Chronic musculoskeletal pain, phantom sensation, phantom and stump pain in veterans with unilateral below-knee amputation.
musculoskeletal pain
prosthesis wear
veterans
Journal
Scandinavian journal of pain
ISSN: 1877-8879
Titre abrégé: Scand J Pain
Pays: Germany
ID NLM: 101520867
Informations de publication
Date de publication:
25 Oct 2019
25 Oct 2019
Historique:
received:
17
03
2019
accepted:
21
05
2019
pubmed:
5
7
2019
medline:
5
7
2019
entrez:
5
7
2019
Statut:
epublish
Résumé
Many individuals with lower limb loss report concerns about other musculoskeletal symptoms resulting from amputation. The objective of this study was to assess chronic musculoskeletal pain in Iranian veterans with unilateral below-knee amputation. The participants agreed to take part in a health needs assessment and were interviewed face-to-face by trained interviewers. The assessment consisted of demographic information, wearing a prosthesis, pain locations in extremities, stump complications, severity of pains related to amputation and low back pain. Of 247 unilateral below knee amputees, 97.9% wore a prosthetic limb and times walking or standing with the prosthesis were 12.47 ± 3.84 and 4.22 ± 3.53 h a day, respectively. Low soft tissue coverage of the stump (15.4%) and symptomatic osteoarthritis in the contralateral lower extremity (40.1%) were the most common complications. The prevalence of stump pain, phantom sensations, phantom pain, low back pain, and knee pain was 84.2%, 77.3%, 73.7%, 78.1%, and 54.7% respectively. The odds ratio of stump pain in amputees with phantom pain was 2.22 times higher than those who did not experience phantom pain [OR = 2.22 (CI: 1.19-4.17); This research enhances our understanding of comorbid musculoskeletal problems in below-knee amputees which can help health providers to identify rehabilitation needs and emphasizes the importance of regular assessments. These findings underline the importance of paying closer attention to different dimensions and aspects of musculoskeletal complications in veterans with unilateral below-knee amputation.
Sections du résumé
BACKGROUND AND AIMS
OBJECTIVE
Many individuals with lower limb loss report concerns about other musculoskeletal symptoms resulting from amputation. The objective of this study was to assess chronic musculoskeletal pain in Iranian veterans with unilateral below-knee amputation.
METHODS
METHODS
The participants agreed to take part in a health needs assessment and were interviewed face-to-face by trained interviewers. The assessment consisted of demographic information, wearing a prosthesis, pain locations in extremities, stump complications, severity of pains related to amputation and low back pain.
RESULTS
RESULTS
Of 247 unilateral below knee amputees, 97.9% wore a prosthetic limb and times walking or standing with the prosthesis were 12.47 ± 3.84 and 4.22 ± 3.53 h a day, respectively. Low soft tissue coverage of the stump (15.4%) and symptomatic osteoarthritis in the contralateral lower extremity (40.1%) were the most common complications. The prevalence of stump pain, phantom sensations, phantom pain, low back pain, and knee pain was 84.2%, 77.3%, 73.7%, 78.1%, and 54.7% respectively. The odds ratio of stump pain in amputees with phantom pain was 2.22 times higher than those who did not experience phantom pain [OR = 2.22 (CI: 1.19-4.17);
CONCLUSIONS
CONCLUSIONS
This research enhances our understanding of comorbid musculoskeletal problems in below-knee amputees which can help health providers to identify rehabilitation needs and emphasizes the importance of regular assessments.
IMPLICATIONS
CONCLUSIONS
These findings underline the importance of paying closer attention to different dimensions and aspects of musculoskeletal complications in veterans with unilateral below-knee amputation.
Identifiants
pubmed: 31271563
doi: 10.1515/sjpain-2019-0045
pii: /j/sjpain.ahead-of-print/sjpain-2019-0045/sjpain-2019-0045.xml
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
779-787Informations de copyright
©2019 Scandinavian Association for the Study of Pain. Published by Walter de Gruyter GmbH, Berlin/Boston. All rights reserved.
Références
Loeser JD, Treede R-D. The Kyoto protocol of IASP Basic Pain Terminology. Pain 2008;137:473–7.
Schatman ME, Campbell A. Chronic pain management: guidelines for multidisciplinary program development. Boca Raton, FL, USA: CRC Press, 2007.
Haskell SG, Ning Y, Krebs E, Goulet J, Mattocks K, Kerns R, Brandt C. Prevalence of painful musculoskeletal conditions in female and male veterans in 7 years after return from deployment in Operation Enduring Freedom/Operation Iraqi Freedom. Clin J Pain 2012;28:163–7.
Goulet JL, Kerns RD, Bair M, Becker WC, Brennan P, Burgess DJ, Carroll CM, Dobscha S, Driscoll MA, Fenton BT, Fraenkel L, Haskell SG, Heapy AA, Higgins DM, Hoff RA, Hwang U, Justice AC, Piette JD, Sinnott P, Wandner L, et al. The musculoskeletal diagnosis cohort: examining pain and pain care among veterans. Pain 2016;157:1696–703.
Buchheit T, Van de Ven T, Hsia HL, McDuffie M, MacLeod DB, White W, Chamessian A, Keefe FJ, Buckenmaier CT, Shaw AD. Pain phenotypes and associated clinical risk factors following traumatic amputation: results from Veterans Integrated Pain Evaluation Research (VIPER). Pain Med 2016;17:149–61.
Kulkarni J, Gaine W, Buckley J, Rankine J, Adams J. Chronic low back pain in traumatic lower limb amputees. Clin Rehabil 2005;19:81–6.
Burke M, Roman V, Wright V. Bone and joint changes in lower limb amputees. Ann Rheum Dis 1978;37:252–4.
Ephraim PL, Wegener ST, MacKenzie EJ, Dillingham TR, Pezzin LE. Phantom pain, residual limb pain, and back pain in amputees: results of a national survey. Arch Phys Med Rehabil 2005;86:1910–9.
Castillo RC, MacKenzie EJ, Wegener ST, Bosse MJ, Group LS. Prevalence of chronic pain seven years following limb threatening lower extremity trauma. Pain 2006;124:321–9.
Hagberg K, Brånemark R. Consequences of non-vascular trans-femoral amputation: a survey of quality of life, prosthetic use and problems. Prosthet Orthot Int 2001;25:186–94.
Kooijman CM, Dijkstra PU, Geertzen JH, Elzinga A, van der Schans CP. Phantom pain and phantom sensations in upper limb amputees: an epidemiological study. Pain 2000;87: 33–41.
Reiber GE, McFarland LV, Hubbard S, Maynard C, Blough DK, Gambel JM, Smith DG. Servicemembers and veterans with major traumatic limb loss from the Vietnam War and OIF/OEF conflicts: survey methods, participants, and summary findings. J Rehabil Res Dev 2010;47:275.
Henderson W, Smyth G. Phantom limbs. J Neurol Neurosurg Psychiatry 1948;11:88.
Feinstein B, Luce JC, Langton JNK. The influence of phantom limbs. In: Klopsteg P, Wilson P, editors. Human Limbs and Their Substitutes. New York: McGrawHill, 1954.
Gaskin DJ, Richard P. The economic costs of pain in the United States. J Pain 2012;13:715–24.
Van Tulder MW, Koes BW, Bouter LM. A cost-of-illness study of back pain in The Netherlands. Pain 1995;62:233–40.
Abdulla A, Adams N, Bone M, Elliott AM, Gaffin J, Jones D, Knaggs R, Martin D, Sampson L, Schofield P, British Geriatric Society. Guidance on the management of pain in older people. Age Ageing 2013;42:i1–57.
Mimi M, Ho SS. Pain management for older persons living in nursing homes: a pilot study. Pain Manag Nurs 2013;14: e10–21.
Gran SV, Festvåg LS, Landmark BT. ‘Alone with my pain–it can’t be explained, it has to be experienced’. A Norwegian in-depth interview study of pain in nursing home residents. Int J Older People Nurs 2010;5:25–33.
Langley P, Müller-Schwefe G, Nicolaou A, Liedgens H, Pergolizzi J, Varrassi G. The impact of pain on labor force participation, absenteeism and presenteeism in the European Union. J Med Econ 2010;13:662–72.
Allami M, Yavari A, Karimi A, Masoumi M, Soroush M, Faraji E. Health-related quality of life and the ability to perform activities of daily living: a cross-sectional study on 1079 war veterans with ankle-foot disorders. Mil Med Res 2017;4:37.
Himes JH. New equation to estimate body mass index in amputees. J Am Diet Assoc 1995;95:646.
Osterkamp LK. Current perspective on assessment of human body proportions of relevance to amputees. J Am Diet Assoc 1995;95:215–8.
Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain 1983;17:45–56.
Madani SP, Fateh HR, Forogh B, Fereshtehnejad SM, Ahadi T, Ghaboussi P, Bouhassira D, Raissi GR. Validity and Reliability of the Persian (Farsi) Version of the DN4 (Douleur Neuropathique 4 Questions) Questionnaire for Differential Diagnosis of Neuropathic from Non-Neuropathic Pains. Pain Pract 2014;14:427–36.
Dillingham TR, Pezzin LE, MacKenzie EJ, Burgess AR. Use and satisfaction with prosthetic devices among persons with trauma-related amputations: a long-term outcome study. Am J Phys Med Rehabil 2001;80:563–71.
Gauthier-Gagnon C, Grisé M-C, Potvin D. Enabling factors related to prosthetic use by people with transtibial and transfemoral amputation. Arch Phys Med Rehabil 1999;80:706–13.
Chan K, Tan E. Use of lower limb prosthesis among elderly amputees. Ann Acad Med Singapore 1990;19:811–6.
Holden JM, Fernie GR. Extent of artificial limb use following rehabilitation. J Orthop Res 1987;5:562–8.
Steinberg F, Sunwoo I, Roettger R. Prosthetic rehabilitation of geriatric amputee patients: a follow-up study. Arch Phys Med Rehabil 1985;66:742–5.
Beekman CE, Axtell LA. Prosthetic use in elderly patients with dysvascular above-knee and through-knee amputations. Phys Ther 1987;67:1510–6.
Smith DG, Horn P, Malchow D, Boone DA, Reiber GE, Hansen ST. Prosthetic history, prosthetic charges, and functional outcome of the isolated, traumatic below-knee amputee. J Trauma Acute Care Surg 1995;38:44–7.
Pezzin LE, Dillingham TR, MacKenzie EJ, Ephraim P, Rossbach P. Use and satisfaction with prosthetic limb devices and related services. Arch Phys Med Rehabil 2004;85:723–9.
Refaat Y, Gunnoe J, Hornicek FJ, Mankin HJ. Comparison of quality of life after amputation or limb salvage. Clin Orthop Relat Res 2002;397:298–305.
Mussman M, Altwerger W, Eisenstein J, Turturro A, Glockenberg A, Bubbers L. Contralateral lower extremity evaluation with a lower limb prosthesis. J Am Podiatry Assoc 1983;73:344–6.
Hungerford D, Cockin J. Fate of the retained lower limb joints in Second World War amputees. J Bone Joint Surg 1975;57:111.
Norvell DC, Czerniecki JM, Reiber GE, Maynard C, Pecoraro JA, Weiss NS. The prevalence of knee pain and symptomatic knee osteoarthritis among veteran traumatic amputees and nonamputees. Arch Phys Med Rehabil 2005;86:487–93.
Hurley G, McKenney R, Robinson M, Zadravec M, Pierrynowski M. The role of the contralateral limb in below-knee amputee gait. Prosthet and Orthot Int 1990;14:33–42.
Lloyd CH, Stanhope SJ, Davis IS, Royer TD. Strength asymmetry and osteoarthritis risk factors in unilateral trans-tibial, amputee gait. Gait Posture 2010;32:296–300.
Harris AM, Althausen PL, Kellam J, Bosse MJ, Castillo R, Group LEAPS. Complications following limb-threatening lower extremity trauma. J Orthop Trauma 2009;23:1–6.
Tintle SM, Shawen SB, Forsberg JA, Gajewski DA, Keeling JJ, Andersen RC, Potter BK. Reoperation after combat-related major lower extremity amputations. J Orthop Trauma 2014;28:232–7.
Sherman RA, Sherman CJ, Parker L. Chronic phantom and stump pain among American veterans: results of a survey. Pain 1984;18:83–95.
Esfandiari E, Masoumi M, Yavari A, Saeedi H, Allami M. Efficacy of long-term outcomes and prosthesis satisfaction in war related above knee amputees of Tehran in 1387. J Res Rehabil Sci 2011;7:1–8.
Nikolajsen L, Ilkjær S, Krøner K, Christensen JH, Jensen TS. The influence of preamputation pain on postamputation stump and phantom pain. Pain 1997;72:393–405.
Smith DG, Ehde DM, Legro MW, Reiber GE, Del Aguila M, Boone DA. Phantom limb, residual limb, and back pain after lower extremity amputations. Clin Orthop Relat Res 1999;361:29–38.
Kusljugić A, Kapidzić-Duraković S, Kudumović Z, Cickusić A. Chronic low back pain in individuals with lower-limb amputation. Bosn J Basic Med Sci 2006;6:67–70.
Devan H, Hendrick P, Ribeiro DC, Hale LA, Carman A. Asymmetrical movements of the lumbopelvic region: is this a potential mechanism for low back pain in people with lower limb amputation? Med Hypotheses 2014;82:77–85.
Devan H, Carman AB, Hendrick PA, Ribeiro DC, Hale LA. Perceptions of low back pain in people with lower limb amputation: a focus group study. Disabil Rehabil 2015;37:873–83.
Hirsh AT, Dillworth TM, Ehde DM, Jensen MP. Sex differences in pain and psychological functioning in persons with limb loss. J Pain 2010;11:79–86.
Apkarian AV, Baliki MN, Geha PY. Towards a theory of chronic pain. Prog Neurobiol 2009;87:81–97.
Tracey I, Bushnell MC. How neuroimaging studies have challenged us to rethink: is chronic pain a disease? J Pain 2009;10:1113–20.
Metz AE, Yau H-J, Centeno MV, Apkarian AV, Martina M. Morphological and functional reorganization of rat medial prefrontal cortex in neuropathic pain. Proc Natl Acad Sci USA 2009;106:2423–8.
Dijkstra PU, Geertzen JH, Stewart R, van der Schans CP. Phantom pain and risk factors: a multivariate analysis. J Pain Symptom Manage 2002;24:578–85.