Postamputation Residual Limb Pain Severity and Prevalence: A Systematic Review and Meta-Analysis

Abstract

Background: Individuals with an extremity amputation are predisposed to persistent pain that reduces their quality of life. Residual limb pain is defined as pain that is felt in the limb after amputation. Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review of 5 databases from inception to June 2020 was performed and is registered under the PROSPERO ID: CRD42020199297. Included studies were clinical trials with residual limb pain assessed at a minimum follow-up of 1 week. Meta-analyses of residual limb pain prevalence and severity were performed with subgroups of extremity and amputation etiology. Results: Twenty clinical trials met criteria and reported on a total of 1347 patients. Mean patient ages ranged from 38 to 77. Residual limb pain prevalence at 1 week, 1 month, 3 months, 6 months, 1 year, and 2 years, respectively, was 50%, 11%, 23%, 27%, 22%, and 24%. Mean residual limb pain severity at the 6 months or longer follow-up was 4.19 out of 10 for cancer amputations, 2.70 for traumatic amputations, 0.47 for vasculopathy amputations, 1.01 for lower extremity amputations, and 3.56 for upper extremity amputations. Conclusions: Residual limb pain severity varies according to the etiology of amputation and is more common after upper extremity amputation than lower extremity amputations. The most severe pain is reported by patients undergoing amputations due to cancer, followed by traumatic amputations, while vascular amputation patients report lower pain severity. Promising methods of reducing long-term pain are preoperative pain control, nerve or epidural blocks, use of memantine, calcitonin-containing blocks, and prophylactic nerve coaptations.

Fatigue, fear of being mobilized and residual limb pain limit independent basic mobility and physiotherapy for patients early after major dysvascular lower extremity amputation: A prospective cohort study

“…Residual limb pain, which was the second most frequent factor limiting the completion of planned physiotherapy, corresponds well with findings in other patient groups that report pain as a frequent limitation for early mobilization and exercise during hospitalization 12,36–38 . Likewise, the prevalence of residual limb pain is high shortly after and at long‐term follow up in LEAs 39,40 . Together, this highlights the importance of giving high priority to effective pain management in acute care settings after LEA.…”

“…12,[36][37][38] Likewise, the prevalence of residual limb pain is high shortly after and at long-term follow up in LEAs. 39,40 Together, this highlights the importance of giving high priority to effective pain management in acute care settings after LEA. The variety of "other" limitations highlights the complexity of LEAs and the many factors that must be considered to achieve successful early mobilization.…”