Elsevier

Social Science & Medicine

Volume 55, Issue 10, November 2002, Pages 1813-1816
Social Science & Medicine

Chronic pain in land mine accident survivors in Cambodia and Kurdistan

https://doi.org/10.1016/S0277-9536(01)00315-XGet rights and content

Abstract

The aims of the study were to study chronic pain in land mine accident survivors, and to study the impact of trauma and trauma care parameters on chronic pain. The level of chronic pain was registered (patient-rated and by clinical examination) in 57 severely injured adult land mine accident survivors in Cambodia and Northern Iraq more than one year after the accident. As all study patients had been managed by a standardized trauma system, we could assess the impact of injury severity and primary trauma care on chronic pain. 64% of the study patients (n=36) had chronic pain syndromes (non-significant difference between the two countries). 68% of the amputees (19 out of 28) had phantom limb pain. Pre-injury trauma exposure, the severity of the actual trauma, and the quality of trauma care had no impact on end point chronic pain. In 85% of cases (n=48), the economic standing of the patients’ family had deteriorated after the accident. Patient-rated loss of income correlated with the rate of chronic pain syndromes.

Introduction

The epidemic of land mine injuries continues to accelerate. Despite international humanitarian campaigns and major mine-clearing operations, more land mines are laid than are cleared. The health impact of land mine injuries is poorly understood (Andersson, da Sousa, & Paredes, 1995; Kakar, Bassani, Romer, & Gunn, 1996). In Western trauma systems we assume that good primary trauma care improves the long-term outcome for the victim. Is this assumption also valid for the mine victim who typically is a poor farmer in a country that has experienced repeated wars, natural catastrophes, and endemic diseases? The aim of the present study was (1) to study post-traumatic chronic pain in land mine accident survivors; and (2) to study the impact of trauma parameters and trauma care on post-injury chronic pain.

Section snippets

Material and methods

Most mine accidents happen in rural areas with poor medical services. The prehospital fatality rate is high, 35%–50% (Ascherio et al., 1995; Jahanlu, Husum, & Wisborg, in press). To address this problem, in 1996, we initiated programs for prehospital mine victim assistance in Cambodia (Battambang province) and Kurdistan (Suleimaniah province) in cooperation with local health authorities. In each country, districts with a high prevalence of mine accidents were identified as target areas where

Results

The study groups from Cambodia and Kurdistan were comparable regarding demographic data and trauma parameters, except for higher prehospital transit times in Cambodia (Table 1). Most study patients had sustained more than one previous wartime or land mine injury (n=47). The mean number of previous injuries in the study group was 6 (range 0–20). The present trauma was severe with a mean physiological severity at 6.2 (range 4.9–7) and ISS at 10 (range 5–22). The physiological severity scores

Conclusion

The study indicates that chronic pain syndromes are a major medical problem in severely injured land mine accident survivors, including both amputees and non-amputees. The study patients were managed by a professional trauma system, judged by quality of care indicators. We were surprised to find that the quality of care did not reduce post-injury pain. The only factor in our study that seemed to be associated with post-injury pain was the economic impact of the injury. Most of our study

Acknowledgements

Manager Odd Edvardsen at Tromsoe Mine Victim Resource Center coordinates the multi-center study of prehospital trauma care to land mine victims. Paramedics Rattana and Hikmat assisted during the data collection for the present study. We acknowledge the professional cooperation and support of Dr. Gino Strada, Head of “Emergency”. Johan Pillgram-Larsen, Section of Trauma Surgery, Ullevaal Hospital; Marja-Liisa Honkasalo, Institute of Medical Anthropology, University of Helsinki; Swee Chai Ang,

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