Chronic pain in lower limb amputees: Is there a correlation with the use of perioperative epidural or perineural analgesia?

2021 ◽  
pp. 1-10
Author(s):  
Benedetti Maria Grazia ◽  
De Santis Letizia ◽  
Mariani Giorgio ◽  
Donati Danilo ◽  
Bardelli Roberta ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Lower Limb ◽  
Phantom Limb Pain ◽  
Postal Survey ◽  
Phantom Limb ◽  
Limb Amputation ◽  
Limb Pain ◽  
Simultaneous Use

BACKGROUND: Chronic pain is common in patients who undergo lower limb amputation. The use of epidural or perineural catheters seems to reduce acute pain after surgery but their effects in a longer follow up are unknown. OBJECTIVE: To evaluate the long-term prevalence of phantom limb sensation (PLS), phantom limb pain (PLP), and residual limb pain (RLP) and their correlation with perioperative use of epidural or perineural catheters. METHODS: Postal survey. Patients with trans-femoral, trans-tibial or hemi-pelvectomy amputation were asked to partake in the study. The Prosthetic Evaluation Questionnaire was used for the presence of chronic post-surgical pain. Presence of catheters was retrieved from medical notes. RESULTS: 57 patients at a mean of 4.4 years follow up were included. PLS was reported in 68.4%, PLP in 63.2 % and RLP in 54.4% of amputees. No correlation was identified between pain syndromes and the presence of individual catheters and the duration of their permanence. The simultaneous use of 2 catheters was related to a lesser presence of PLP. CONCLUSIONS: Data on prevalence of PLP, PLS and RLP are consistent with the literature. Favourable effects in PLP reduction in the long term follow up was related to the simultaneous use of two catheters.

Psychosocial predictors of long-term adjustment to lower-limb amputation and phantom limb pain

2004 ◽  
Vol 26 (14-15) ◽  
pp. 882-893 ◽  
Author(s):  
Marisol A Hanley ◽  
Mark P Jensen ◽  
Dawn M Ehde ◽  
Amy J Hoffman ◽  
David R Patterson ◽  
...  
Keyword(s):  
Lower Limb ◽  
Phantom Limb Pain ◽  
Lower Limb Amputation ◽  
Phantom Limb ◽  
Limb Amputation ◽  
Psychosocial Predictors ◽  
Limb Pain

scholarly journals Treatment of Chronic Phantom Limb Pain Using a Trauma-Focused Psychological Approach

2010 ◽  
Vol 15 (2) ◽  
pp. 65-71 ◽  
Author(s):  
C de Roos ◽  
AC Veenstra ◽  
A de Jongh ◽  
ME den Hollander-Gijsman ◽  
NJA van der Wee ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Repeated Measures ◽  
Psychological Intervention ◽  
Psychological Treatment ◽  
Phantom Limb Pain ◽  
Phantom Limb ◽  
Limb Pain ◽  
Before And After

BACKGROUND: Chronic phantom limb pain (PLP) is a disabling chronic pain syndrome for which regular pain treatment is seldom effective. Pain memories resulting from long-lasting preamputation pain or pain flashbacks, which are part of a traumatic memory, are reported to be powerful elicitors of PLP.OBJECTIVE: To investigate whether a psychological treatment directed at processing the emotional and somatosensory memories associated with amputation reduces PLP.METHODS: Ten consecutive participants (six men and four women) with chronic PLP after leg amputation were treated with eye movement desensitization and reprocessing (EMDR). Pain intensity was assessed during a two-week period before and after treatment (mean number of sessions = 5.9), and at short- (three months) and long-term (mean 2.8 years) follow-up.RESULTS: Multivariate ANOVA for repeated measures revealed an overall time effect (F[2, 8]=6.7; P<0.02) for pain intensity. Pairwise comparison showed a significant decrease in mean pain score before and after treatment (P=0.00), which was maintained three months later. All but two participants improved and four were considered to be completely pain free at three months follow-up. Of the six participants available at long-term follow-up (mean 2.8 years), three were pain free and two had reduced pain intensity.CONCLUSIONS: These preliminary results suggest that, following a psychological intervention focused on trauma or pain-related memories, substantial long-term reduction of chronic PLP can be achieved. However, larger outcome studies are required.

scholarly journals Development of a Multimodal Analgesia Protocol for Perioperative Acute Pain Management for Lower Limb Amputation

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Roberta De Jong ◽  
Alexander J. Shysh
Keyword(s):  
Pain Management ◽  
Lower Limb ◽  
Phantom Limb Pain ◽  
Multimodal Analgesia ◽  
Lower Limb Amputation ◽  
Phantom Limb ◽  
Limb Amputation ◽  
Multiple Sources ◽  
Limb Pain ◽  
Pain Mechanisms

Multimodal analgesia may include pharmacological components such as regional anesthesia, opioid and nonopioid systemic analgesics, nonsteroidal anti-inflammatories, and a variety of adjuvant agents. Multimodal analgesia has been reported for a variety of surgical procedures but not yet for lower limb amputation in vasculopathic patients. Perioperative pain management in these patients presents a particular challenge considering the multiple sources and pathways for acute and chronic pain that are involved, such as chronic ischemic limb pain, postoperative residual limb pain, coexisting musculoskeletal pain, phantom limb sensations, and chronic phantom limb pain. These pain mechanisms are explored and a proposed protocol for multimodal analgesia is outlined taking into account the common patient comorbidities found in this patient population.

scholarly journals EP.WE.501The Role of Nerve Sheath Catheters after Major Lower Limb Amputations in Post-operative Pain Control

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Cara Vincenti ◽  
Nisheeth Kansal ◽  
Vishwanath Bhattacharya
Keyword(s):  
Lower Limb ◽  
Pain Control ◽  
Phantom Limb Pain ◽  
Phantom Limb ◽  
Limb Amputation ◽  
Opioid Use ◽  
Limb Pain ◽  
Nerve Sheath ◽  
Post Operative Pain ◽  
Pain Outcomes

Abstract Aim Pain is a common post-operative complication after limb amputation. Though the evidence is mixed, current literature suggests nerve sheath catheters (NSC) have no effect on chronic stump pain, phantom limb pain or post-operative pain score but reduces opioid use. This study aims to compare pain outcomes in those with and without NSC after above knee amputations (AKA) and below knee amputations (BKA). Method This retrospective study collected information from 32 patients after lower-limb amputation from April 2014 - March 2017. Information regarding indication, anaesthetic and morphine requirement at 72 hours were collected from medical records and standardised questions used to assess phantom limb pain, chronic limb pain and pain intensity (1-10) at 24, 48 and 72 hours. Results Of the 11 patients who received a NSC catheter for pain control, 33% experienced no post-operative pain, 18% experienced phantom limb pain, 18% reported chronic limb pain and 62% required higher dosages of morphine at 72 hours. However, two patients used large amounts of morphine potentially giving spurious results. In comparison, of those patients without NCS, 43% experienced no pain, 9% experienced phantom limb pain, 33% reported chronic limb pain and only 47% required morphine at 72 hours and at lower doses compared to with NSC. The incidence of phantom limb pain was higher in those who had AKA regardless of the analgesic technique used. Conclusion Patients with NSC were less likely to experience chronic limb pain thus proving their role in post-operative pain control despite having higher morphine requirements.

scholarly journals Characterisation of Phantom Limb Pain in Traumatic Lower-Limb Amputees

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
André Tadeu Sugawara ◽  
Marcel Simis ◽  
Felipe Fregni ◽  
Linamara Rizzo Battistella
Keyword(s):  
Lower Limb ◽  
Phantom Limb Pain ◽  
Cross Sectional Study ◽  
Phantom Limb ◽  
Limb Amputation ◽  
Limb Pain ◽  
Cross Sectional ◽  
Proper Diagnosis ◽  
Pain Descriptors ◽  
Lower Limb Amputees

Introduction. There is no diagnosis for phantom limb pain (PLP), and its investigation is based on anamnesis, which is subject to several biases. Therefore, it is important to describe and standardize the diagnostic methodology for PLP. Objective. To characterise PLP and, secondarily, to determine predictors for its diagnosis. Methodology. This is a cross-sectional study involving patients with unilateral traumatic lower-limb amputation aged over 18 years. Those with clinical decompensation or evidence of disease, trauma, or surgery in the central or peripheral nervous system were excluded. Sociodemographic and rehabilitative data were collected; PLP was characterised using the visual analogue scale (VAS), pain descriptors, and weekly frequency. Results. A total of 55 eligible patients participated in the study; most were male, young, above-knee amputees in the preprosthetic phase of the rehabilitation. The median PLP VAS was 60 (50–79.3) mm characterised by 13 (6–20) different descriptors in the same patient, which coexist, alternate, and add up to a frequency of 3.94 (2.5–4.38) times per week. The most frequent descriptor was movement of the phantom limb (70.91%). Tingling, numbness, flushing, itchiness, spasm, tremor, and throbbing are statistically significant PLP descriptor numbers per patient predicted by above-knee amputation, prosthetic phase, higher education level, and greater PLP intensity by VAS ( p < 0.05 ). Conclusion. PLP is not a single symptom, but a set with different sensations and perceptions that need directed and guided anamnesis for proper diagnosis.

Risk factors for post-amputation pain

2018 ◽  
Author(s):  
Tudor Phillips
Keyword(s):  
Older Patients ◽  
Clinical Characteristics ◽  
Phantom Limb Pain ◽  
Phantom Limb ◽  
Limb Amputation ◽  
Limb Pain ◽  
Experienced Pain ◽  
Stump Pain ◽  
Peripheral Pain

The landmark paper discussed in this chapter is ‘Immediate and long-term phantom limb pain in amputees: Incidence, clinical characteristics and relationship to pre-amputation limb pain’, published by Jensen et al. in 1985. This study examined a cohort of older patients undergoing limb amputation, and carefully related pre-amputation pain to the development and nature of phantom limb pain. The authors demonstrated that a third of patients experienced pain similar to the pre-amputated limb pain immediately after amputation; patients who had experienced pre-amputation pain were more likely to experience phantom limb pain in the first 6 months after the amputation; and persistent phantom limb pain was more likely in patients who experienced stump pain after amputation. The study had clear implications for pain management but, importantly, it also demonstrated that peripheral pain, in the form of pre-amputation and stump pain, was important in determining the development and maintenance of phantom limb pain.

Epidural block and phantom limb pain

2018 ◽  
Author(s):  
Stephan Schug
Keyword(s):  
Epidural Analgesia ◽  
Lower Limb ◽  
Phantom Limb Pain ◽  
Epidural Block ◽  
Phantom Limb ◽  
Limb Amputation ◽  
Control Group ◽  
Limb Pain ◽  
Epidural Group ◽  
Number Of Patients

The landmark paper discussed in this chapter, published by Bach et al. in 1988 is a Danish paper that describes a study where patients who were to undergo lower-limb amputation received either preventive, preoperative epidural analgesia for 72 hours before the amputation, or systemic analgesia. At 6 and 12 months post-operatively, all patients in the epidural group were pain free, while 38% and 27%, respectively, in the control group had phantom limb pain. The study has been criticized for a number of points including the pseudorandomization by year of birth, the lack of any blinding, and the small number of patients used in the study (only 25 patients overall).

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