Chronic Low Back Pain in Individuals with Lower-limb Amputation

Abstract

Low back pain (LBP) is a common condition in individuals which experienced psychology and physical trauma. LBP is usually found in persons with lower-limb amputation (LLA), as the most common sign of somatisation or inappropriately made prostheses. Our goal was to investigate cases of chronic pain syndrome in persons with LLA and to determine factors, which influence their functional inability due to LBP. Pain after LLA has been studied. 37 persons, including 26 war veterans (70.2 %) and 11 (29.8 %) civilians with LLA due to an illness, were examined. All participants gave their informed consent and filled Oswestry index of disability due to chronic LBP, divided into 10 sections with 6 questions each, with marks in the range 0-5. The average age of 37 analyzed participants with LLA was 46.2+-10.92 years. 30 participants (81.1 %) were married, 4 (10.8 %) were single and 3 (8.1 %) were widows. 27 (73.0 %) participants had below the knee amputation, 5 (13.5 %) had above the knee amputation and 5 (13.5 %) had foot amputation. 33 (89.6 %) participants experienced chronic LBP in the last 2-10 years and 4 (10.8 %) did not have pains. According to Oswestry index for chronic pain higher level of social functionality was found in civilian amputees than in war veterans (p<0.05). Married civilian amputees have higher level of disability during seating (p<0.01), sleeping (p<0.01) and traveling (p<0.05). Higher level of social disorder among civilian amputees is due to the fact that they belong to older group of participants which usually have social integration at the lower degree. More serious problems during seating, traveling and sleeping among this group are probably due to co morbidity. Chronic LBP was found among 89.6 % of the participants. Higher level of social disorder, problems during seating, traveling and sleeping were identified in the civilian amputees and the married participants.

Prevalence of back pain, its effect on functional ability and health-related quality of life in lower limb amputees secondary to trauma or tumour

“…Back pain has, however, been shown to occur frequently among lower extremity amputees, and has been reported as persistent and chronic by 52–72% of participants with different levels of amputation caused either by trauma or other illnesses (tumour/dysvascular). 8,15 In yet another study, prevalence of low back pain among transfemoral amputees was frequent to permanent in 26.3% of the sample. 16…”

“…6 The use of an increased pelvic tilt and Trendelenburg gait to maintain knee stability and reduce the lever arm of the hip abductors 7 often leads to back pain. 8 Transtibial amputees have better biomechanical prerequisites compared to transfemoral and knee disarticulation amputees. 6,9,10 There is evidence that distal and unilateral amputees have better walking ability 11 and walk faster 12 than transfemoral amputees.…”

Veränderungen am Bewegungsapparat als Folge von Amputationen an der unteren Extremität

“…In vielen der Literaturstellen werden mehrere Veränderungen mehr oder weniger detailliert bearbeitet. 17 Literaturstellen berichten über Rückenschmerzen bei Amputierten [3,4,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]…”

“…In der Mehrzahl der Studien wurden Kriegsversehrte untersucht [9,10,15,17,28], aber auch andere Amputationsursachen wie nicht kriegsbedingte Traumata, Tumoren, Durchblutungsstörungen oder angeborene Fehlbildungen sind in den analysierten Studien [ Um eine grobe Abschätzung der Prävalenz von Veränderungen am Bewegungsapparat als Folge einer Amputation an der unteren Extremität vornehmen zu können, wurden die quantitativen Ergebnisse aus verschiedenen Studien zusammengefasst. Ziel war es dabei, eine möglichst große und damit auch repräsentative Datenmenge zu erhalten.…”

More than half of persons with lower limb amputation suffer from chronic back pain or residual limb pain: a systematic review with meta-analysis

“…Furthermore, 67% of persons experienced pain in one area, 28% in two areas, and 5% in three areas. The other included studies predominantly reported low back pain [4][5][6]8,12,13,22,24,27,29,33,[37][38][39]41,[44][45][46][47][48][49][50][51][52]60,62]. Several studies reported data about the experienced pain frequency [6,8,27,45,47,49].…”