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Pournajaf S, Damiani C, Agostini F, Morone G, Proietti S, Casale R, Franceschini M, Goffredo M. Identifying discriminant factors between phantom limb pain, residual limb pain, and both in people with lower limb amputations: a cross-sectional study. Int J Rehabil Res 2024:00004356-990000000-00101. [PMID: 38995163 DOI: 10.1097/mrr.0000000000000634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
Postamputation pain is a common condition in patients with lower limb amputation (LLA), which compromises amputees' rehabilitation, use of the prosthesis, and quality of life. The aim of our study was to investigate the prevalence of phantom limb pain (PLP), residual limb pain (RLP), or both types of pain among individuals with LLA, and to identify the factors associated with the presence of one type of pain versus the other. Patients who underwent amputation for traumatic or vascular reasons and who reported on RLP or PLP were analyzed and divided into three groups: PLP, RLP, or a group of subjects that presented both pains. We searched for factors that affect the occurrence of limb pain using univariate analyses, followed by multinomial logistic regression. Among the 282 participants with transtibial and transfemoral amputations, 192 participants (150 male and 42 female) presented PLP, RLP, or both types of pain, while 90 participants declared to perceive no pain. The estimated prevalence of any type of pain after transfemoral and transtibial amputation was therefore 68% (27% PLP, 10% RLP, and 31% both). Among the studied characteristics, only amputation level was associated with the type of pain (P = 0.001). Multinomial logistic regression identified transfemoral amputation as the only statistically significant predictor for PLP (odds ratio = 2.8; P = 0.002). Hence, it was estimated that individuals with transfemoral amputation have nearly three times higher odds of experiencing PLP compared with those with transtibial amputation.
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Affiliation(s)
- Sanaz Pournajaf
- Research Area in Neuromotor Rehabilitation and Rehabilitation Robotics, Department of Neurosciences, IRCCS San Raffaele
| | - Carlo Damiani
- Research Area in Neuromotor Rehabilitation and Rehabilitation Robotics, Department of Neurosciences, IRCCS San Raffaele
| | - Francesco Agostini
- Research Area in Neuromotor Rehabilitation and Rehabilitation Robotics, Department of Neurosciences, IRCCS San Raffaele
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome
| | - Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Aquila
- San Raffaele Institute of Sulmona, Sulmona
| | - Stefania Proietti
- Research Area in Neuromotor Rehabilitation and Rehabilitation Robotics, Department of Neurosciences, IRCCS San Raffaele
| | | | - Marco Franceschini
- Research Area in Neuromotor Rehabilitation and Rehabilitation Robotics, Department of Neurosciences, IRCCS San Raffaele
| | - Michela Goffredo
- Research Area in Neuromotor Rehabilitation and Rehabilitation Robotics, Department of Neurosciences, IRCCS San Raffaele
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, Rome, Italy
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Vallejos González J, Muñoz Nieto S, Castro Lara A. [Medical-surgical complications and their impact on patients' return to work whilst follow-up major lower-limb amputations in Hospital del Trabajador in Santiago (HTS)]. Rehabilitacion (Madr) 2024; 58:100850. [PMID: 38705100 DOI: 10.1016/j.rh.2024.100850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 03/04/2024] [Accepted: 03/30/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION The presence of different complications whilst follow-up amputee patients reaches 10-80%. The main objective of this research is to assess the impact of these in the return-to-work of lower-limb traumatic amputation cases. MATERIALS AND METHODS A retrospective cohort research was carried out. Clinic-demographic variables information was recollected in order to assess its linkage to different medical-surgical complications and functional outcomes. Survival curves were created to evaluate the return-to-work of patients with and without complications. RESULTS A total of 46 patients, on average aged 45.7 years old (91.3% men, 71.7% without comorbidities), were included on this research. The most frequent level of amputation was transtibial (65.2%). Residual limb pain, phantom pain, dermatological-infectious complications and painful neuroma were registered in 80.4%, 58.7%, 50% y 30.4% of the cases respectively. Half of the patients had returned to their workplace after 2years of post-surgical follow-up. The return-to-work rates were significantly lower in patients suffering from residual limb pain (p=0.0083) and from painful neuroma (p=0.0051). CONCLUSION Complications are frequent during traumatic-amputee patients' follow-up and, some of them, may impact on the return-to-work rate.
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Affiliation(s)
- J Vallejos González
- Servicio de Medicina Física y Rehabilitación, Hospital Clínico de la Universidad de Chile, Santiago, Chile.
| | - S Muñoz Nieto
- Unidad de Medicina Física y Rehabilitación, Hospital del Trabajador de Santiago ACHS-HT, Santiago, Chile
| | - A Castro Lara
- Oficina de Apoyo a la Investigación, Hospital Clínico Universidad de Chile, Santiago, Chile
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Emvalomenos GM, Kang JWM, Jupp B, Mychasiuk R, Keay KA, Henderson LA. Recent developments and challenges in positron emission tomography imaging of gliosis in chronic neuropathic pain. Pain 2024:00006396-990000000-00597. [PMID: 38713812 DOI: 10.1097/j.pain.0000000000003247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/05/2024] [Indexed: 05/09/2024]
Abstract
ABSTRACT Understanding the mechanisms that underpin the transition from acute to chronic pain is critical for the development of more effective and targeted treatments. There is growing interest in the contribution of glial cells to this process, with cross-sectional preclinical studies demonstrating specific changes in these cell types capturing targeted timepoints from the acute phase and the chronic phase. In vivo longitudinal assessment of the development and evolution of these changes in experimental animals and humans has presented a significant challenge. Recent technological advances in preclinical and clinical positron emission tomography, including the development of specific radiotracers for gliosis, offer great promise for the field. These advances now permit tracking of glial changes over time and provide the ability to relate these changes to pain-relevant symptomology, comorbid psychiatric conditions, and treatment outcomes at both a group and an individual level. In this article, we summarize evidence for gliosis in the transition from acute to chronic pain and provide an overview of the specific radiotracers available to measure this process, highlighting their potential, particularly when combined with ex vivo/in vitro techniques, to understand the pathophysiology of chronic neuropathic pain. These complementary investigations can be used to bridge the existing gap in the field concerning the contribution of gliosis to neuropathic pain and identify potential targets for interventions.
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Affiliation(s)
- Gaelle M Emvalomenos
- School of Medical Sciences [Neuroscience], and the Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - James W M Kang
- School of Medical Sciences [Neuroscience], and the Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Bianca Jupp
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Richelle Mychasiuk
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Kevin A Keay
- School of Medical Sciences [Neuroscience], and the Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Luke A Henderson
- School of Medical Sciences [Neuroscience], and the Brain and Mind Centre, The University of Sydney, Sydney, Australia
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Doshi TL, Sandbrink F, Cohen SP. Postamputation limb pain in military personnel: separate but equal or separate and never equal? Pain 2024; 165:723-724. [PMID: 38112618 DOI: 10.1097/j.pain.0000000000003095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 12/21/2023]
Affiliation(s)
- Tina L Doshi
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Friedhelm Sandbrink
- Department of Neurology, Washington Veterans Affairs Medical Center, Washington, DC, United States
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
- Department of Neurology, George Washington University School of Medicine, Washington, DC, United States
| | - Steven P Cohen
- Departments of Anesthesiology and Critical Care Medicine, Neurology, Physical Medicine and Rehabilitation and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Department of Physical Medicine and Rehabilitation and Anesthesiology, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
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Langeveld M, Bosman R, Hundepool CA, Duraku LS, McGhee C, Zuidam JM, Barker T, Juszczak M, Power DM. Phantom Limb Pain and Painful Neuroma After Dysvascular Lower-Extremity Amputation: A Systematic Review and Meta-Analysis. Vasc Endovascular Surg 2024; 58:142-150. [PMID: 37616476 PMCID: PMC10756018 DOI: 10.1177/15385744231197097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
BACKGROUND Phantom limb pain (PLP) and symptomatic neuroma can be debilitating and significantly impact the quality of life of amputees. However, the prevalence of PLP and symptomatic neuromas in patients following dysvascular lower limb amputation (LLA) has not been reliably established. This systematic review and meta-analysis evaluates the prevalence and incidence of phantom limb pain and symptomatic neuroma after dysvascular LLA. METHODS Four databases (Embase, MEDLINE, Cochrane Central, and Web of Science) were searched on October 5th, 2022. Prospective or retrospective observational cohort studies or cross-sectional studies reporting either the prevalence or incidence of phantom limb pain and/or symptomatic neuroma following dysvascular LLA were identified. Two reviewers independently conducted the screening, data extraction, and the risk of bias assessment according to the PRISMA guidelines. To estimate the prevalence of phantom limb pain, a meta-analysis using a random effects model was performed. RESULTS Twelve articles were included in the quantitative analysis, including 1924 amputees. A meta-analysis demonstrated that 69% of patients after dysvascular LLA experience phantom limb pain (95% CI 53-86%). The reported pain intensity on a scale from 0-10 in LLA patients ranged between 2.3 ± 1.4 and 5.5 ± .7. A single study reported an incidence of symptomatic neuroma following dysvascular LLA of 5%. CONCLUSIONS This meta-analysis demonstrates the high prevalence of phantom limb pain after dysvascular LLA. Given the often prolonged and disabling nature of neuropathic pain and the difficulties managing it, more consideration needs to be given to strategies to prevent it at the time of amputation.
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Affiliation(s)
- Mirte Langeveld
- Department of Plastic, Reconstructive Surgery and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
- Hand and Peripheral Nerve Injury Service, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Romy Bosman
- Department of Plastic, Reconstructive Surgery and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
- Hand and Peripheral Nerve Injury Service, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Caroline A Hundepool
- Department of Plastic, Reconstructive Surgery and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Liron S Duraku
- Department of Plastic, Reconstructive Surgery and Hand Surgery, Amsterdam UMC, Amsterdam, the Netherlands
| | - Christopher McGhee
- Hand and Peripheral Nerve Injury Service, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - J Michiel Zuidam
- Department of Plastic, Reconstructive Surgery and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Tom Barker
- Department of Vascular Surgery, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Maciej Juszczak
- Department of Vascular Surgery, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Dominic M Power
- Hand and Peripheral Nerve Injury Service, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Kubiak CA, Lee JC, Hamill JB, Kim HM, Roth RS, Cederna PS, Geisser ME, Kung TA, Kemp SWP. Agreement between Patient-reported Pain Medication Use and Electronic Medical Record Data in Surgical Amputation Patients. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5415. [PMID: 38025619 PMCID: PMC10681441 DOI: 10.1097/gox.0000000000005415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 09/29/2023] [Indexed: 12/01/2023]
Abstract
Background Opioid misuse after surgery remains a public health crisis in the United States. Recent efforts have focused on tracking pain medication use in surgical populations. However, accurate interpretations of medication use remain quite challenging given inconsistent usage of different datasets. The purpose of this study was to investigate the agreement between electronic medical records (EMR) versus patient self-reported use of pain medications in a surgical amputation population. Methods Patients undergoing major lower extremity amputation or amputation-related procedures were included in this study. Both self-reported and EMR data for pain medication intake were obtained for each patient at three time points (preoperatively, 4 months postoperatively, and 12 months postoperatively). Percentage agreement and the kappa statistic were calculated for both usage (yes/no) and dose categories. Results Forty-five patients were included in this study, resulting in 108 pairs of self-reported and EMR datasets. Substantial levels of agreement (>70% agreement, kappa >0.61) for opioid use was seen at preoperative and 12 months postoperative. However, agreement dropped at 4 months postoperatively. Anticonvulsant medication showed high levels, whereas acetaminophen showed lower levels of agreements at all time points. Conclusions Either self-reported or EMR data may be used in research and clinical settings for preoperative or 12-month postoperative patients with little concern for discrepancies. However, at time points immediately following the expected end of acute surgical pain, self-reported data may be needed for more accurate medication reporting. With these findings in mind, usage of datasets should be driven by study objectives and the dataset's strength (eg, accuracy, ease, lack of bias).
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Affiliation(s)
- Carrie A Kubiak
- From the Department of Surgery, Section of Plastic Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Jennifer C Lee
- From the Department of Surgery, Section of Plastic Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Jennifer B Hamill
- From the Department of Surgery, Section of Plastic Surgery, Michigan Medicine, Ann Arbor, Mich
| | - H Myra Kim
- Center for Statistical Consulting & Research, The University of Michigan, Ann Arbor, Mich
| | - Randy S Roth
- Department of Physical Medicine and Rehabilitation, The University of Michigan, Ann Arbor, Mich
| | - Paul S Cederna
- From the Department of Surgery, Section of Plastic Surgery, Michigan Medicine, Ann Arbor, Mich
- Department of Biomedical Engineering, The University of Michigan, Ann Arbor, Mich
| | - Michael E Geisser
- Department of Physical Medicine and Rehabilitation, The University of Michigan, Ann Arbor, Mich
| | - Theodore A Kung
- From the Department of Surgery, Section of Plastic Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Stephen W P Kemp
- From the Department of Surgery, Section of Plastic Surgery, Michigan Medicine, Ann Arbor, Mich
- Center for Statistical Consulting & Research, The University of Michigan, Ann Arbor, Mich
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Bao B, Sun Y, Lin J, Gao T, Shen J, Hu W, Zhu H, Zhu T, Li J, Wang Z, Wei H, Zheng X. Altered cortical thickness and structural covariance networks in upper limb amputees: A graph theoretical analysis. CNS Neurosci Ther 2023; 29:2901-2911. [PMID: 37122148 PMCID: PMC10493660 DOI: 10.1111/cns.14226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 04/03/2023] [Accepted: 04/09/2023] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND The extensive functional and structural remodeling that occurs in the brain after amputation often results in phantom limb pain (PLP). These closely related phenomena are still not fully understood. METHODS Using magnetic resonance imaging (MRI) and graph theoretical analysis (GTA), we explored how alterations in brain cortical thickness (CTh) and structural covariance networks (SCNs) in upper limb amputees (ULAs) relate to PLP. In all, 45 ULAs and 45 healthy controls (HCs) underwent structural MRI. Regional network properties, including nodal degree, betweenness centrality (BC), and node efficiency, were analyzed with GTA. Similarly, global network properties, including global efficiency (Eglob), local efficiency (Eloc), clustering coefficient (Cp), characteristic path length (Lp), and the small-worldness index, were evaluated. RESULTS Compared with HCs, ULAs had reduced CThs in the postcentral and precentral gyri contralateral to the amputated limb; this decrease in CTh was negatively correlated with PLP intensity in ULAs. ULAs showed varying degrees of change in node efficiency in regional network properties compared to HCs (p < 0.005). There were no group differences in Eglob, Eloc, Cp, and Lp properties (all p > 0.05). The real-worldness SCN of ULAs showed a small-world topology ranging from 2% to 34%, and the area under the curve of the small-worldness index in ULAs was significantly different compared to HCs (p < 0.001). CONCLUSION These results suggest that the topological organization of human CNS functional networks is altered after amputation of the upper limb, providing further support for the cortical remapping theory of PLP.
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Affiliation(s)
- Bingbo Bao
- Department of Orthopedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
| | - Yi Sun
- Department of Orthopedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
| | - Junqing Lin
- Department of Orthopedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
| | - Tao Gao
- Department of Orthopedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
| | - Junjie Shen
- Department of Orthopedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
| | - Wencheng Hu
- Department of Orthopedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
| | - Hongyi Zhu
- Department of Orthopedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
| | - Tianhao Zhu
- Department of Orthopedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
| | - Jing Li
- Institute of Diagnostic and Interventional RadiologyShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
| | - Zhibin Wang
- Institute of Diagnostic and Interventional RadiologyShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
| | - Haifeng Wei
- Department of Orthopedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
| | - Xianyou Zheng
- Department of Orthopedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
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Lendaro E, Earley EJ, Ortiz-Catalan M. Statistical analysis plan for an international, double-blind, randomized controlled clinical trial on the use of phantom motor execution as a treatment for phantom limb pain. Trials 2022; 23:138. [PMID: 35152915 PMCID: PMC8842736 DOI: 10.1186/s13063-021-05962-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/21/2021] [Indexed: 11/19/2022] Open
Abstract
Background Phantom limb pain (PLP) is a detrimental condition that can greatly diminish the quality of life. Purposeful control over the phantom limb activates the affected neural circuitry and leads to dissolution of the pathological relationship linking sensorimotor and pain processing (which gives rise to PLP). An international, double-blind, randomized controlled clinical trial (RCT) on the use of phantom motor execution (PME) as a treatment for PLP is currently undertaken, where PME is compared to an active placebo treatment, namely phantom motor imagery (PMI). Methods and design Sixty-seven subjects suffering from PLP in upper or lower limbs are randomly assigned in 2:1 ratio to PME or PMI interventions respectively. Subjects allocated to either treatment receive 15 interventions where they are exposed to the same VR-AR environments using the same device. The only difference between interventions is whether phantom movements are performed (PME) or imagined (PMI). Results The primary outcome of the study is to examine whether 15 sessions of PME can induce a greater PLP relief, compared to PMI. The secondary objectives are to examine whether 15 sessions of PME provide a greater improvement in different aspects related to PLP compared to PMI, such as pain duration, pain intensity as measured by other metrics, and the patient’s own impression about the effect of treatment. Long-term retention of treatment benefits will be assessed as change in all the variables (both primary and secondary) between baseline and follow-up timepoints (at 1, 3, and 6 months post-treatment). Conclusion This manuscript serves as the formal statistical analysis plan (version 1.0) for the international, double-blind, randomized controlled clinical trial on the use of PME as a treatment for PLP. The statistical analysis plan was completed on 3 August 2021. Trial registration ClinicalTrials.govNCT03112928. Registered on April 13, 2017 SAP version: version: 1.0, date: 2021/08/03 Protocol version: This document has been written based on information contained in the study protocol published in Lendaro et al. (BMJ Open 8:e021039, 2018), in July 2018. SAP revisions: Not applicable
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