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The Early Detection and Management of Neuropathic Pain Following Combat Injury
  1. SJ Mercer, Specialist Registrar in Anaesthesia1,
  2. S Chavan, Specialist Registrar in Anaesthesia2,
  3. Lt Col JL Tong, RAMC, Department of Military Anaesthesia and Critical Care, Reader in Anaesthesia3,
  4. DJ Connor, Consultant in Anaesthesia4 and
  5. WF de Mello, Consultant in Anaesthesia and Pain Medicine5
  1. 1Triservice Deanery
  2. 2University Hospital Birmingham
  3. 3Royal Centre for Defence Medicine, Birmingham Research Park, Vincent Drive, Edgbaston, Birmingham, B15 2SQ 0121 6271627 j.l.tong{at}
  4. 4MDHU Portsmouth
  5. 5University of South Manchester Hospital


The mechanism of injury on the modern battlefield results in a pattern of wounding which is associated with both nociceptive and neuropathic pain. Nociceptive pain is managed using the WHO Analgesic Ladder but neuropathic pain requires the use of co-analgesic drugs, e.g. antidepressants and anticonvulsants. This study was designed to determine the incidence of neuropathic pain within military casualties with limb injuries. From May to November 2007, 50 casualties were interviewed and assessed using the Leeds Assessment of Neuropathic Symptoms and Signs Scale (LANSS) over consecutive weeks. During the first week post injury, 30%of casualties had a LANSS pain score >12, suggesting a neuropathic element to their pain. The early detection (using LANSS) and management of neuropathic pain using robust protocols represent the most effective strategy to address this significant problem.

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