Cross-sectional study of alteration of phantom limb pain with visceral stimulation in military personnel with amputation

Abstract

Abstract-While phantom limb pain is a well-recognized phenomenon, clinical experience has suggested that the augmentation of phantom limb pain with visceral stimulation is an issue for many military personnel with amputation (visceral stimulation being the sensation of the bowel or bladder either filling or evacuating). However, the prevalence of this phenomenon is not known. The aim of this study was to investigate the prevalence of the alteration in phantom limb pain and the effect that visceral stimulation has on phantom limb pain intensity. A crosssectional study of 75 military personnel who have lost one or both lower limbs completed a questionnaire to assess the prevalence of the alteration of phantom limb pain with visceral stimulation. Included in the questionnaire was a pain visual analog scale (VAS) graded from 0 to 10. Patients recorded the presence and intensity of phantom limb pain. They also recorded whether and how this pain altered with a need to micturate or micturition, and/or a need to defecate or defecation, again using a pain VAS. Time since amputation, level of amputation, and medications were also recorded. Patients reported a phantom limb pain prevalence of 85% with a mean VAS of 3.6. In all, 56% of patients reported a change in the severity of phantom limb pain with visceral stimuli. The mean increase in VAS for visceral stimulation was 2.5 +/-1.6 for bladder stimulation and 2.9 +/-2.0 for bowel stimulation. Of the patients questioned, 65% reported an improvement in symptoms over time. VAS scores were highest in the subgroup less than 6 mo postamputation. An increase in phantom limb pain with visceral stimulation is a common problem for military personnel with amputation.

The prevalence and risk factors for phantom limb pain in people with amputations: A systematic review and meta-analysis

“…Six studies scored “low risk” for selection bias, for using a sample that was a close representation of the national population [ 2 , 34 , 35 , 37 – 39 ]. Eight studies scored “low risk” for study participation bias, because their response rates for participation were ≥75% [ 2 , 13 , 34 , 36 , 40 – 43 ]. Twelve studies scored “low risk” for measurement bias, for using a clear definition of PLP [ 1 , 4 , 5 , 12 , 16 , 33 , 35 – 38 , 44 , 45 ].…”

Prevalence and incidence of phantom limb pain, phantom limb sensations and telescoping in amputees: A systematic rapid review

“…Of the included studies, 12 were cross-sectional (Aldington et al, 2014;Bekrater-Bodmann et al, 2015;Buchheit et al, 2016;Giummarra et al, 2015;Morgan, Friedly, Amtmann, Salem, & Hafner, 2017;Poor Zamany Nejat Kermany, 2016;Rafferty, Bennett Britton, Drew, & Phillip, 2015;Razmus, Daniluk, & Markiewicz, 2017;Resnik, Ekerholm, Borgia, & Clark, 2019;Richardson, Crawford, Milnes, Bouch, & Kulkarni, 2015;Richardson, Olleveant, Crawford, & Kulkarni, 2018;Streit et al, 2015) and three were prospective, longitudinal designs recruiting inception cohorts (i.e. recruiting participants prior to amputation) (Agha, 2017;Ahmed et al, 2017;Larbig et al, 2019).…”

Neuromuscular electrical stimulation for pain management in combat‐related transtibial amputees during rehabilitation and prosthetic training

“…For example, Rafferty et al. () found that only 42% of amputees reported that their medications improved their phantom limb pain. During rehabilitation, managing pain is critical, especially when multiple trauma is involved.…”

“…Phantom limb pain can be defined as "painful sensations perceived in the missing portion of the amputated limb" (Ehde et al, 2000). Phantom limb pain is very common among amputees, with between 70% and 85% of amputees reporting experiencing phantom limb pain in the early recovery period (Behr et al, 2009;Ehde et al, 2000;Ephraim, Wegener, MacKenzie, Dillingham, & Pezzin, 2005;Hanley et al, 2009;Jensen et al, 2002;Rafferty, Drew, & Phillip, 2015;Reiber et al, 2010) with intensity ranging from 5.5-7.3 out of 10 (Ephraim et al, 2005;Jensen, Smith, Ehde, & Robinson, 2001). Phantom limb pain may decrease over time; Hanley (2009) reported that 64% of amputees reported phantom limb pain at 2 years after surgery.…”

“…However, the amount of pain relief achieved with these medications is less than ideal, particularly for phantom limb pain and neuropathic pain. For example, Rafferty et al (2015) found that only 42% of amputees reported that their medications improved their phantom limb pain. During rehabilitation, managing pain is critical, especially when multiple trauma is involved.…”