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Biomedical subjects

William A Macrae

Publications and source records attributed to William A Macrae.

7 recordsLinked to original sources
PubMed2002

Pain in traumatic upper limb amputees in Sierra Leone.

Data on 40 upper limb amputees (11 bilateral) with regard to stump pain, phantom sensation and phantom pain is presented. All the patients lost their limbs as a result of violent injuries intended to terrorise the population and were assessed 10-48 months after the injury. All amputees reported stump pain in the month prior to interview and ten of the 11 bilateral amputees had bilateral pain. Phantom sensation was common (92.5%), but phantom pain was only present in 32.5% of amputees. Problems in translation and explanation may have influenced the low incidence of phantom pain and high incidence of stump pain. In the bilateral amputees phantom sensation, phantom pain and telescoping all showed bilateral concordance, whereas stump pain and neuromas did not show concordance. About half the subjects (56%) had lost their limb at the time of injury (primary) while the remainder had an injury, then a subsequent amputation in hospital (secondary). There was no association between the incidence of phantom pain and amputation irrespective of being primary or secondary.

Adolescent↗
PubMed1993

Polarised views on treating neurogenic pain.

This study aimed to identify areas of disagreement in the management of neurogenic pain. A short questionnaire was mailed to 179 consultants with an interest in chronic pain (response rate 89%). The questionnaire listed 11 specific conditions involving nerve pain (e.g., post-herpetic neuralgia, causalgia) together with 11 treatments (e.g., antidepressants, neurectomy). Consultants were asked to rate the use of each treatment for each condition as 'appropriate', 'no value or positively harmful' or 'no opinion'. Much disagreement emerged about the value of each therapy for each condition: in almost every instance at least some consultants disagreed with the majority view. The dissenting minority was greater than 20% of those who gave an opinion for 48 of the 121 applications of therapy asked about. The appropriateness of treatments for trigeminal neuralgia, amputation stump pain and phantom pain was most often in dispute and there was little consensus on the value of nerve blocks. There were a few areas of near agreement. Antidepressants and anticonvulsants were mostly identified as appropriate for all the conditions listed and there was some agreement that strong opioids and the neuroablative techniques were appropriate for cancer pressure or infiltration of nerves but, with a few exceptions, of no value for all other neurogenic pain conditions. Divergence of views about treatments may indicate a lack of credible evidence on the value of therapies or a lack of professional knowledge. Where published evidence is clear, the consequences for patients may be under-use of useful therapies or potential iatrogenic harm.

Chronic Disease↗
PubMed1993

Pain assessment with interactive computer animation.

A method of assessing pain using interactive computer animation is described. This method provides quantitative measurements of different qualitative aspects of pain experience without reliance on fine verbal distinctions. A clinical comparison of this procedure and the Short-Form McGill Pain Questionnaire (SF-MPQ) is reported. Correlations between paper and animated visual analogue scales (VAS) showed that animated measurements can be reliably compared to traditional paper-based reporting. Measurements using animations designed to assess different qualities of pain experience correlated significantly with SF-MPQ measures, providing good concurrent validity. A difference was found between patients who chose only one quality-of-pain animation and those who chose more than one, possibly indicating a difference in patients' verbal fluency. Patients overwhelmingly preferred the interactive animations to the paper-based method.

Adult↗
PubMed1991

Consensus and contention in the treatment of chronic nerve-damage pain.

A postal questionnaire survey was carried out to investigate beliefs in the efficacy of specific treatments held by consultants involved in the treatment of chronic nerve-damage pain. One hundred eighty-eight consultants experienced in the treatment of chronic pain were identified by local Pain Clinic consultants in 5 centres. The specialties represented were neurology, neurosurgery, orthopaedic surgery, oncology/radiotherapy, plastic surgery and anaesthesia. Replies were received from 181 consultants (96%). Over one fifth of the consultants expressed no opinion about half of the treatments assessed. Widely divergent views were held by those who did give an opinion. Many clinicians assessed some treatments as 'poor' while other clinicians assessed the same treatments as 'excellent' (neurolytic nerve block, somatic nerve block, cordotomy and opioids). For some treatments divergence of opinion can be explained in part by differences between specialties. For other treatments marked diversity was seen within as well as between specialties. There is a clear need for education in the use of particular treatments, even amongst those clinicians who regularly see this type of patient.

Chronic Disease↗
PubMedDate not supplied

Field research in humanitarian medical programmes. Treatment of neuropathic pain in Sierra Leone.

A pilot study was carried out among 223 war wounded and amputees in Sierra Leone in 2001 to investigate whether an intervention using proven medication for clinically diagnosed neuropathic pain would work in a developing country with limited health services. Compliance with medication was assessed in 79 patients and their pain and mood scores were assessed by questionnaire before medication and 6-10 months later. The pain and mood scores of 33 patients who stopped taking medication were compared for the initial and follow-up assessments indicating that, although the scores showed an improvement at follow-up, there was no significant improvement. Compliance was reasonable in 46 patients who continued with their medication, with 86.5% of possible doses collected although many had difficulty understanding how to take the drugs properly. Their pain and mood scores showed significant improvement at reassessment indicating that pain will be reduced with a longer duration of treatment. This study showed that it is possible to run an effective intervention for neuropathic pain in Sierra Leone with intermittent expert involvement and MSF have been able to develop a protocol for the assessment and treatment of neuropathic pain that may be useful in other difficult settings in which they work.

Adolescent↗