Title: Phantom Pain, Residual Limb Pain, and Back Pain in Amputees: Results of a National Survey
Authors: Patti Ephraim MPH, Stephen T. Wegener, PhD, Ellen Mackenzie PhD, Timothy R. Dillingham, MD.
Source: Archives of Physical Medicine and Rehabilitation , Volume 86:1910-1919, October 2005
PODIATRIC RELEVANCE:
There is an increasing number of individuals being diagnosed with diabetes and other associated diseases such as peripheral vascular disease. Amputations have become common place in podiatric clinics. In podiatric medicine, emphasis is being placed on preventative evaluations and treatments. However, diabetic foot ulcerations still lead to the majority of lower extremity amputations in this country. Amputations are often painful and cause a great deal of emotional stress.
METHODS:
This was a cross sectional survey conducted as part of the Limb Loss Research and Statistics Program. 914 patients with upper and lower extremity amputations ranging in age from 18-84 with diabetes, peripheral vascular disease and traumatic injuries. Patients were surveyed on the basis of pain, depression, and demographics. Excluded from the survey were patients with single digit amputations of the toe or finger. 38 % of the 914 subjects were classified as dysvascular amputees. 372 individuals had below the knee amputations and 352 had above the knee amputations.
RESULTS:
Most of the patients surveyed had chronic pain associated pain with the amputations. It was noted that patients who had prior treatment for depression had more significant pain rating. 79% of people had phantom pain. 67% had residual limb pain with 62% of people having back pain. Older patients ages, 55 to 64, were more likely to report bothersome pain than younger patients ages 18 to 44. Lower limb amputees were three times more likely to report residual limb pain.
COMMENTS:
The majority of the patients surveyed had pain regardless of the time since their amputation. Proper management of chronic pain associated with amputations could prolong the length and quality of life for the patient. With the growing number of amputations of the lower extremities, podiatrists should acquire a better understanding of the patient’s emotional status, along with improved and standardized treatment protocols to deal with the total health of the patient. All amputees should be enrolled in rehabilitation programs to help them function and cope in every day circumstances. Podiatrists must recognize that many patients will have chronic pain after amputation and should equip themselves to participate in the management of chronic pain presentations.
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Disclaimer:
Scientific Abstract Monthly postings are submitted by podiatric surgical residents. The ideas presented are not the opinions of the American College of Foot and Ankle Surgeons (ACFAS), nor are they presented as facts. ACFAS presents this information without any warranty of any kind, expressed or implied, and is not liable for its accuracy nor for any loss or damage caused by the user's reliance on information obtained in these areas.