The influence of preamputation pain on postamputation stump and phantom pain

Abstract

The significance of preamputation pain for the development of postamputation stump and phantom pain has been discussed over the years and is still a matter of dispute. It has been argued that preamputation pain increases the risk of phantom pain and that phantom pain is a revivification of pain experienced before the amputation. The purpose of this prospective study was to clarify the relation between preamputation pain and phantom pain. Fifty-six patients scheduled for amputation of a lower limb were interviewed the day before the amputation about preamputation pain and about stump and phantom pain 1 week, 3 and 6 months after the amputation. Pain was quantitated and described using a visual analogue scale (VAS), 10 different word descriptors, the McGill Pain Questionnaire (MPQ) and the patients' own words. If phantom pain was present patients were asked if the pain was similar to any pain experienced before the amputation. At each postoperative interview patients were asked to recall preamputation pain intensity. Location of pain and analgesic requirements were registered. Preamputation pain significantly increased the incidence of stump pain (P = 0.04) and phantom pain (P = 0.04) after 1 week and the incidence of phantom pain after 3 months (P = 0.03). About 42% of the patients reported that their phantom pain resembled the pain they had experienced at the time of the amputation. However, there was no relation between the patients' own opinion about similarity between preamputation pain and phantom pain and the actual similarity found when comparing pre- and postoperative recordings of pain. Patients significantly overestimated preamputation pain intensity after 6 months.

Incidence and etiology of postoperative chronic pain after breast surgery

“…Many studies about hernia repair have showed that preoperative pain is a risk factor for chronic pain (15,16) . Page et al (15) found the pain scores of patients who had hernia operation, without preoperative resting pain, significantly low at postoperative 1 year.…”

Chronic-Post Operative Pain.

“…Amputations of the lower limb are usually the outcome of vascular disease that is related to smoking and diabetes. Nikolajsen et al (1997) concluded that the pain incidence following an operation for breast augmentation lies at 13 percent, alternating from 21 percent to 50 percent based on the type of operation. The study also established a 22 percent incidence in surgical procedures meant to do breast reductions.…”

Safety of opioid patch initiation in Australian residential aged care

“…It can be acute (usually nociceptive) or chronic (usually neuropathic) and is most common in the immediate postoperative period (Jensen et al, 1985;Nikolajsen & Jensen, 2001). The overall incidence of stump pain is uncertain but the risk of early stump pain is increased by the presence of severe preamputation pain (Nikolajsen et al, 1997).…”

“…The incidence of phantom limb pain is estimated to be 30% to 85% after limb amputation and occurs usually in the distal portion of the missing limb (Jensen et al, 1985;Perkins & Kehlet, 2000;Nikolajsen & Jensen, 2001). Pain can be immediate -75% of patients will report phantom pain within the first few days after amputation (Nikolajsen et al, 1997) -or delayed in onset. The pain is typically intermittent and diminishes with time after amputation.…”