Journal Club – Pain and NFCI in the Military

Capsaicin 8% Patch Treatment in Non-Freezing Cold Injury: Evidence for Pain Relief and Nerve Regeneration. https://doi.org/10.3389/fneur.2021.722875

An interesting paper purely from a research perspective. Cohort of 20 patients, 16 of whom completed the trial. Mean duration of symptoms 49 months (looks skewed – median should have been used). Not blinded, in fact no control group. 8% capsaicin patch applied and followed up in 3 months. Pain scores improved and histology improved – useful from a research perspective. However, from a pain perspective, we cannot say anything without a control arm. The authors acknowledge this in their discussion.

I have a small issue with the terminology. The paper describes the duration of NFCI in months. This should be duration of pain symptoms. NFCIs are usually measured in hours or occasionally repeated over days (unless your are Scott of the Antarctic & that didn’t end well!).

Tools, Time, Training, and Team—Military Primary Care Providers’
Perspectives on Improving Chronic Pain Assessment and
Management. https://doi.org/10.1093/milmed/usab367

This was a qualitative study of US Military Primary Care Physicians who were interviewed about their experiences managing CNCP in primary care. It’s worth just reading the conclusion in the abstract as, funnily enough, they drew similar conclusions to what I found. The study itself seems solid – iterative and inductive thematic analysis, 12 interviewees. If you do have time, the themes they encountered are worth a look, especially the quotes. I’ve only skimmed it but will have a closer look especially if there is reference to problem based learning.