Phantom limb complex includes phantom sensation (PS), residual limb pain, and phantom limb pain (PLP). A study of the association between phantom limb complex in patients who had not received treatment for it and the level of lower-limb amputations found that the intensity and frequency of untreated PLP were higher early in the post-operative period in patients who had knee disarticulations, transfemoral amputations, or hip-level amputations. After six months, there were no significant differences in pain among people with any level of amputation. The results also showed no relationship between pre-operative pain and PLP.
The study design was a retrospective review and cross-sectional interview that included 101 patients with lower-limb amputations. The clinical trial was conducted at Cukurova University, Adana, Turkey. Patients were divided into three groups according to amputation level: Group I included patients with hip disarticulations to knee disarticulations, including knee disarticulations (25 patients with a mean age of 55.9 years, 19 of whom were men); Group II included patients with transtibial amputations, including ankle disarticulations (41 patients with a mean age of 58.6 years, 33 of whom were men); and Group III included patients with below-ankle to toe amputations (35 patients with a mean age of 58.7 years, 26 of whom were men).
The patients were evaluated at the early post-operative period and six months after amputation. Data included amputation date, level, cause, residual limb pain, PLP, components of PLP, and PS based on information obtained from patient and hospital files. As a result of the retrospective design, the researchers only evaluated intensity and frequency of phantom limb complex episodes.
Pain intensity scores for residual limb pain in Group I and pain intensity scores for PLP in Group I and Group III were higher at the early post-operative period, but all groups had similar scores at the six-month post-amputation evaluation. There was no residual limb pain in most patients at the six month evaluation. The most common amputation etiology in Group I was trauma, which may account for higher initial pain intensity scores, according to the study’s authors.
The researchers suggest that pain management strategies should be considered in the early post-operative period in patients who had undergone amputations at the knee-disarticulation level or higher. Limitations of the study include the relatively small number of patients in all groups; a lack of etiological comparison because primary etiology was trauma in Group I, while diabetes mellitus was most common cause in Group III; and the retrospective design of study, which meant many patients were excluded due to insufficient data.
To read the open-access article, “Association Between Phantom Limb Complex and the Level of Amputation in Lower Limb Amputee,” visit Acta Orthopaedica et Traumatologica Turcica at Science Direct.
