Pain after amputation

Pain after limb amputation was undoubtedly the first of all the postsurgical pain syndromes to be recognized. Silas Weir Mitchell described phantom limbs and pain syndromes caused by gunshot wounds following the American Civil War.36 Pain following limb amputation falls into two broad categories, phantom pain and stump pain (also called residual limb pain). Many lower limb amputees also report back pain.37 For a detailed review of phantom pain, see the excellent article by Nikolajsen and Jensen, and Chapter 31, Postamputation pain.38

The incidence of phantom limb pain varies from around 50 to 85 percent.39,404142 In a study of amputees from the Yom Kippur war, Carlen et al.43 reported an incidence of phantom pain of 67 percent. The onset of the phantom pain was immediate in 12 percent of patients, during the first day in 10 percent, during the first week in 12 percent, in the second week in 5 percent, third week in 16 percent, and longer than three weeks in 2 percent. The remaining patients had no pain or were uncertain about the date of onset. A study of upper limb amputees from the Iran-Iraq War found an incidence of phantom pain of 32 percent.44 In general, phantom pain seems to be less common after upper limb amputation than lower limb amputation.45,46 The severity of phantom pain varies between studies, from 59 percent with mostly mild or moderate pain,41 to 40 percent of amputees with severe pain.47 Although several studies have shown that phantom pain can improve or resolve in individuals, in a population of amputees the prevalence of phantom limb pain changes little; some patients improve, while others become worse. Overall, the literature does suggest that the duration and frequency of phantom limb episodes tends to decrease in the first six months, but remain stable thereafter.40 Several studies have investigated risk factors for phantom limb pain, but areas of controversy

In the past it was thought that young children rarely suffer phantom limb pain and that those with congenital absence of limbs do not experience phantom limbs or phantom limb pain. However, a study of children by Smith and Thompson51 found a pain prevalence of 12 percent for amputation following trauma and 48 percent for amputations because of cancer. Interestingly, in this subgroup of cancer patients the incidence rose to 74 percent if the children had chemotherapy at or before the time of amputation, but the incidence was 44 percent if the chemotherapy was given after the amputation. The prevalence was only 12 percent if chemotherapy was not used. Melzack et al.52 have shown that children with congenital absence of limbs can indeed suffer phantom pain.

The prevalence of stump pain varies in different studies. In a survey of US Army veterans, Sherman et al.39 found an incidence of 62 percent and Richardson et al.42 reported 51 percent, in a prospective study of patients with peripheral vascular disease. However, Pohjolainen41 found a prevalence of stump pain in only 5 percent in a study of amputees attending a prosthetics factory. The differences in prevalence between these studies probably reflect methodological rather than real differences.

Phantom pain can occur after removal of other body parts as well as limbs, such as breast,9, 10 eye,53 rectum,54, 55

tongue,56 teeth,57 and genitals.58 Despite the fact that circumcision is the most common operation carried out on males, there are no reports of phantom foreskin in the literature.

Back Pain Revealed

Back Pain Revealed

Tired Having Back Pains All The Time, But You Choose To Ignore It? Every year millions of people see their lives and favorite activities limited by back pain. They forego activities they once loved because of it and in some cases may not even be able to perform their job as well as they once could due to back pain.

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