Phantom limb pain: theories and therapies Weeks, Sharon R; Anderson-Barnes, Victoria C; Tsao, Jack W
The Neurologist (Baltimore, Md.),
2010-September, Volume:
16, Issue:
5
Journal Article
Peer reviewed
Since the beginning of the conflicts in Iraq and Afghanistan, there has been a dramatic increase in the number of military service members with single and multiple-limb amputations. Phantom limb pain ...(PLP) frequently develops in these individuals. As a result, identifying the best methods to treat PLP is critical. The review highlights areas of inquiry related to phantom pain, with a focus on PLP.
This review discusses phantom sensations and phantom pain that arise after amputation of a body part, and summarizes the differences between the 2 conditions. Characteristics of PLP are also discussed, including the onset, duration, and location of PLP. Theories explaining the etiology and presence of PLP are reviewed, along with the numerous treatment options reported in the published data for such pain, including the use of mirrors for treating pain. We conclude with a description of one military hospital's experiences with PLP.
Although more research has been done in previous years, this review identifies the need for continuing investigations. The etiology of PLP needs to be determined through more vigorous investigation, and a focus must be placed on defining treatment options in addition to mirror therapy that will improve the quality of life of those who suffer from this condition.
In this FASD prevention feasibility study, we found that FASD prevention messages, particularly paired with pregnancy test dispensers, placed in the women’s restrooms of establishments that serve ...alcohol can effectively promote informed alcohol consumption decisions among women who are, or may become, pregnant.
Abstract
Aims
To evaluate the feasibility, acceptability and effectiveness of placing FASD prevention messages in the women’s restrooms of establishments serving alcohol in Alaska and the Yukon, regions with high rates of FASD.
Methods
Our team placed an FASD educational poster, and posters affixed to a pregnancy test dispenser, in women’s restrooms of bars and restaurants. We compared drinking behaviors and knowledge and beliefs about FASD among participants at baseline and at follow-up.
Results
Respondents consisted of 2132 women who completed a baseline survey and 1182 women who completed both a baseline and a follow-up survey. Women in both groups showed improvement in knowledge of FASD; the dispenser group scored higher than participants in the poster group on the FASD Health Belief questions at both baseline and follow-up. Forty-three women learned they were pregnant from our pregnancy tests and alcohol consumption among pregnant women was lower at follow-up than at baseline.
Conclusions
FASD prevention messages, particularly paired with pregnancy test dispensers, in the women’s restrooms of establishments that serve alcohol can effectively promote informed alcohol consumption decisions among women who are, or may become, pregnant.
Short Summary
In this FASD prevention feasibility study, we found that FASD prevention messages, particularly paired with pregnancy test dispensers, placed in the women’s restrooms of establishments that serve alcohol can effectively promote informed alcohol consumption decisions among women who are, or may become, pregnant.
The article focuses on the British banking sector in the late twentieth century. It explores the approach of the managers of Barclays Bank, who in contrast to their competitors, decided to use female ...staff at the forefront of their strategy to increase business and to improve customer perceptions of the bank within its branches. In particular, we explore the decision to place women on the 'shop floor', to sell financial services and to dress them in a corporate uniform. Special clothing is often seen as a symbolic representation of an organization's identity and culture. The article examines the way in which managers used female employees and their femininity as a device to attempt to build stronger customer relationships that eventually became part of a wider branding exercise.
STUDY DESIGN. Prospective observational study among soldiers medically evacuated out of theaters of combat operations for neck pain, with retrospective analysis of variables associated with ...return-to-duty.
To provide an epidemiological overview of the burden of neck pain in deployed soldiers involved in combat operations and to identify factors associated with return-to-duty.
Neck pain represents one of the leading causes of medical evacuation out of theaters of combat operations. Yet when compared to other diagnostic categories, treatment outcomes, militarily defined as returning a soldier to duty, remain appallingly low.
Demographic, military-specific, and outcome data were prospectively collected over a 2-week period at the Deployed Warrior Medical Management Center in Germany on 374 consecutive soldiers medically evacuated out of theaters of combat operations for a primary diagnosis pertaining to neck pain between 2004 and 2007. The 2-week period represents the maximal allowable time an evacuated soldier can spend in treatment before disposition (i.e., return to theater or evacuate to United States) is rendered. Electronic medical records were reviewed to examine the effect the following variables had on the categorical outcome measure, return-to-unit: age, gender, service-affiliation, rank and seniority, smoking history, coexisting psychiatric diagnosis, prior neck pain, mechanism of injury, whether or not the injury was combat-related, presence of headache, quality of symptoms, correlation with radiologic imaging, and referral to pain specialist.
Only 14% of service members returned to their units. Significant correlations were found between female gender and non-army service affiliation, and a service member returning to their unit. Weak trends toward returning to duty were noted for nonsmokers, absence of prior neck pain, concomitant psychiatric diagnosis, corresponding complaints of headache, and referral to a pain specialist.
The treatment of service members medically evacuated for neck pain at the main receiving center, the level IV military treatment facility in Landstuhl, Germany, is associated with a low return-to-unit rate. Future studies should consider whether treating personnel predisposed towards a positive outcome with the limited resources available can improve return-to-duty rates.
Background: Headache is often associated with physical trauma and psychological stress. The aim of this study is to evaluate the impact of headache on personnel deployed in war zones and to identify ...factors associated with return to duty (RTD).
Methods: Outcome data were prospectively collected on 985 personnel medically evacuated out of Operations Iraqi and Enduring Freedom for a primary diagnosis of headache between 2004 and 2009. Electronic medical records were reviewed to examine clinical and treatment patterns and the effect that myriad factors had on RTD.
Results: 33.6% of evacuees returned to duty. The most common headaches were post-concussion (34.1%) and migraine (30.0%). Headaches typically associated with trauma such as post-concussion (18.7%), occipital neuralgia (23.1%), and cervicogenic headache (29.7%) had the lowest RTD rates, whereas tension headache (49.6%) was associated with the best outcome. Other variables associated with negative outcome included presence of aura (OR 0.51, 95% CI 0.30–0.88; p = 0.02), traumatic brain injury (OR 0.50, 95% CI 0.29–0.87; p = 0.01), opioid (OR 0.41, 95% CI 0.26–0.63; p < 0.001), and beta-blocker (OR 0.26, 95% CI 0.12–0.61; p = 0.002) use, and co-existing psychopathology (p < 0.001 in univariable analysis).
Conclusion: Headaches represent a significant cause of unit attrition in personnel deployed in military operations, with physical trauma and co-existing psychopathology associated with poorer outcomes.
Autobiographies are now popular forms of literature, but for those in the legal profession, this tradition has a much longer history. This article examines the memoir written by Lord Nathaniel ...Lindley (1828-1921). Lord Lindley is famed for his writings in company law and for his judgments in a considerable number of landmark cases in the court of appeal and in the house of lords. The article uses Lindley's memoir alongside other archival records to shed some much-needed light on Lindley's background, his relationships and his private life. In doing so, it raises points of note about his life but also some wider methodological concerns. Lindley's memoir is key in unearthing new insights into Lindley's life. In this document, he explains how he was able to reach the upper echelons of the legal profession. This article considers the way that autobiographies can be used to present certain narratives. The analysis shows how the evidence presented in these sources can be triangulated and combined with other sources to overcome natural biases and flaws in order to create a fuller and more balanced legal biography. Overall, the article considers the value of autobiographies and memoirs in the construction of a legal biography.
Financial instruments are the subject of considerable interest. The supply of promissory notes has attracted the attention of financial historians, political economists and antiquarians, alike. We ...consider bank notes as a mechanism for building corporate identity. The article focuses on the bank notes that were issued in the early nineteenth century by newly established joint stock banks in the English provinces. Despite not having a legal personality, which could be separated from the bank's owners, the banks did not use symbols of the owners, such as family crests or other personal means, to communicate their identity. The article shows that these notes displayed symbols of a collective culture and regional identity. We argue that this was crucial to building the bank's position within the local commercial community and in generating a persona which customers could trust.
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