Browsing by Person "Martin, D. J."

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A focus group study of health professionals? views on phantom sensation, phantom pain and the need for patient information
(Elsevier, 2004-08) Mortimer, C. M.; MacDonald, R. J. M.; Martin, D. J.; McMillan, Ian R.; Ravey, J.; Steedman, W. M.
Focus groups with 32 health professionals from pre- and post-amputation care in central Scotland were used to explore perceptions of phantom sensation and pain, and current practice and potential improvements to patient information. Findings were compared to our parallel study of patients' experiences of phantom phenomena and information needs. Professionals' perceptions of phantom phenomena did not always match patient experiences: few professionals were fully aware of the nature, or the problems associated with phantom pain. There was uncertainty about who provided information and reported information was inconsistent and only weakly grounded in theory and mechanism-based management. Whilst there was awareness of the benefits of information, content, mode of delivery and co-ordination were all identified as areas for improvement. Our findings suggest that the information given to patients on phantom phenomena is inconsistent and insufficient. Possible solutions are the development of minimum standards of information and specifically targeted interprofessional education.
Detection theory analysis of scaling and discrimination tasks: Responses to noxious thermal stimuli
(Psychonomic Society, 2007-08) Tan, Chee-Wee; Palmer, S.; Martin, D. J.; Roche, Patricia
This study's main purpose was to examine the sensitivity estimates obtained from scaling and discrimination approaches for nociception assessment in healthy individuals. This investigation may inform future applications in diagnostic procedures for painful conditions. Models of psychophysical judgment based on those of Durlach and Braida (1969), Laming (1984), and Irwin and Whitehead (1991) were used as the common analytical framework. Noxious thermal contact stimuli were used. The results show that the scaling approach produced lower detection theory sensitivity estimates than did the discrimination approach. The additional judgment variance in scaling tasks could explain this lowered sensitivity. The relative judgmental variance value of 2.18 obtained in this study is lower than variance values found in previous investigations. This discrepancy is probably due to the relatively smaller stimulus range employed in this study. The authors propose that the theoretical framework used in this study may be used in future studies to investigate the different dimensions of pain perception. Perception & Psychophysics,
Interventions for treating Morton's neuroma: a systematic review
(2004) Thomson, Colin E.; Martin, D. J.; Gibson, J. N. A.
Background Morton's neuroma is a common, paroxysmal neuralgia affecting the web spaces of the toes, typically the third. The pain is often so debilitating that patients become anxious about walking or even putting their foot to the ground. Insoles, corticosteroid injections, excision of the nerve, transposition of the nerve and neurolysis of the nerve are commonly used treatments. Their effectiveness is poorly understood. Objectives To examine the evidence from randomised controlled trials concerning the effectiveness of interventions in adults with Morton's neuroma. Search strategy We searched the Cochrane Neuromuscular Disease Group trials register (searched January 2003), MEDLINE (January 1966 to January Week 2 2003), EMBASE (January 1980 to February Week 2 2003), and CINAHL (January 1982 to February Week 1 2003). Selection criteria Randomised or quasi-randomised (methods of allocating participants to an intervention which were not strictly random e.g. date of birth, hospital record, number alternation) controlled trials of interventions for Morton's neuroma were selected. Studies where participants were not randomised into intervention groups were excluded. Data collection and analysis Two reviewers selected trials for inclusion in the review, assessed their methodological quality and extracted data independently. Main results Three trials involving 121 people were included. There is, at most, a very limited indication that transposition of the transected plantar digital nerve may yield better results than standard resection of the nerve in the long term. There is no evidence to support the use of supinatory insoles. There are, at best, very limited indications to suggest that dorsal incisions for resection of the plantar digital nerve may result in less symptomatic post-operative scars when compared to plantar excision of the nerve. Authors' conclusions There is insufficient evidence with which to assess the effectiveness of surgical and non-surgical interventions for Morton's neuroma. Well designed trials are needed to begin to establish an evidence base for the treatment of Morton's neuroma pain.
Patient information on phantom limb pain: a focus group study of patient experiences, perceptions and opinions
(Oxford University Press, 2002-06) Mortimer, C. M.; Steedman, W. M.; McMillan, Ian R.; Martin, D. J.; Ravey, J.
Educating patients about their condition is regarded as a fundamental step in pain management. This study used focus groups with patients to explore their experiences and perceptions of the information on phantom pain that they received before and after amputation, and their views on improving this information. Thirty-one patients with a lower limb amputation attended one of seven focus groups. The majority reported phantom pain although there were individual variations in character, severity and persistence. There were wide variations in what people were told from occasional reports of good information to instances of people reporting little or no information from professionals. There were strong feelings that information should be given before or soon after amputation with a preference for verbal one-to-one explanations. Professionals, particularly nurses and surgeons, were regarded as the best source of information, although peer support was seen to be important. These findings indicate that people require timely up-to-date information on phantom pain which sensitively addresses the variability of the experience and provides the foundation for ongoing pain management. We propose that the information process could be improved by ensuring that professionals use standard information for patients derived from purposefully written sections in national guidelines.
The effect of stimulus number on the stability of responses for an extensive heat pain test
(2012-06) Tan, Chee-Wee; Palmer, S. T.; Martin, D. J.
Background.The use of relatively lower stimulus presentation numbers in quantitative sensory testing may influence the computation accuracy of participants' discriminability. The minimum trial number for obtaining a stabilized participant discrimination ability was determined. Materials and methods.Twelve participants' ability to discriminate between noxious heat stimuli pairs (45C/46C, 46C/47C, and 47C/48C) was assessed using a six-category confidence rating scale. Heat stimuli were administered to the forearm. Two conditions with presentation numbers of 17 trials per stimulus (representing the median number of trials in previous studies) and 40 trials per stimulus (used in a previous study with a similar protocol) were used. Results and discussion.Participants' discriminability stabilized at approximately the 20th trial based on the lowest frequency of indeterminate and non-model conforming results under both conditions. A simple linear regression model showed a statistically significant positive relationship between discriminability for the two conditions (slope=0.65, p<0.001; constant=0.33, p=0.02; r 2=0.51). As a rule of thumb, approximately 20 trials per stimulus intensity could be used to obtain a stabilized discriminability outcome. 2012 Informa Healthcare Ltd.