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94Update in AnaesthesiaImplementation of a total ban on production, sale, stockpiling,and use of these weapons will prove difficult if not impossible,as has been the case with biological and chemical weapons.According to the World Health Organization (WHO), at currentrates more than ten centuries would be required to remove themore than 100 million landmines already scattered around theglobe.Preventive measures in the countries afflicted with largenumbers of mines include awareness programs on the risk ofhandling and efforts to clear or recover mines for commercialgain. Treatment and rehabilitation of victims will continue to bethe principal humanitarian action needed. Rehabilitation andpain control for landmine survivors have gained little attentionso far. Instructions for the treatment of postamputation painand PLP should be made available for use by relief agenciesand local health care workers.The precise impact of PLP on the outcome of rehabilitationof minefield victims in the developing world must be assessedbefore we can estimate the response needed. However, datacollection must not impede continued efforts by relief andmedical agencies such as Douleur Sans Frontières. Theincidence of severe PLP is at least 25 % in published surveys.PLP may prevent use of prostheses. In the case of single lowerlimb amputation, injury to the remaining limb may make weightbearingmore hazardous, further jeopardizing rehabilitation.The importance of pain control for optimal quality of lifeand long-term rehabilitation is increasingly obvious.Treating the individual with relatively inexpensive andeffective treatments is possible, and neurolytic blockade ofneuromas and TENS have been shown to be effective underthese circumstances (J. Meynadier, personal observation). Theauthors’ observations support the multimodal treatment planadvocated by Sherman and colleagues 19,21 . They encourage asympathetic discussion between health care worker andpatient about phantom sensation and PLP and emphasize useof a prosthesis. They also advocate use of TENS and minoranalgesics to disrupt the pain-anxiety-tension cycle. Theirrecommendation for referral to multidisciplinary pain treatment,however, is often difficult to carry out in practice.Public discussion of landmines has taken place more as apolitical than a medical dialogue 43 . For other sources of painsuch as cancer, burns, or operation, society’s perspective isevolving from a view of the individual as an anonymous hostof a pathophysiological process toward a patient-centeredfocus. As this evolution advances, the importance of paincontrol for optimal quality of life and long-term rehabilitation isincreasingly obvious. In parallel fashion, the crucial yet stillunmet need for pain control among victims of landmine injurymust now receive the attention of pain specialists worldwide.Johan de SmetJ. Edmond CharltonConsultant in Pain Management Consultant in Pain Managementand Anesthesiaand AnesthesiaLeuven, BelgiumNewcastle upon Tyne, UnitedKingdomJacques MeynadierConsultant in Pain Management and AnesthesiaLille, FranceReferences1. ICRC. The Geneva Conventions of August 12, 1949. Geneva 1986.2. Coupland RM, Russbach R. Medicine and Global Survival 1994; 1:1.3. Coupland RM. ICRC, Geneva 1997.4. Adams DB. J Trauma 1988; 28:S159–S162.5. Coupland RM. BMJ 1991; 303:1509–12.6. Coupland RM. BMJ 1994; 308:1693–7.7. Strada G. Scientific American May 1996; 26–31.8. Anderson N et al. BMJ 1995; 311:718–21.9. Ascherio A et al. Lancet 1995; 346:721–724.10. Stover E et al. JAMA 1994; 272:331–36.11. American Pain Society: Quality of Care Committee. JAMA 1995;274:1874–1880.12. Charlton JE. WFSA Update in Anesthesia 1997;7:2–17.13. Hill CS. JAMA 1995; 274:1881–2.14. Carr DB. Pain: Clinical Updates 1993; 1(1).15. WFSA, Level 8, Imperial House, 15–18 Kingsway, london WC2B 6TH, United Kingdom.16. Tessler MJ, Kleimann SJ. Anaesthesia 1994; 49:439–41.17. Uncles DR, Glynn CJ. Anaesthesia 1996; 51:69–70.18. Malone JM et al. Arch Surg. 1981; 116:93–102.19. Sherman R et al. Pain 1980; 8:85–99.20. Jensen TS et al. Pain 1985; 21:267–278.21. Sherman RA. Phantom Pain. New York: Plenum, 1997.22. Melzack R et al. Brain 1997; 120:1603–1620.23. Krane EJ et al. Anesthesiology 1991; 75:A691.24. Wartan SW et al. Br J Anesthesia 1997; 78:652–659.25. Sherman R et al. Pain 1984; 18:83–95.26. Merskey H, Bogduk N. Classification of Chronic Pain 2 nd ed. Seattle: IASP Press, 1994.27. Nikolajsen L et al. Pain 1997; 72:393–405.28. Bach S et al. Pain 1988; 33:297–301.29. Jahangiri M et al. Ann Roy College Surgeons of England 1994; 76:324–326.30. Nikolajsen L et al. Lancet 350; 1997:1353–1357.31. Kirvela O, Nieminen S. Pain 1990; 41:161–165.32. Meynardier J. Developpement et Santé 1997; 131:33–34.33. Finsen V et al. J Bone Joint Surg (Br) 1988; 70-B:109–12.34. Jaeger H, Maier C. Pain 1992; 48:21–27.35. Nikolajsen L et al. Pain 1996; 67:69–77.36. Gross D. Pain 1982; 13:313–320.37. Winkelmuller M, Winkelmuller W. J Neurosurg 1996; 85:458–467.38. North R et al. Neurosurgery 1993; 32:384–394.39. Wester K. Acta Neurol Scand 1987; 75:151–153.40. Knox DJ et al. Anaesth Intens Care 1995; 23:620.41. Walker SM, Cousins MJ. J Pain Symptom Manage 1997; 14:129–133.42. Lema MJ. Pain: Clinical Updates 1998; 6(1).43. Krug EG et al. JAMA 1998; 280:465–466.International Association for the Study of Pain (IASP) / 9th World Congress on Pain, Vienna, Austria, August 22–27, 1999IASP was founded in 1973 as a nonprofit organization to foster and encourage research on pain mechanisms and pain syndromes, and to help improve themanagement of patients with acute and chronic pain. The Association brings together basic scientists, physicians, dentists, nurses, psychologists, physicaltherapists, and other health professionals who work in or have an interest in pain research and management. Benefits of membership include: subscription to themonthly journal Pain • receipt of a bimonthly newsletter containing technical articles, comprehensive meetings calendar, list of new books in the field of pain • receiptof a triannual clinical newsletter • receipt of an annual directory of members • reduced rate on IASP book purchases • reduced registration fees for Congresses. Formembership information contact IASP at the address below.Timely topics in pain research and treatment have been selected for publication but the information provided and opinions expressed have not involved anyverification of the findings, conclusions, and opinions by IASP. Thus, opinions expressed in Pain: Clinical Updates do not necessarily reflect those of IASP or ofthe Officers or Councillors. No responsibility is assumed by IASP for any injury and/or damage to persons or property as a matter of product liability, negligence,or from any use of any methods, products, instruction, or ideas contained in the material herein. Because of the rapid advances in the medical sciences, thepublisher recommends that there should be independent verification of diagnoses and drug dosages.For permission to reprint or translate this article, contact:International Association for the Study of Pain • 909 NE 43rd St, Suite 306, Seattle, WA 98105 USATel: 206-547-6409 • Fax: 206-547-1703 • email: IASP@locke.hs.washington.edu • http://www.halcyon.com/iaspCopyright © 1998. All rights reserved. ISSN 1083-0707.Printed in the U.S.A.
Update in Anaesthesia 95Editor: Dr Iain Wilson. Sub Editors: Drs Henry Bulwirwa, David Conn, Mike Dobson, Frank Walters and Mr Mike Yeats.Designed and Typeset by: Angela FrostWFSA Representative: Dr Roger EltringhamSponsored by: World Federation of Societies of AnaesthesiologistsLevel 8, Imperial House, 15-19 Kingsway, London WC2B 6TH, United Kingdom.Tel: +44 171 836 5652. Fax: +44 171 836 5616E-mail: wfsa@compuserve.comPrinted in Great Britain by: Media PublishingCorrespondence to: Dr I H Wilson, Anaesthetics Dept., Royal Devon and Exeter Healthcare NHS Trust,Barrack Road, Exeter, EX2 5DW, UK. E-mail: iain.wilson5@virgin.net
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