Do chronic pain syndromes in lower limb amputees have an effect on the use of prostheses?

2021 ◽  
pp. 1-9
Author(s):  
Danilo Donati ◽  
Stefano Brunelli ◽  
Letizia De Santis ◽  
Giorgio Mariani ◽  
Elisabetta Mariani ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Lower Limb ◽  
Phantom Limb Pain ◽  
Phantom Limb ◽  
Below The Knee ◽  
Pain Syndromes ◽  
Long Term Follow Up ◽  
Rizzoli Orthopaedic Institute ◽  
Lower Limb Amputees ◽  
Chronic Pain Syndromes

BACKGROUND: The use of a prosthesis is critical to regain the ability to walk in lower limb amputees but the relationship between the use of a prosthesis and chronic pain syndromes (PLS, PLP, RLP), common in amputees patients, is still poorly understood. OBJECTIVE: This long-term follow-up study investigates the possible correlation between prosthesis use and the presence of PLP, PLS and RLP in lower limb amputees. METHODS: Patients undergoing transtibial, transfemoral or hemipelvectomy amputation of any aetiology at the Rizzoli Orthopaedic Institute from 2008 to 2018 were included. The Houghton scale was used to assess functional use of the prosthesis. RESULTS: The results show that, in lower limb amputees, prosthesis use is greater in individuals with below-the-knee amputation and in those who were younger at the time of amputation. No significant correlation between the presence of pain syndromes (PLS, PLP, RLP) and the various items on the Houghton scale was found. CONCLUSIONS: The study found no significant correlation indicating that phantom limb pain syndromes affect amputee use of a prosthesis.

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.

Phantom Limb: A Phenomenological Study

1982 ◽  
Vol 141 (1) ◽  
pp. 54-58 ◽  
Author(s):  
G. D. Shukla ◽  
S. C. Sahu ◽  
R. P. Tripathi ◽  
D. K. Gupta
Keyword(s):  
Upper Limb ◽  
Lower Limb ◽  
Phenomenological Study ◽  
Phantom Limb Pain ◽  
Phantom Limb ◽  
Limb Pain ◽  
Post Operative Period ◽  
The Right ◽  
Lower Limb Amputees

SummaryPhantom limb phenomena during the post-operative period were studied in 72 amputees. All were right handed. Phantom limb was present in 86.1 per cent of the cases, significantly more commonly following amputation of the right arm. Nearly half of the phantoms developed within the first 24 hours and another quarter in the next 24 hours, appearing earlier in lower limb amputees. Movements in the phantom were felt by three-quarters of the cases, an incidence unaffected by site or side of amputation. Telescopy was present in nearly two-thirds and phantom limb pain in over two-thirds, significantly more commonly in the upper limb amputees but uninfluenced by the side of amputation. Thirty-one of the patients dreamed that their limbs were intact.

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.

scholarly journals Efferent retargeting in above-knee amputees is positively related to phantom limb pain

2020 ◽  
Author(s):  
Amanda S. Therrien ◽  
Cortney Howard ◽  
Laurel J. Buxbaum
Keyword(s):  
Upper Limb ◽  
Lower Limb ◽  
Phantom Limb Pain ◽  
Cortical Reorganization ◽  
Phantom Limb ◽  
Thigh Muscle ◽  
Emg Activity ◽  
Phantom Pain ◽  
Limb Pain ◽  
Lower Limb Amputees

AbstractMany individuals who undergo limb amputation experience persistent phantom limb pain (PLP). The underlying mechanism of PLP is unknown, but the phenomenon has been associated with reorganization in sensorimotor cortex following amputation. The traditional view is that cortical reorganization degrades the missing limb’s representation. However, recent work suggests that an amputated limb’s cortical representation remains intact and that reorganization reflects a retargeting of efferent projections to residual muscles proximal to the amputation site. Evidence of retargeting has only been shown in individuals with upper limb amputations, and the relationship of retargeting to PLP is controversial. This study assessed retargeting and its relationship to PLP in 10 individuals with lower limb amputations. We recorded electromyographic (EMG) activity in a residual thigh muscle (vastus lateralis, VL) in patients with above-knee amputations during cyclical movements of the foot. VL activity on the amputated side was compared to that recorded on patients’ intact side while they moved their phantom and intact feet, respectively. VL activity in the patient group was also compared to VL activity from a sample of 9 control participants with no amputation. We show that phantom foot movement is associated with greater VL activity in the amputated leg than that seen in the intact leg as well as that exhibited by controls. The magnitude of residual VL activity was also positively related to ratings of PLP. These results provide the first support for retargeting in lower limb amputees and suggest that retargeting is related to the experience of phantom pain.New and NoteworthyPrevious work has only examined retargeting in upper limb amputees. This study provides evidence for retargeting in lower limb amputees and suggests that retargeting is related to phantom limb pain.

scholarly journals Effect of one session of mirror therapy on phantom limb pain and recognition of limb laterality in military traumatic lower limb amputees: a pilot study

2018 ◽  
Vol 166 (3) ◽  
pp. 146-150 ◽  
Author(s):  
Andrew P Wareham ◽  
V Sparkes
Keyword(s):  
Reaction Time ◽  
Lower Limb ◽  
Phantom Limb Pain ◽  
Phantom Limb ◽  
Mirror Therapy ◽  
Limb Pain ◽  
Main Driver ◽  
Post Test ◽  
Lower Limb Amputees ◽  
Cortical Reorganisation

Up to 70 % of military amputees suffer phantom limb pain (PLP), which is difficult to treat. PLP has been attributed to cortical reorganisation and associated with impaired laterality. Repeated sessions of mirror therapy (MT) can benefit PLP; however, anecdotal evidence suggests one MT session could be effective. In a one-group pretest and post-test design, 16 UK military unilateral lower limb amputees (median age: 31.0, 95% CI 25.0 to 36.8 years) undertook one 10 min MT session. Visual analogue scale (VAS) pain and laterality (accuracy and reaction time) measurements were taken pre-MT and post-MT. Median VAS PLP did not differ significantly between pre-MT 15 mm (2–53 mm) and post-MT 12 mm (1–31) (p=0.875) scores. For the amputated limb, there were no significant differences between pre-MT and post-MT scores for laterality accuracy, 95.3%, 95% CI 90.5% to 97.6% and 96.7%, 95% CI 90.0% to 99.4%, respectively (p=0.778), or reaction time, 1.42 s, 95% CI 1.11 to 2.11 s and 1.42 s, 95% CI 1.08 to 2.02 s, respectively (p=0.629). Laterality was also not different between limbs for accuracy, p=0.484, or reaction time, p=0.716, and did not correlate with PLP severity. No confounding variables predicted individual responses to MT. Therefore, one 10 min MT session does not affect laterality and is not effective as standard treatment for PLP in military lower limb amputees. However, substantial PLP improvement for one individual and resolution of a stuck phantom limb for another infers that MT may benefit specific patients. No correlation found between PLP and laterality implies associated cortical reorganisation may not be the main driver for PLP. Further research, including neuroimaging, is needed to help clinicians effectively target PLP.

Sign in / Sign up

Export Citation Format

Share Document