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Pain

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Blast Injury Science and Engineering

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Abstract

Blast injury is associated with significant widespread trauma that often results in pain, both acute and chronic. Persistent pain is thought to be predominately neuropathic in nature.

This chapter starts by considering some of the probable pathophysiological processes that may lead to the development of neuropathic pain.

In the second section, techniques to manage the pains, both acute and chronic, are outlined. There is an emphasis on the biopsychosocial nature of pain, especially persistent pain.

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References

  1. Mercer SJ, Chavan S, Tong JL, Connor DJ, de Mello WF. The early detection and management of neuropathic pain following combat injury. J R Army Med Corps. 2009;155:94–8.

    Article  CAS  Google Scholar 

  2. Wood P, Small C, Lewis S, Mahoney P. Neuropathic pain treatment and research: experiences from the United Kingdom mission to Afghanistan and future prospects. J R Army Med Corps. 2018;164:207–12.

    Article  Google Scholar 

  3. IASP Terminolgy [cited 2019 Sep 22]. https://www.iasp-pain.org/Education/Content.aspx?ItemNumber=1698

  4. Melzack R, Wall P. The challenge of pain. 2nd ed. England: Penguin Books; 2008.

    Google Scholar 

  5. Todd AJ. Neuronal circuitry for pain processing in the dorsal horn. Nat Rev Neurosci. 2010;11:823–36.

    Article  CAS  Google Scholar 

  6. Ossipov MH, Dussor GO, Porreca F. Central modulation of pain. J Clin Invest. 2010;120:3779–87.

    Article  CAS  Google Scholar 

  7. Lee MC, Zambreanu L, Menon DK, Tracey I. Identifying brain activity specifically related to the maintenance and perceptual consequence of central sensitization in humans. J Neurosci. 2008;28:11642–9.

    Article  CAS  Google Scholar 

  8. Rasband MN. Glial contributions to neural function and disease. Molecular & Cellular Proteomics. Mol Cell Proteomics. 2016;15:355–61.

    Article  CAS  Google Scholar 

  9. Scholz J, Woolf CJ. The neuropathic pain triad: neurons, immune cells and glia. Nat Neurosci. 2007;10:1361–8.

    Article  CAS  Google Scholar 

  10. Chiu IM, Hehn von CA, Woolf CJ. Neurogenic inflammation and the peripheral nervous system in host defense and immunopathology. Nat Neurosci. 2012;15:1063–7.

    Article  CAS  Google Scholar 

  11. Ellis A, Bennett DLH. Neuroinflammation and the generation of neuropathic pain. Br J Anaesth. 2013;111:26–37.

    Article  CAS  Google Scholar 

  12. Walker AK, Kavelaars A, Heijnen CJ, Dantzer R. Neuroinflammation and comorbidity of pain and depression. Pharmacol Rev. 2014;66:80–101.

    Article  CAS  Google Scholar 

  13. Irvine K-A, Clark JD. Chronic pain after traumatic brain injury: pathophysiology and pain mechanisms. Pain Med. 2018;19:1315–33.

    Article  Google Scholar 

  14. Cernak I. The importance of systemic response in the pathobiology of blast-induced neurotrauma. Front Neurol. 2010;1:151.

    Article  Google Scholar 

  15. Elder GA, Gama Sosa MA, De Gasperi R, Stone JR, Dickstein DL, Haghighi F, et al. Vascular and inflammatory factors in the pathophysiology of blast-induced brain injury. Front Neurol. 2015;6:48.

    Article  Google Scholar 

  16. Ji R-R, Xu Z-Z, Gao Y-J. Emerging targets in neuroinflammation-driven chronic pain. Nat Rev Drug Discov. 2014;13:533–48.

    Article  CAS  Google Scholar 

  17. Mitchell SW. Injuries of nerves and their consequences. Philadelphia: J.B. Lippincott & Co.; 1872. http://resource.nlm.nih.gov/66230920R

    Book  Google Scholar 

  18. Seddon HJ. A classification of nerve injuries. Br Med J. 1942;2:237–9.

    Article  CAS  Google Scholar 

  19. Sunderland S. A classification of peripheral nerve injuries producing loss of function. Brain. 1951;74:491–516.

    Article  CAS  Google Scholar 

  20. Dubový P. Wallerian degeneration and peripheral nerve conditions for both axonal regeneration and neuropathic pain induction. Ann Anat. 2011;193:267–75.

    Article  Google Scholar 

  21. Uceyler N, Sommer C. Wallerian degeneration and neuropathic pain. Drug Discov Today Dis Mech. 2006;3:351–5.

    Article  Google Scholar 

  22. Calvo M, Dawes JM, Bennett DLH. The role of the immune system in the generation of neuropathic pain. Lancet Neurol. 2012;11:629–42.

    Article  CAS  Google Scholar 

  23. Wei F, Guo W, Zou S, Ren K, Dubner R. Supraspinal glial–neuronal interactions contribute to descending pain facilitation. J Neurosci. 2008;28:10482–95.

    Article  CAS  Google Scholar 

  24. Banati RB, Cagnin A, Brooks DJ, Gunn RN, Myers R, Jones T, et al. Long-term trans-synaptic glial responses in the human thalamus after peripheral nerve injury. Neuroreport. 2001;12:3439–42.

    Article  CAS  Google Scholar 

  25. Gupta R, Truong L, Bear D, Chafik D, Modafferi E, Hung CT. Shear stress alters the expression of myelin-associated glycoprotein (MAG) and myelin basic protein (MBP) in Schwann cells. J Orthop Res. 2005;23:1232–9.

    Article  CAS  Google Scholar 

  26. Suneson A, Hansson HA, Seeman T. Pressure wave injuries to the nervous system caused by high-energy missile extremity impact: part I. local and distant effects on the peripheral nervous system–a light and electron microscopic study on pigs. J Trauma. 1990;30:281–94.

    Article  CAS  Google Scholar 

  27. Lundborg G, Myers R, Powell H. Nerve compression injury and increased endoneurial fluid pressure: a "miniature compartment syndrome". J Neurol Neurosurg Psychiatry. 1983;46:1119–24.

    Article  CAS  Google Scholar 

  28. Birch R, Misra P, Stewart MPM, Eardley WGP, Ramasamy A, Brown K, et al. Nerve injuries sustained during warfare: part I–epidemiology. J Bone Joint Surg Br. 2012;94:523–8.

    Article  CAS  Google Scholar 

  29. Quarterly Afghanistan and Iraq amputation statistics. [cited 2019 Sep 22]. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/449400/AnnexA_20150730_DAY-RELEASE_Quarterly_Afghanistan_Iraq_Amputation_Statistics.pdf

  30. Collins KL, Russell HG, Schumacher PJ, Robinson-Freeman KE, O’Conor EC, Gibney KD, et al. A review of current theories and treatments for phantom limb pain. J Clin Invest. 2018;128:2168–76.

    Article  Google Scholar 

  31. Aldington D, Small C, Edwards D, Ralph J, Wood P, Jagdish S, Moore RA. A survey of post-amputation pains in serving military personnel. J R Army Med Corps. 2014;160:38–41.

    Article  Google Scholar 

  32. McDonald SJ, Sun M, Agoston DV, Shultz SR. The effect of concomitant peripheral injury on traumatic brain injury pathobiology and outcome. J Neuroinflammation. 2016;13:90–14.

    Article  Google Scholar 

  33. Penn-Barwell JG, Roberts SAG, Midwinter MJ, Bishop JRB. Improved survival in UK combat casualties from Iraq and Afghanistan: 2003-2012. J Trauma Acute Care Surg. 2015;78:1014–20.

    Article  Google Scholar 

  34. Aldington DJ, Mcquay HJ, Moore RA. End-to-end military pain management. Philos Trans R Soc Lond B Biol Sci. 2011;366:268–75.

    Article  CAS  Google Scholar 

  35. Quintner JL, Cohen ML, Buchanan D, Katz JD, Williamson OD. Pain medicine and its models: helping or hindering? Pain Med. 2008;9:824–34.

    Article  Google Scholar 

  36. Hodgetts TJ, Mahoney PF, Russell MQ, Byers M. ABC to <C>ABC: redefining the military trauma paradigm. Emerg Med J. 2006;23:745–6.

    Article  CAS  Google Scholar 

  37. Moore RA, Straube S, Aldington D. Pain measures and cut-offs - “no worse than mild pain” as a simple, universal outcome. Anaesthesia. 2013;68:400–12.

    Article  CAS  Google Scholar 

  38. Graham GG, Davies MJ, Day RO, Mohamudally A, Scott KF. The modern pharmacology of paracetamol: therapeutic actions, mechanism of action, metabolism, toxicity and recent pharmacological findings. Inflammopharmacology. 2013;21:201–32.

    Article  CAS  Google Scholar 

  39. McQuay, Moore. NSAIDs COXIBS smoking and bone. Bandolier. 2004 [cited 2010 May 14]. pp. 1–7. http://www.medicine.ox.ac.uk/bandolier/booth/painpag/wisdom/NSB.pdf

  40. Jennings PA, Cameron P, Bernard S, Walker T, Jolley D, Fitzgerald M, et al. Morphine and ketamine is superior to morphine alone for out-of-hospital trauma analgesia: a randomized controlled trial. Ann Emerg Med. 2012;59:497–503.

    Article  Google Scholar 

  41. Jennings PA, Cameron P, Bernard S. Ketamine as an analgesic in the pre-hospital setting: a systematic review. Acta Anaesthesiol Scand. 2011;55:638–43.

    Article  CAS  Google Scholar 

  42. Porter KM, Siddiqui MK, Sharma I, Dickerson S, Eberhardt A. Management of trauma pain in the emergency setting: low-dose methoxyflurane or nitrous oxide? A systematic review and indirect treatment comparison. J Pain Res. 2017;11:11–21.

    Article  Google Scholar 

  43. Methoxyflurane. en.wikipedia.org. [cited 2019 Aug 11]. https://en.wikipedia.org/wiki/Methoxyflurane

  44. Hanson S, Hanson A, Aldington D. Pain priorities in pre-hospital care. Anaesth Intensive Care Med. 2017;18:380–2.

    Article  Google Scholar 

  45. Hughes S, Birt D. Continuous peripheral nerve blockade on OP Herrick 9. J R Army Med Corps. 2009;155:57–8.

    Article  CAS  Google Scholar 

  46. van Seventer R, Bach FW, Toth CC, Serpell M, Temple J, Murphy TK, et al. Pregabalin in the treatment of post-traumatic peripheral neuropathic pain: a randomized double-blind trial. Eur J Neurol. 2010;17:1082–9.

    Article  Google Scholar 

  47. Bornemann-Cimenti H, Lederer AJ, Wejbora M, Michaeli K, Kern-Pirsch C, Archan S, et al. Preoperative pregabalin administration significantly reduces postoperative opioid consumption and mechanical hyperalgesia after transperitoneal nephrectomy. Br J Anaesth. 2012;108:845–9.

    Article  CAS  Google Scholar 

  48. Moore RA, Derry S, Aldington D, Cole P, Wiffen PJ. Amitriptyline for neuropathic pain in adults. Cochrane Database Syst Rev. 2015;7:CD008242.

    Google Scholar 

  49. Derry S, Wiffen PJ, Aldington D, Moore RA. Nortriptyline for neuropathic pain in adults. Cochrane Database Syst Rev. 2015;1:CD011209.

    Google Scholar 

  50. Hearn L, Derry S, Phillips T, Moore RA, Wiffen PJ. Imipramine for neuropathic pain in adults. Cochrane Database Syst Rev. 2014;145:3018–35.

    Google Scholar 

  51. Tzschentke TM, Christoph T, Kogel B, Schiene K, Hennies HH, Englberger W, et al. (3)-(1R,2R)-3-(3-Dimethylamino-1-ethyl-2-methyl-propyl)-phenol hydrochloride (tapentadol HCl): a novel -opioid receptor agonist/norepinephrine reuptake inhibitor with broad-Spectrum analgesic properties. J Pharmacol Exp Ther. 2007;323:265–76.

    Article  CAS  Google Scholar 

  52. Pergolizzi JV, Taylor R, LeQuang JA, Raffa RB, Bisney J. Tapentadol extended release in the treatment of severe chronic low back pain and osteoarthritis pain. Pain Ther. 2018;7:37–57.

    Article  Google Scholar 

  53. Derry S, Wiffen PJ, Kalso EA, Bell RF, Aldington D, Phillips T, et al. Topical analgesics for acute and chronic pain in adults - an overview of Cochrane reviews. Cochrane Database Syst Rev. 2017;5:CD008609.

    Google Scholar 

  54. Doleys DM. Chronic pain as a hypothetical construct: a practical and philosophical consideration. Front Psychol. 2017;8:81–7.

    Article  Google Scholar 

  55. McCulloch Gallagher R, Sandbrink F. The socioeconomic burden of pain from war. Am J Public Health. 2019;109:41–5.

    Article  Google Scholar 

  56. Ravn SL, Hartvigsen J, Hansen M, Sterling M, Andersen TE. Do post-traumatic pain and post-traumatic stress symptomatology mutually maintain each other? A systematic review of cross-lagged studies. Pain. 2018;159:2159–69.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Academic Department of Military Anaesthesia & Critical Care, Royal Centre for Defence Medicine, Birmingham, UK

    Paul Wood

  2. Centre for Blast Injury Studies, Imperial College London, London, UK

    Peter F. Mahoney

  3. Royal Hampshire County Hospital, Winchester, UK

    Dominic J. Aldington

Authors
  1. Paul Wood
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  2. Peter F. Mahoney
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  3. Dominic J. Aldington
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Editor information

Editors and Affiliations

  1. Department of Bioengineering and Centre for Blast Injury Studies, Imperial College London, London, UK

    Anthony M. J. Bull

  2. Department of Bioengineering and Centre for Blast Injury Studies, Imperial College London, Surrey, UK

    Jon Clasper

  3. Centre for Blast Injury Studies, Imperial College London, London, UK

    Peter F. Mahoney

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Wood, P., Mahoney, P.F., Aldington, D.J. (2022). Pain. In: Bull, A.M.J., Clasper, J., Mahoney, P.F. (eds) Blast Injury Science and Engineering. Springer, Cham. https://doi.org/10.1007/978-3-031-10355-1_47

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  • DOI: https://doi.org/10.1007/978-3-031-10355-1_47

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-10354-4

  • Online ISBN: 978-3-031-10355-1

  • eBook Packages: MedicineMedicine (R0)

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