“Doomed to go in company with miserable pain”: surgical recognition and treatment of amputation-related pain on the Western Front during World War 1

• Published in: The Lancet (British edition) Vol. 384; no. 9955; pp. 1715 - 1719
• Main Authors: Edwards, Dafydd S, FRCS, Mayhew, Emily R, Dr, Rice, Andrew S C, Prof
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier 08.11.2014; Elsevier Limited
• Subjects: Afghan Campaign 2001; Amputation; Amputation - adverse effects; Amputation - history; Amputation Stumps; Biological and medical sciences; General aspects; History, 20th Century; History, 21st Century; Humans; Injuries; Internal Medicine; Iraq War, 2003-2011; Medical sciences; Military Medicine - history; Military personnel; Miscellaneous; Orthopedic surgery; Pain; Pain - diagnosis; Pain - etiology; Pain - history; Phantom Limb - diagnosis; Phantom Limb - history; Phantom Limb - therapy; Postoperative period; Prostheses; Public health. Hygiene; Public health. Hygiene-occupational medicine; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Traumatology - history; Traumatology - methods; War; World War I; World; Medicine; Pain; Treatment; Surgical amputation; Surgery; War; Recognition; Public health; International
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(14)61643-3

Summary The principal feature of injuries from World War 1 was musculoskeletal trauma and injury to peripheral nerves as a result of damage to the upper and lower limbs caused by gunshot wounds and fragments of artillery munitions. Amputation was used as a treatment in field hospitals to save lives; limb conservation was a secondary consideration. A century later, the principal feature of injuries to soldiers in today's wars in Iraq and Afghanistan is also musculoskeletal trauma and injury to the peripheral nerves caused by improvised explosive devices. Common to both types of injury is postamputation pain. We searched The Lancet's archives in this Series paper to show the efforts of surgeons in World War 1 to understand and treat postamputation pain in its own right both during and immediately after the war. Despite unprecedented patient numbers and levels of civilian medical expertise, little progress was made in providing relief from this type of pain, a grave concern to the surgeons treating these soldiers. Today postamputation pain is understood beyond a surgical context but remains a complex and poorly understood condition with few effective treatments.