Prosthesis use in persons with lower- and upper-limb amputation.

This study identified clinical (e.g., etiology) and demographic factors related to prosthesis use in persons with upper- and lower-limb amputation (ULA and LLA, respectively) and the effect of phantom limb pain (PLP) and residual limb pain (RLP) on prosthesis use. A total of 752 respondents with LLA and 107 respondents with ULA completed surveys. Factors related to greater use (hours per day) for persons with LLA included younger age, full- or part-time employment, marriage, a distal amputation, an amputation of traumatic etiology, and an absence of PLP. Less use was associated with reports that prosthesis use worsened RLP, and greater prosthesis use was associated with reports that prosthesis use did not affect PLP. Having a proximal amputation and reporting lower average PLP were related to greater use in hours per day for persons with an ULA, while having a distal amputation and being married were associated with greater use in days per month. Finally, participants with LLA were significantly more likely to wear a prosthesis than those with ULA. These results underscore the importance of examining factors related to prosthesis use and the differential effect that these variables may have when the etiology and location of amputation are considered.

Self-reported treatments used for lower-limb phantom pain: descriptive findings.

OBJECTIVE: To examine the types and relative frequency of treatments used for lower-limb phantom limb pain (PLP), including both pharmacologic and rehabilitative interventions. DESIGN: Cross-sectional survey. SETTING: Community-based survey from clinical databases. PARTICIPANTS: Community-based sample (N=255) of persons with lower-limb amputations. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Intensity of PLP and type and helpfulness of treatments (both past and present) used for PLP. RESULTS: Although 72% of the sample (n=183) reported current PLP, 53% of the respondents with PLP (and 38% of those with severe PLP) had never used treatment for PLP. Those who had used treatment reported greater pain severity and interference. The most commonly used treatment modality was analgesic medication, including acetaminophen, opioids, and nonsteroidal anti-inflammatory drugs. Of the treatments surveyed, only opioids and chiropractic care were rated as moderately to extremely helpful by the majority of those who had tried them, and many pain interventions had been discontinued. CONCLUSIONS: As hypothesized, a significant proportion of persons with PLP have not used treatment for this pain, and, among those who have used pain treatments, few treatments are perceived as substantially helpful. More research is needed to identify effective management strategies for PLP and to examine further patient perceptions of pain treatment.

Efficacy of gabapentin in treating chronic phantom limb and residual limb pain.

Twenty-four adults with phantom limb pain (PLP) and/or residual limb pain (RLP) participated in a double-blind crossover trial. Participants were randomly assigned to receive gabapentin or placebo and later crossed over to the other treatment, with a 5-week washout interval in which they did not receive medication. Gabapentin was titrated from 300 mg to the maximum dose of 3,600 mg. Measures of pain intensity, pain interference, depression, life satisfaction, and functioning were collected throughout the study. Analyses revealed no significant group differences in pre- to posttreatment change scores on any of the outcome measures. More than half of the participants reported a meaningful decrease in pain during the gabapentin phase compared with about one-fifth who reported a meaningful decrease in pain during the placebo phase. In this trial, gabapentin did not substantially affect pain. More research on the efficacy of gabapentin to treat chronic PLP and RLP is needed.

Trial of amitriptyline for relief of pain in amputees: results of a randomized controlled study.

OBJECTIVE: To evaluate whether amitriptyline is more effective than placebo in improving phantom limb pain or residual limb pain. DESIGN: Randomized controlled trial of amitriptyline for 6 weeks. SETTING: University hospital. PARTICIPANTS: Thirty-nine persons with amputation-related pain lasting more than 6 months. INTERVENTION: Six-week trial of amitriptyline (titrated up to 125 mg/d) or an active placebo (benztropine mesylate). MAIN OUTCOME MEASURES: Analyses were conducted to examine whether there was a medication group effect on the primary outcomes (average pain intensity) and secondary outcome measures (disability, satisfaction with life, handicap). RESULTS: No significant differences were found between the treatment groups in outcome variables when controlling for initial pain scores. CONCLUSIONS: Our findings do not support the use of amitriptyline in the treatment of postamputation pain.

Pain site and impairment in individuals with amputation pain.

OBJECTIVE: To determine the association between pain site and pain interference with activities of daily living (ADLs) among persons with acquired amputation. DESIGN: Survey. SETTING: Community-based survey from clinical databases, flyer postings, and an advertisement in the inMotion magazine. PARTICIPANTS: Persons with lower-limb amputations (N=478). INTERVENTIONS: Six or more months after lower-limb amputation, participants completed an amputation pain questionnaire that included several standardized pain measures. MAIN OUTCOME MEASURES: Numeric rating scale measures of average phantom limb, residual limb, and back pain and pain-related impairment as measured by a modified version of the Pain Interference Scale of the Brief Pain Inventory. RESULTS: Phantom limb, residual limb, and back pain intensity ratings, as a group, accounted for 20% of the variance in pain interference. The pain intensity ratings associated with each individual pain site made a statistically significant contribution to the prediction of pain interference with ADLs even after controlling for the pain intensity of the other 2 sites. CONCLUSIONS: Pain in each of 3 sites (phantom limb, residual limb, back) appears to be important to pain-related impairment and function. Measurement of the intensity of pain at each site appears to be required for a thorough assessment of amputation pain-related impairment.