“I did not expect the doctor to treat a ghost”: a systematic review of published reports regarding chronic postamputation pain in British First World War veterans
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Limb trauma remains the most prevalent survivable major combat injury. In the First World War, over 700,000 British soldiers received limb wounds and over 41,000 underwent an amputation, creating one of the largest amputee cohorts in history. Postamputation pain affects up to 85% of military amputees, suggesting that up to 33,000 British First World War veterans potentially reported postamputation pain.
This qualitative systematic review explores the professional medical conversation around clinical management of chronic postamputation pain in this patient cohort, its development over the 20th century, and how this information was disseminated amongst medical professionals.
We searched The Lancet and British Medical Journal archives (1914-1985) for reports referring to postamputation pain, its prevalence, mechanisms, descriptors or clinical management. Participants were First World War veterans with a limb amputation, excluding civilians and veterans of all other conflicts. The search identified 9809 potentially relevant texts, of which 101 met the inclusion criteria.
Reports emerged as early as 1914 and the discussion continued over the next four decades. Unexpected findings included early advocacy of multidisciplinary pain management, concerns over addiction and the impact of chronic pain on mental health emerging decades earlier than previously thought.
Chronic postamputation pain is still a significant issue for military rehabilitation. Similarities between injury patterns in the First World War and recent Iraq and Afghanistan conflicts mean these historical aspects remain relevant to today’s military personnel, clinicians, researchers and policymakers.
This qualitative systematic review explores the professional medical conversation around clinical management of chronic postamputation pain in this patient cohort, its development over the 20th century, and how this information was disseminated amongst medical professionals.
We searched The Lancet and British Medical Journal archives (1914-1985) for reports referring to postamputation pain, its prevalence, mechanisms, descriptors or clinical management. Participants were First World War veterans with a limb amputation, excluding civilians and veterans of all other conflicts. The search identified 9809 potentially relevant texts, of which 101 met the inclusion criteria.
Reports emerged as early as 1914 and the discussion continued over the next four decades. Unexpected findings included early advocacy of multidisciplinary pain management, concerns over addiction and the impact of chronic pain on mental health emerging decades earlier than previously thought.
Chronic postamputation pain is still a significant issue for military rehabilitation. Similarities between injury patterns in the First World War and recent Iraq and Afghanistan conflicts mean these historical aspects remain relevant to today’s military personnel, clinicians, researchers and policymakers.
Date Issued
2023-12-01
Date Acceptance
2023-07-21
Citation
PAIN Reports, 2023, 8 (6)
ISSN
2471-2531
Publisher
Wolters Kluwer
Journal / Book Title
PAIN Reports
Volume
8
Issue
6
Copyright Statement
This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
Identifier
https://journals.lww.com/painrpts/fulltext/2023/12000/_i_did_not_expect_the_doctor_to_treat_a_ghost___a.3.aspx
Subjects
Amputation
Amputation, Traumatic
Chronic Pain
History
History of Medicine
History, 20th Century
Military Health
Military Health Services
Military Medicine
Neuropathology
World War I
Publication Status
Published
Article Number
e1094
Date Publish Online
2023-12-01