02685nas a2200349   4500000000100000008004100001653001100042653002300053653002000076653002000096653001200116653001700128653001200145653001700157100001200174700001500186700001400201700001200215700001600227700001100243700001100254700001600265700001600281700001400297700001600311245007100327856007900398300001300477490000600490520182500496022001402321       2015                            d10aUlcers10aPatient perception10aPain management10aMEdical doctors10aLesions10aDrug Therapy10aCulture10aBuruli ulcer1 aZeeuw J1 aAlferink M1 aBarogui Y1 aSopoh G1 aPhillips RO1 aWerf T1 aLoth S1 aMolenbuur B1 aPlantinga M1 aRanchor A1 aStienstra Y00aAssessment and treatment of pain during treatment of Buruli ulcer.  uhttp://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0004076   ae00040760 v93 a<p>BACKGROUND:<strong> </strong>Buruli ulcer (BU) is described as a relatively painless condition; however clinical observations reveal that patients do experience pain during their treatment. Knowledge on current pain assessment and treatment in BU is necessary to develop and implement a future guideline on pain management in BU.</p>

<p>METHODOLOGY:<strong> </strong>A mixed methods approach was used, consisting of information retrieved from medical records on prescribed pain medication from Ghana and Benin, and semi-structured interviews with health care personnel (HCP) from Ghana on pain perceptions, assessment and treatment. Medical records (n = 149) of patients treated between 2008 and 2012 were collected between November 2012 and August 2013. Interviews (n = 11) were audio-taped, transcribed verbatim and qualitatively analyzed.</p>

<p>PRINCIPAL FINDINGS:<strong> </strong>In 113 (84%) of the 135 included records, pain medication, mostly simple analgesics, was prescribed. In 48% of the prescriptions, an indication was not documented. HCP reported that advanced BU could be painful, especially after wound care and after a skin graft. They reported not be trained in the assessment of mild pain. Pain recognition was perceived as difficult, as patients were said to suppress or to exaggerate pain, and to have different expectations regarding acceptable pain levels. HCP reported a fear of side effects of pain medication, shortage and irregularities in the supply of pain medication, and time constraints among medical doctors for pain management.</p>

<p>CONCLUSIONS:<strong> </strong>Professionals perceived BU disease as potentially painful, and predominantly focused on severe pain. Our study suggests that pain in BU deserves attention and should be integrated in current treatment.</p>
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