Rehabilitation Traumatology: A Narrative Review.

Rehabilitation traumatology has developed within the field of physical medicine and rehabilitation as a specialized area of knowledge in which the physiatrist works with the traumatology team to enhance the functional outcome of trauma patients. Based on the definition of traumatology in the American Heritage Dictionary, the authors propose rehabilitation traumatology be "the branch of medicine that deals with the treatment of serious wounds, injuries, and disabilities," "to restore [the patient] to good health or useful life." This article reviews the history of traumatology, special considerations of the traumatology patient through the continuum of care, and concepts toward the creation of a rehabilitation traumatology program. LEVEL OF EVIDENCE: V.

Physical medicine and rehabilitation conditions in the Astrodome clinic after hurricane Katrina.

OBJECTIVE: To report the physical medicine and rehabilitation (PMR) conditions seen in the Astrodome Clinic after Hurricane Katrina. DESIGN: Retrospective chart analysis from the county hospital-sponsored disaster-relief clinic in large urban city, including a study of 239 patients with 292 PMR conditions. The total number of patients seen in the Astrodome Medical Clinic was 11,245. The Astrodome database was reviewed for PMR condition diagnostic codes. A retrospective chart analysis was conducted, including date of visit, age, gender, ethnicity, and PMR diagnosis category. Descriptive statistics were obtained for the entire sample. chi2 or t tests were used to determine gender, age, or date-of-service predominance for the most common diagnostic categories. RESULTS: Mean +/- SD age was 45.7 +/- 14.3 yrs; 56% were women, 43% were men (1% unspecified), and 76% were African American. The majority (75%) of PMR conditions presented in the first week. Most frequent were swollen feet and legs (22%), leg pain and cramps (17%), headache (12%), and neck and back pain (10%). Persons with headaches were younger than those without (41.3 vs. 46.3 yrs, P = 0.048). Persons with neck and/or back pain were older than those without those conditions (51.3 vs. 44.8 yrs, P = 0.004). Women had more headaches (20.9%) than did men (6.7%, P = 0.002). There were no Caucasians with leg pain/cramps, whereas 20.2% of African Americans had this condition (P = 0.028). CONCLUSIONS: This study documents the time of clinic presentation and most frequent types of PMR conditions of patients treated in the Astrodome Clinic after a historic hurricane. Most PMR conditions were treated by PMR personnel during the first week. Thus, future disaster planning should include PMR professionals as early responders.

Hurricane Katrina: medical response at the Houston Astrodome/Reliant Center Complex.

On September 1, 2005, with only 12 hours notice, various collaborators established a medical facility--the Katrina Clinic--at the Astrodome/Reliant Center Complex in Houston. By the time the facility closed roughly two weeks later, the Katrina Clinic medical staff had seen over 11,000 of the estimated 27,000 Hurricane Katrina evacuees who sought shelter in the Complex. Herein, we describe the scope of this medical response, citing our major challenges, successes, and recommendations for conducting similar efforts in the future.

Opioids in the treatment of chronic pain: legal framework and therapeutic indications and limitations.

The most important message that physicians must communicate to persons with chronic pain is that, currently, no medication exists that will take away more than 30% of the pain they experience. Chronic pain is a chronic disease and, like diabetes or hypertension, requires chronic concessions and lifestyle modifications. In controlled trials of short duration and small sample size with highly selected patients, patients sustaining moderate-to-severe pain still experience moderate pain even on opioid medication. Adverse drug effects are predictable and common, and, in fact, long-term compliance with opioids is low owing to side effects. Screening for substance abuse by history taking, observing behavior, obtaining old medical records,and using UDS in patients before initiating opioid therapy is important to identify patients with comorbid addictive disease who require coincident or antecedent treatment. Familiarity with federal and state controlled substance legislation and state health care provider and pain treatment acts is a mundane but essential educational endeavor for all physicians prescribing opioids. If physicians educate their patients with chronic pain about the limited efficacy of the medications, patients' expectations for drug treatment can be more realistic.

Issues in opioid management.

Although a universal consensus has evolved concerning the utility of opioids in cancer pain, the use of opioids for the treatment of chronic nonmalignant pain syndromes is much debated in the medical literature. Although for clinical, regulatory, and medicolegal reasons, many clinicians disagree with their use, others find them helpful, with little prevalence of abuse behaviors or intolerable adverse effects. In a review of this topic, several issues of relevance to management decisions, including efficacy, medication compliance, and safety, are evaluated. As a clinically distinct population among chronic pain sufferers, patients with arthritis-associated pain (including rheumatoid and osteoarthritis) are discussed separately. Particularly important issues with regard to prescribing decisions, including divergent goals and expectations, and factors associated with avoidance of withdrawal and addiction, are also evaluated to ensure that management of patients with nonmalignant chronic pain is optimized when opioids are considered.

Comparison of stochastic vs. conventional transcutaneous electrical stimulation for pain modulation in patients with electromyographically documented radiculopathy.

OBJECTIVE: To determine if a transcutaneous electrical stimulation (TENS) unit modified to deliver electrical impulses at random (R) or stochastic frequency, called TENS-R, provided better pain relief than conventional TENS. DESIGN: A prospective, randomized, double-blinded, placebo-controlled study at an urban teaching hospital. A total of 13 adult subjects with radiculopathy on electromyogram and chronic radicular pain rated pain before and after walking 100 feet with proximal (axial) placement of TENS leads with randomized settings on conventional TENS, placebo, or TENS-R and, subsequently, with distal (limb) placement of TENS leads with randomized settings, all on the same day. The pain measures used were the McGill Pain Questionnaire, parts 1 and 2, and the Visual Analog Scale. The functional measure was speed of walking. RESULTS: Four men and seven women completed the study pain scores, measured by McGill Pain Questionnaire part 2, significantly improved when the patient used TENS-R vs. conventional TENS (P = 0.006, analysis of variance). Placement of TENS electrodes on the back significantly decreased pain compared with lead placement on the legs for McGill Pain Questionnaire part 1 (P = 0.007), McGill Pain Questionnaire part 2 (P = 0.042), and the Visual Analog Scale (P = 0.026) measures. CONCLUSIONS: Qualitative pain scores significantly improved when the patient used TENS-R vs. conventional TENS. Lead placement of any TENS modality over the back vs. over the leg improved all pain scores.