Chronic pain in land mine accident survivors in Cambodia and Kurdistan
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.
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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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