Gunshot Injuries Assessment and Treatment Considerations

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Introduction[edit | edit source]

General Rules in the Management of Gunshot Injuries[edit | edit source]

  1. Build a therapeutic alliance and trust relationship with your patient
  2. Explain your roles and your abilities
  3. Be realistic and set your patient's expectations
  4. Agree on some mutual goals and responsibilities with your patient
  5. Collect information related to patient's history throughout assessment and interventions
  6. Use trauma-informed approach
  7. Avoid re-traumatisation of your patient
  8. Be sensitive to unrevealed story of captivity or torture

Pain and Disability Drivers Model[edit | edit source]

Pain and Disability Drivers Model (PDDM) provides an assessment frame to standardise healthcare provider's approach for the management of gunshot injuries. It "identifies the domains driving pain and disability to guide clinical decisions." [1]PDDM besets the multidimensional elements from the International Classification of Functioning, Disability and Health framework. This model includes the following five biopsychosocial domains that drive pain and disability:[2]

  1. Nociceptive pain drivers
  2. Nervous system dysfunction drivers
  3. Comorbidity factors
  4. Cognitive-emotional drivers
  5. Contextual drivers (social and environmental)

Each domain is further divided into two categories: (1)modifiable drivers of pain and disability, and (2)more complex and/or less modifiable elements. [2]Based on the assessment results, the provider can weigh the relative contribution of each domain in the patient’s profile.[3]

Pain and Disability Drivers Model and Gunshot Injuries[edit | edit source]

In gunshot injuries, the PDDM allows to create a "comprehensive picture of the patient's clinical presentation". [4] Gunshot injuries can be complex and challenging, and people surviving gunshot injury live with long-term disabilities: [5]

  • Pain or neurologic deficits associated with gunshot injury are severe and can become long lasting [6]
  • Anxiety, depression or other signs of stress affect 50% of patients with gunshot injury while in hospital[7]
  • Disfigurement following gunshot injury can cause further complications and mental health issues [8]
  • Gunshot injuries affect sleeping, eating, working, and other previously taken-for-granted activities [9]

PDDM in gunshot injury should be followed from contextual drivers to nociceptive pain drivers. It is a reversed model of PDDM as compared to PDDM used in patients with musculoskeletal conditions:[4]

5.Nociceptive pain drivers

4.Nervous system dysfunction drivers

3.Comorbidity factors

2.Cognitive-emotional drivers

1.Contextual drivers (social and environmental)


This approach is based on the following factors:[4]

  • Addressing a negative or passive coping style first is necessary because the patient will not follow healthcare providers advice on active lifestyle modifications related to their comorbidities
  • Addressing central sensitisation issues is required for a successful peripheral interventions

Assessment and Interventions Rules in the Gunshot Injuries[edit | edit source]

  1. Choose an assessment frame to standardise your approach
  2. Use outcome measures when appropriate
  3. Focus on providing self-capacity to your patient and refer them to required services
  4. Select treatment tools based on the combat field's reality and the PDDM examination findings

Resources[edit | edit source]

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References[edit | edit source]

  1. ↑ Longtin C, Décary S, Cook CE, Martel MO, Lafrenaye S, Carlesso LC, Naye F, Tousignant-Laflamme Y. Optimizing management of low back pain through the pain and disability drivers management model: A feasibility trial. PLoS One. 2021 Jan 20;16(1):e0245689.
  2. ↑ 2.0 2.1 Naye F, Décary S, Tousignant-Laflamme Y. Development and content validity of a rating scale for the pain and disability drivers management model. Arch Physiother 2022; 12(14).
  3. ↑ Tousignant-Laflamme Y, Cook CE, Mathieu A, Naye F, Wellens F, Wideman T, Martel MO, Lam OT. Operationalization of the new Pain and Disability Drivers Management model: A modified Delphi survey of multidisciplinary pain management experts. J Eval Clin Pract. 2020 Feb;26(1):316-325.
  4. ↑ 4.0 4.1 4.2 Zafer A. Gunshot Injuries Assessment and Treatment Considerations. Plus course 2024
  5. ↑ Raza S, Thiruchelvam D, Redelmeier DA. Death and long-term disability after gun injury: a cohort analysis. CMAJ Open. 2020 Jul 14;8(3):E469-E478.
  6. ↑ Ajmal S, Enam SA, Shamim MS. Neurogenic claudication and radiculopathy as delayed presentations of retained spinal bullet. Spine J. 2009 Oct;9(10):e5-8.
  7. ↑ Wiseman T, Foster K, Curtis K. Mental health following traumatic physical injury: an integrative literature review. Injury. 2013 Nov;44(11):1383-90.
  8. ↑ Smith RN, Seamon MJ, Kumar V, Robinson A, Shults J, Reilly PM, Richmond TS. Lasting impression of violence: Retained bullets and depressive symptoms. Injury. 2018 Jan;49(1):135-140.
  9. ↑ Lee J. Wounded: life after the shooting. The ANNALS of the American Academy of Political and Social Science. 2012 Jul;642(1):244-57.
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