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Quantifying Pain Following Amputation: A Large Scale Outcomes Analysis From 768 Survey Respondents
Lauren M Mioton, M.D.; Northwestern Feinberg School of Medicine, Chicago, IL; Jason M. Souza, MD; Division of Plastic and Reconstructive Surgery, Walter Reed National Medical Center, Chicago, IL; Mickey S Cho, MD; South Texas Orthopedic Specialty Group, San Antonio, TX; Benjamin K Potter, MD; Walter Reed National Military Medical Center, Bethesda, MD; Scott M Tintle, MD; Walter Reed National Medical Center, Bethesda, MD; Reuben Bueno, MD; Vanderbilt Unversity, Nashville, TN; George P. Nanos, MD; Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD; Ian Valerio, MD; The Ohio State University, Columbus, OH; Jason H Ko, MD; Division of Plastic and Reconstructive Surgery, Northwestern University, Chicago, IL; Gregory A Dumanian, MD; Northwestern University, Chicago, IL

Background: Neuroma, stump, and phantom limb pain are all known potential complications following extremity amputation. There are a number of various proposed treatments for any one of the previously listed conditions. However, without a large-scale study providing key baseline data regarding pain following amputation, it is difficult to appropriately measure the impact of treatments on pain in these patients.

Methods: From 2014-2017, patients with a history of upper or lower extremity amputation were invited to take a 80-question online pain survey. Survey data included patient demographics, amputation specific data, as well as stump and phantom pain related questions. Individuals who failed to answer all of the questions were deemed "partial responders" and were excluded from the study.

Results: There were a total of 1203 survey responses; 435 of these were "partial responders" and excluded, leaving 768 surveys for final analysis. Females comprised 33.7% of the respondents. The reason for the amputation was predominantly trauma-related (43.4%), followed by infection (13.2%), cancer (8.1%), ischemia (6.1%), diabetes (5.1%), and congenital defects (4.4%). Most patients had a lower extremity amputation (below the knee amputation, 48.6%; above the knee amputation, 33.6%). A fair number of patients experienced burning "sometimes" or "often" (43.6%) and a quarter of patients reported electrical shocks "often" or "always." Over two thirds (68.0%) of respondents endorsed phantom limb pain (PLP) and within this group, phantom pain averaged a 5.41 (on a scale of 10) at its worst. A similar number of patients (72.3%) endorsed stump pain, which averaged 5.18 at its worst. Females were more likely to experience stump pain (76.1% vs 70.5%) as well as phantom limb pain (78.0% vs 64.2%). Women also experienced higher average pain scores for both phantom and stump pain. Analysis on the level of amputation shows that an above the elbow amputation led to significantly higher phantom limb and stump pain average scores compared to below the elbow or any lower extremity amputation (p<0.05).

Conclusion: We present the largest study to-date regarding phantom limb, neuroma, and stump pain data in the amputee population. This study provides standard pain measurements for future therapeutic measurements to be compared to. Moreover, we identify high risk subgroups for pain following amputation, including females and those with above the elbow amputations.


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