title: Assessment and Treatment of Pain during Treatment of Buruli Ulcer.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Internal Medicine/Infectious Diseases, Groningen, The Netherlands.
authors.forename: Janine
authors.initials: J
authors.lastname: de Zeeuw
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Health Psychology, Groningen, The Netherlands.
authors.forename: Marike
authors.initials: M
authors.lastname: Alferink
authors.affiliation: Programme National de Lutte contre la Lèpre et l´Ulcère de Buruli, Ministère de la Santé, Cotonou, République du Bénin.
authors.forename: Yves T
authors.initials: YT
authors.lastname: Barogui
authors.affiliation: Programme National de Lutte contre la Lèpre et l´Ulcère de Buruli, Ministère de la Santé, Cotonou, République du Bénin.
authors.forename: Ghislain
authors.initials: G
authors.lastname: Sopoh
authors.affiliation: Kwame Nkrumah University of Science and Technology, School of Medical Sciences, Department of Medicine, Kumasi, Ghana.
authors.forename: Richard O
authors.initials: RO
authors.lastname: Phillips
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Internal Medicine/Infectious Diseases, Groningen, The Netherlands.
authors.forename: Tjip S
authors.initials: TS
authors.lastname: van der Werf
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Internal Medicine/Infectious Diseases, Groningen, The Netherlands.
authors.forename: Susanne
authors.initials: S
authors.lastname: Loth
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Anesthesiology, Groningen, The Netherlands.
authors.forename: Bouwe
authors.initials: B
authors.lastname: Molenbuur
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Genetics, Groningen, The Netherlands.
authors.forename: Mirjam
authors.initials: M
authors.lastname: Plantinga
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Health Psychology, Groningen, The Netherlands.
authors.forename: Adelita V
authors.initials: AV
authors.lastname: Ranchor
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Internal Medicine/Infectious Diseases, Groningen, The Netherlands.
authors.forename: Ymkje
authors.initials: Y
authors.lastname: Stienstra
mesh_terms: D000293:Adolescent; D000328:Adult; D000700:Analgesics / Q000627:therapeutic use*; D001541:Benin; D054312:Buruli Ulcer / Q000150:complications*; D002648:Child; D004363:Drug Utilization; D005260:Female; D005869:Ghana; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D010146:Pain / Q000188:drug therapy* / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000700:Analgesics