PDF(Pubmed)
Abstract：
Limb trauma remains the most prevalent survivable major combat injury. In the First World War, more than 700,000 British soldiers received limb wounds and more than 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 among 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 4 decades. Unexpected findings included early advocacy of multidisciplinary pain management, concerns over addiction, and the effect 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 that these historical aspects remain relevant to today\'s military personnel, clinicians, researchers, and policymakers.
摘要：
肢体创伤仍然是最普遍的可存活的主要战斗伤害。在第一次世界大战中,超过70万英国士兵四肢受伤，超过41,000人截肢，创造了历史上最大的截肢者之一。截肢后疼痛影响高达85%的军事截肢者，这表明，多达33,000名英国第一次世界大战退伍军人可能报告截肢后疼痛。这项定性系统评价探讨了该患者队列中围绕慢性截肢后疼痛临床管理的专业医学对话，它在20世纪的发展，以及这些信息是如何在医疗专业人员中传播的。我们搜索了《柳叶刀》和《英国医学杂志》的档案（1914-1985）中有关截肢后疼痛的报道，其患病率,机制,描述符,或临床管理。参与者是一战退伍军人截肢，排除所有其他冲突的平民和退伍军人。搜索确定了9809条潜在相关文本，其中101人符合纳入标准。早在1914年就出现了报告，在接下来的40年里，讨论仍在继续。意想不到的发现包括早期倡导多学科疼痛管理，对成瘾的担忧，慢性疼痛对心理健康的影响比以前认为的早了几十年。慢性截肢后疼痛仍然是军事康复的重要问题。第一次世界大战中的伤害模式与最近的伊拉克和阿富汗冲突之间的相似性意味着这些历史方面仍然与今天的军事人员相关，临床医生,研究人员,和政策制定者。
