1177/2049463713489939|hwp:resource-id:spbjp;7/2/65
  Issue No: Vol. 7, No. 2 (2013)
Guest Editorial
- Authors: Quinlan; J.
  Pages: 66 - 66
  PubDate: 2013-05-16T23:37:53-07:00
  DOI: 10.1177/2049463713486775|hwp:resource-id:spbjp;7/2/66
  Issue No: Vol. 7, No. 2 (2013)
Traumatic amputations
- Authors: Clasper, J; Ramasamy, A.
  Pages: 67 - 73
  Abstract: Traumatic amputations remain one of the most emotionally disturbing wounds of conflict, as demonstrated by their frequent use in films to illustrate the horrors of war. Unfortunately, they remain common injuries, particularly following explosions, and, in addition, many survivors require primary amputation for unsalvageable injuries or to save their life. A third group, late amputations, is being increasingly recognised, often as a result of the sequelae of complex foot injuries. This article will look at the epidemiology of these injuries and their acute management, complications and outcome.
  PubDate: 2013-05-16T23:37:53-07:00
  DOI: 10.1177/2049463713487324|hwp:master-id:spbjp;2049463713487324
  Issue No: Vol. 7, No. 2 (2013)
Trauma pain - a military perspective
- Authors: Wyldbore, M; Aldington, D.
  Pages: 74 - 78
  Abstract: This paper outlines the system developed by the United Kingdom’s Defence Medical Services to manage the pain associated with combat trauma from the point of wounding, through repatriation back home to rehabilitation and eventual discharge from the Forces, whenever that may be. The system is founded upon the principles of integration and sustainability and this article includes discussion of both clinical and non-clinical components.
  PubDate: 2013-05-16T23:37:53-07:00
  DOI: 10.1177/2049463713487515|hwp:master-id:spbjp;2049463713487515
  Issue No: Vol. 7, No. 2 (2013)
Veterans and chronic pain
- Authors: Gauntlett-Gilbert, J; Wilson, S.
  Pages: 79 - 84
  Abstract: Summary points 1. Musculoskeletal problems are the commonest reason for medical discharge in all the British armed forces. By definition, these problems are chronic and resistant to treatment. 2. Pain is also common in veterans who have experienced severe injuries (polytrauma), often accompanied by post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) orpostconcussive syndrome. 3. In veterans seeking treatment for chronic pain, PTSD is common. There is also evidence for elevated levels of alcohol misuse in veterans who have been deployed to conflict. However, most veterans do not have pain, PTSD or alcohol problems. 4. Pain clinicians would benefit from training in meeting veterans’ needs, in order to promote their engagement and successful treatment. This should include countering stereotypes, information about the military and support for the assessment and onward referral of PTSD and alcohol problems.
  PubDate: 2013-05-16T23:37:53-07:00
  DOI: 10.1177/2049463713482082|hwp:master-id:spbjp;2049463713482082
  Issue No: Vol. 7, No. 2 (2013)
Acute high-altitude illness: a clinically orientated review
- Authors: Smedley, T; Grocott, M. P.
  Pages: 85 - 94
  Abstract: Acute high-altitude illness is an encompassing term for the range of pathology that the unacclimatised individual can develop at increased altitude. This includes acute mountain sickness, high-altitude cerebral oedema and high-altitude pulmonary oedema. These conditions represent an increasing clinical problem as more individuals are exposed to the hypobaric hypoxic environment of high altitude for both work and leisure. In this review of acute high-altitude illness, the epidemiology, risk factors and pathophysiology are explored, before their prevention and treatment are discussed. Appropriate ascent rate remains the most effective acute high-altitude illness prevention, with pharmacological prophylaxis indicated in selected individuals. Descent is the definitive treatment for acute high-altitude illness, with the adjuncts of oxygen and specific drug therapies.
  PubDate: 2013-05-16T23:37:53-07:00
  DOI: 10.1177/2049463713489539|hwp:master-id:spbjp;2049463713489539
  Issue No: Vol. 7, No. 2 (2013)
Aluminium foil for the prevention of post-amputation pain: a randomised, double-blinded, placebo-controlled, crossover trial
- Authors: Minnee, R. C; Bosma, J, Lam, K. Y, Wisselink, W, Vahl, A. C.
  Pages: 95 - 100
  Abstract: Introduction: Phantom limb pain (PLP) is a painful sensation perceived in the missing limb after amputation. The underlying pathophysiology remains unclear. Until recently, only opioid analgesics have been proven to be effective in prospective studies. Anecdotally, patients with PLP employ self-help measures, sometimes including ‘wrapping up’ or rubbing their stump with aluminium foil for relief. Our hypothesis is that wrapping an amputation stump with aluminium foil perioperatively will prevent PLP in the postoperative period. Methods: From September 2007 to September 2009, 32 consecutive patients were included in a crossover, double-blinded, randomised clinical trial. Perioperative fitting of an aluminium stump bandage was compared with a placebo paper foil. Scores were noted daily in a variable diary. The observation period was 2 weeks: in the first week participants were double blinded, and in the second week there was a change of bandage from aluminium to placebo or vice versa. A visual analogue scale (VAS) score was used as primary research variable. Secondary variables were use of analgesics, VAS measures of wound pain and the incidence of wound infections. Statistical analysis was done by means of Student’s t-test for non-paired observations. Results: Baseline characteristics were similar between groups. A period effect (p= 0.84) and treatment–period interaction (p = 0.79) were not present. There was no significant difference (mean difference 0.42) between both treatments in PLP VAS scores (95% CI –2.56 to –1.81, p = 0.71). VAS measure of wound pain showed no significant difference between both groups (mean difference 0.34, 95% CI –2.32 to –1.66, p = 0.72). Also, the other secondary endpoints did not differ. Conclusion: Patients receiving an aluminium foil stump wrapping do not experience less phantom pain than with a placebo.
  PubDate: 2013-05-16T23:37:53-07:00
  DOI: 10.1177/2049463713485727|hwp:master-id:spbjp;2049463713485727
  Issue No: Vol. 7, No. 2 (2013)
The psychological impact of torture
- Authors: de C Williams, A. C; van der Merwe, J.
  Pages: 101 - 106
  Abstract: Many refugees in the developed world are survivors of torture and present with health needs without their traumatic experience being disclosed or identified. Chronic pain is a common problem, as are symptoms of post-traumatic stress disorder (PTSD), anxiety, depression, and other distress. Current circumstances, particularly poverty, uncertainty about asylum, separation from or loss of family and roles, and difficulties settling in the host country, all contribute to current psychological problems and exacerbate existing ones. Psychological treatment studies tend to be focused either on PTSD diagnosis and use protocol-driven treatment, usually in the developed world, or on multiple problems using multimodal treatment including advocacy and welfare interventions, usually in the developing world. Reviews of both of these, and some of the major criticisms, are described. Psychological interventions tend to produce medium-sized changes in targeted measures of distress, when compared with waiting lists or standard treatment, but these may fall well short of enabling recovery, and long-term follow-up is rare. A human rights context, with reference to cultural difference in expressing distress and seeking help, and with reference to the personal meaning of torture, is essential as a basis for formulating treatment initiatives based on the evidence reviewed. Summary points
  Refugees with a history of torture may have a wide range of psychological and social difficulties which do not easily fit within diagnostic categories.
  Torture and its sequelae can have multiple meanings and, in the clinical context, it is the interpretation of the torture survivor that matters.
  There are doubts about applying the concept and measures of post-traumatic stress disorder: symptoms should be assessed separately.
  Current circumstances can be as important as trauma history in understanding the psychological state of a torture survivor.
  Cognitive behavioural therapy and narrative exposure therapy seem equally effective in reducing trauma symptoms, and to a lesser extent, depression.
  PubDate: 2013-05-16T23:37:53-07:00
  DOI: 10.1177/2049463713483596|hwp:master-id:spbjp;2049463713483596
  Issue No: Vol. 7, No. 2 (2013)
Case studies illustrating the management of trigeminal neuropathic pain using topical 5% lidocaine plasters
- Authors: Khawaja, N; Yilmaz, Z, Renton, T.
  Pages: 107 - 113
  Abstract: Chronic trigeminal pain, with its severe related functional problems, is difficult to treat. Treatment is often empirically based on medications used for other chronic pain conditions. Systemic sodium channel and calcium channel blocking agents may cause a multitude of complications that are often poorly tolerated by the patient. Aim: The aim of this case report was to assess the efficacy of topical 5% lidocaine plasters in reducing pain and reducing adjuvant medication in patients with orofacial neuropathic pain. Method: Fourteen patients with chronic orofacial pain conditions referred to the oral surgery department were instructed to wear 5% lidocaine plasters for 12 hours each day over the painful area. The conditions included post-surgical neuropathy (n = 10), multiple sclerosis-related pain (n = 1), persistent idiopathic facial pain (n = 1), Ramsay Hunt syndrome (post-herpetic neuralgia, n = 1) and trigeminal neuralgia (n = 1). Data were collected on patient demographics, pain levels and medication. Results: Pain levels improved in 12 out of 14 patients. Nine patients had a reduction in adjuvant medication, two of whom completely stopped adjuvant treatment. Conclusion: This case series demonstrates that of the use of 5% lidocaine plasters may play a useful role in the management of chronic trigeminal pain. A suggested novel approach for the management of orofacial pain, for clinicians, is presented. Summary points
  Management of chronic orofacial pain continues to be a major challenge to the clinician.
  Patients are often placed on a multitude of medications in an attempt to alleviate pain without success.
  Topical 5% lidocaine plasters, currently used for the management of post-herpetic neuralgia, offer the option of locally targeting trigeminal pain without the multiple side-effects of systemic medication.
  This case series demonstrates that lidocaine plasters decrease verbal pain scores in extraoral, trigeminal and neuropathic pain, and reduce the use of other neuromodulatory agents in some, but not all, patients.
  The plasters should be considered as a useful adjuvant in the management of pain in these patients.
  PubDate: 2013-05-16T23:37:53-07:00
  DOI: 10.1177/2049463713483459|hwp:master-id:spbjp;2049463713483459
  Issue No: Vol. 7, No. 2 (2013)