A survey of post-amputation pains in serving military personnel

Abstract

Introduction Amputation is a common injury in survivors of current military conflicts. The primary aim of this study was to establish the prevalence rate of phantom limb pain (PLP) in military personnel undergoing rehabilitation at the UK's Defence Medical Rehabilitation Centre. The secondary aims were to establish treatment failure rates and prevalence rates of phantom limb sensations (PLS) and residual limb pains (RLP). Method A questionnaire survey was developed from that used in a previous study of pains in veterans. Questions were asked of the intensity of PLP, RLP and PLS over the previous month and the entire time since amputation. Treatment failure was defined as greater than 'mild' pain. A literature review for similar studies was undertaken.Results There were 48 responders with 65 amputations. PLP in the previous month was reported by 49% of respondents and 20% were classed as treatment failures; 76% had PLP at some point and 56% were analgesic failures. PLS was commoner with 70% reported over the previous month and 66% at any time. 65% had RLP over the previous month, 31% were treatment failures and 80% had experienced RLP at some point and 63% of these were failures of treatment. Eight other papers were found for comparison. Conclusions This is the first paper that describes prevalence of pains associated with amputation in a serving military population. It also describes the use of analgesic failure as a concept and provides an encouraging rate of as low as 20% in this population.

Pain and the global burden of disease

“…Modern munitions dictated that limb trauma and amputation (and therefore postamputation pain) were one of the major survivable injuries of the First World War 10 and this continues to be a major feature of modern day conflicts, including those inflicted on civilians by landmines long after active conflicts have finished. 3,7,16,17,19 Finally, the contribution of harms associated with analgesic treatments to the global burden of disease cannot be ignored, although it is difficult to ascertain the exact impact of prescribed, as opposed to misused, therapies. Overall, the adverse effects of medical treatment globally accounted for 201,000 YLDs.…”

Pain Management in Military Trauma

“…19 This may prove particularly beneficial in the management of postamputation pain, where phantom limb sensations were more effectively treated with early regional blockade. 20 Continuous peripheral nerve blocks, including placement of continuous transversus abdominis plane catheters, demonstrated that advanced regional anesthesia could be accomplished in a forward deployed environment. Although current evidence concerning battlefield use is limited, common combat wounds, namely traumatic amputations, are compatible with this technique.…”

Brain and spinal stimulation therapies for phantom limb pain: a systematic review

“…Phantom limb pain occurs in around 60% to 80% of amputees, but the intensity, frequency and duration of PLP can vary widely. 5 Risk factors have been reported to include female sex, 6,7 pre-amputation pain 8 and depression. 9 PLP may be severe in around one-third of patients; 9,10 however, for many patients, the pain may be episodic and not particularly disabling.…”