Targeted muscle reinnervation in quadruple amputees: self-reported outcomes

Targeted muscle reinnervation (TMR) reduces pain and physical and psychological disabilities in amputees. We present the first two cases reported globally of quadruple amputees that underwent acute TMR. Each patient completed our novel ‘The Alfred Hospital Osteointegration Survey’ (TAHOS) for each limb at six, 12 and 24 months post amputation which evaluated aspects of prosthesis wear, neuroma-related residual limb pain (RLP), phantom limb pain (PLP) and overall function. Our findings that TMR reduced or eliminated RLP and PLP by 12 months and clinically improved prosthetic function in both quadruple amputees reflects the current literature for single and multiple limb amputees.

Complex regional pain syndrome of the residual limb in a transtibial lower-limb amputee: diagnosis and treatment

We present the unusual case of complex regional pain syndrome (CRPS) of the residual limb in a 54-year-old woman with transtibial lower-limb amputation. Intractable pain developed 14 months after amputation, followed by successful rehabilitation. Anamnesis and clinical findings included sensory symptoms, vasomotor symptoms and signs, and oedema. The Budapest criteria for a diagnosis of CRPS were met. After infusions of bisphosphonates during a 5-week inpatient interdisciplinary rehabilitation programme, the pain decreased. Clinicians should suspect CRPS in case of chronic or recurrent residual limb pain. The Budapest criteria seem applicable even if interpretation of symptoms and findings can be complicated in vascular polymorbid lower-limb amputation. Bisphosphonates, proposed as first-line pharmacological treatment, can be useful.

Postamputation Residual Limb Pain Severity and Prevalence: A Systematic Review and Meta-Analysis

Background: Individuals with an extremity amputation are predisposed to persistent pain that reduces their quality of life. Residual limb pain is defined as pain that is felt in the limb after amputation. Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review of 5 databases from inception to June 2020 was performed and is registered under the PROSPERO ID: CRD42020199297. Included studies were clinical trials with residual limb pain assessed at a minimum follow-up of 1 week. Meta-analyses of residual limb pain prevalence and severity were performed with subgroups of extremity and amputation etiology. Results: Twenty clinical trials met criteria and reported on a total of 1347 patients. Mean patient ages ranged from 38 to 77. Residual limb pain prevalence at 1 week, 1 month, 3 months, 6 months, 1 year, and 2 years, respectively, was 50%, 11%, 23%, 27%, 22%, and 24%. Mean residual limb pain severity at the 6 months or longer follow-up was 4.19 out of 10 for cancer amputations, 2.70 for traumatic amputations, 0.47 for vasculopathy amputations, 1.01 for lower extremity amputations, and 3.56 for upper extremity amputations. Conclusions: Residual limb pain severity varies according to the etiology of amputation and is more common after upper extremity amputation than lower extremity amputations. The most severe pain is reported by patients undergoing amputations due to cancer, followed by traumatic amputations, while vascular amputation patients report lower pain severity. Promising methods of reducing long-term pain are preoperative pain control, nerve or epidural blocks, use of memantine, calcitonin-containing blocks, and prophylactic nerve coaptations.

Factors Associated With Prosthesis Embodiment and Its Importance for Prosthetic Satisfaction in Lower Limb Amputees

Perceptual integration of a prosthesis into an amputee's body representation, that is, prosthesis embodiment, has been proposed to be a major goal of prosthetic treatment, potentially contributing to the user's satisfaction with the device. However, insufficient knowledge about individual or prosthetic factors associated with prosthesis embodiment challenges basic as well as rehabilitation research. In the present study, hierarchical multiple regression analyses on prosthesis embodiment—as assessed with the recently introduced Prosthesis Embodiment Scale—were applied to the survey data of a large sample of prosthesis-using lower limb amputees, entering relevant objective-descriptive (i.e., unbiased characteristics of the amputation or the prosthesis) and subjective-evaluative variables (i.e., the amputee's perceptions related to the amputation or the prosthesis) as first- or second-level regressors, respectively. Significant regressors identified in these analyses together explained R2 = 36.3% of prosthesis embodiment variance in the present sample, with a lower level of amputation, less intense residual limb pain, more realistic visual appearance of the device, higher prosthetic mobility, and more positive valence of prosthesis-induced residual limb stimulations representing significantly associated factors. Using the identical set of regressors hierarchically complemented by prosthesis embodiment on measures of prosthetic satisfaction—as assessed with the Trinity Amputation and Prosthesis Experience Scales—revealed that prosthesis embodiment was significantly and positively associated with aesthetic as well as functional prosthesis satisfaction. These findings emphasize the importance of psychological factors for the integration of a prosthesis into the amputee's body representation, which itself represents a crucial factor associated with prosthesis satisfaction. The results might have important implications for future prosthetic treatment; however, replication of the findings in an independent sample is required, as well as sophisticated experimental designs in order to elucidate the causality of effects.

Residual limb pain: An evidence-based review

Acquired limb loss, whether from accident or amputation, occurs with an incidence of greater than 175,000 per year in the United States. Current prevalence is estimated at greater than 1.5 million and is expected to double within 30 years. While many patients with amputations may have no significant pain or sensory issues after healing from the initial loss, one-quarter to one-half of patients may have ongoing difficulties with residual limb pain, phantom limb pain, or phantom limb sensation. This review explores the potential etiologies of those symptoms, as well as a variety of treatment options that a practitioner may consider when approaching this condition.