Prevalence of phantom limb pain, stump pain, and phantom limb sensation among the amputated cancer patients in India: A prospective, observational study

Abstract

Introduction:The phantom limb pain (PLP) and phantom limb sensation (PLS) are very common among amputated cancer patients, and they lead to considerable morbidity. In spite of this, there is a lack of epidemiological data of this phenomenon among the Asian population. This study was done to provide the data from Indian population.Methods:The prevalence of PLP, stump pain (SP), and PLS was prospectively analyzed from the amputated cancer patients over a period of 2 years in Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi. The risk factors and the impact of phantom phenomenon on patients were also noted.Results:The prevalence of PLP was 41% at 3 and 12 months and 45.3% at 6 months, whereas that of SP and PLS was 14.4% and 71.2% at 3 months, 18.75% and 37.1% at 6 months, 15.8% and 32.4% at 12 months, respectively. There was higher prevalence of PLP and PLS among the patients with history of preamputation pain, smoking with proximal level of amputation, receiving general anesthesia, receiving intravenous (IV) opioid postoperative analgesia, and developing neuroma or infection.Conclusion:The prevalence of PLP and PLS was higher among the cancer amputees as compared to SP, and a few risk factors responsible for their higher prevalence were found in our study. The PLP and PLS lead to considerable morbidity in terms of sleep disturbance and depression.

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

“…Sex, age and traumatic cause of amputation were the most commonly assessed of these proposed risk factors. Sex was consistently not associated with PLP in six studies representing a total of 1836 participants [3,5,13,38,51,52]. Age was not associated with PLP in three studies representing a total of 1062 adult participants [5,38,52] but higher age was positively associated with PLP (weak association) in one study representing a total of 716 adult participants [53].…”

“…The meta-analysis that stratified the studies by country developmental status suggested that the prevalence of PLP was significantly lower in developing countries compared to developed countries [53.98% vs 66.55%; p = 0.03]. This discrepancy is surprising and might be an artefact of selection bias linked either to the lower recruitment success rates (57.9% -68.4%) seen in most of the included studies conducted in developing countries [3,34]. The strategy of recruiting participants from amongst patients receiving follow-up medical care may have contributed to underestimation of PLP prevalence if amputees with PLP without continuing medical care were excluded from samples (in developing countries), or overestimation if having PLP made amputees more likely to remain in medical care (in developed countries).…”

“…The high PLP prevalence could be explained by these risk factors, which are typically absent in people with upper limb amputations, who are typically healthy and undergo amputation due to trauma [13]. Studies that report PLP prevalence in people receiving continuing medical care have a selection bias [3,4,14], in that they fail to account for patients not receiving continuing medical care, who may have different prevalence rates [15]. In addition, previous studies suggest that PLP prevalence rates may be lower in developing countries [16].…”

Targeted Muscle Reinnervation at the Time of Major Limb Amputation in Traumatic Amputees

“…Multiple studies have evaluated the prevalence of symptomatic phantom limb pain and residual limb pain in amputees to denote the magnitude of these morbidities. Reported rates of symptomatic phantom limb pain and residual neuroma pain among amputee patients are 9% to 67% and 2% to 25%, respectively 2 - 4 , 6 , 14 , 15 . In a military population, Carlen et al found that 67% of soldiers with traumatic amputation had phantom limb pain in the first few months after surgery 16 .…”

“…Initially used for patients with shoulder disarticulation or who have had a transhumeral amputation, TMR transfers the transected peripheral nerves that no longer have motor or sensory end-organs into recipient motor nerves of residual muscle in the amputated extremity 2 - 4 , 6 , 14 . While initially developed in an effort to “bioamplify” myoelectric signals for advanced bioprosthetic limbs, early clinical results demonstrated an improvement in neuroma-related pain and other postoperative pain symptoms 15 - 21 .…”