Risk Factors for Prolonged Opioid Consumption in Lower Extremity Amputees

Park, Rachel H; Liston, Jared M; Samuel, Ankhita; Forster, BA Grace L.; DeGeorge, Brent R.

doi:10.1097/gox.0000000000004026

Cited by 5 publications

(1 citation statement)

References 18 publications

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“…Pharmacologic treatments may include local anesthetics, amitriptyline, duloxetine, acetaminophen, gabapentin, and opioids (Urits et al, 2019). Pharmacologic treatments often lose efficacy over time, have serious side effects, and can lead to addiction (Hsu and Cohen, 2013; Park et al, 2022). Surgical interventions are typically explored when other treatment methods have been deemed ineffective (Davis, 1993).…”

Section: Introductionmentioning

confidence: 99%

Transcutaneous Spinal Cord Stimulation to Reduce Phantom Limb Pain in People with a Transtibial Amputation

Dalrymple

Fisher

Weber

2023

Preprint

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Phantom limb pain (PLP) is debilitating and affects over 70% of people with a lower-limb amputation. In chronic pain conditions, there are plastic changes at the spinal cord level, typically causing increased excitability. Altered spinal excitability can be measured using reflexes, such as the posterior root-muscle (PRM) reflex. Neuromodulation of the spinal cord can be used to reduce chronic pain in a variety of conditions. Here we propose using a non-invasive neuromodulation method, transcutaneous spinal cord stimulation (tSCS), to reduce PLP in people with transtibial amputation. We recruited three participants, two males (5- and 9-years post-amputation; alcohol-induced neuropathy, traumatic) and one female (3 months post-amputation; diabetic dysvascular) for this 5-day study. We measured their pain using pain questionnaires and the pain pressure threshold test. We measured spinal reflex excitability using PRM reflexes. We provided neuromodulation using tSCS at 30 Hz with a carrier frequency of 10 kHz for 30 minutes/day for 5 days. Mean pain scores decreased from 34.0±7.0 on Day 1 to 18.3±6.8 on Day 5, which was a clinically meaningful difference. Two participants had increased pain pressure thresholds across the residual limb (Day 1: 5.4±1.6 lbf; Day 5: 11.4±1.0 lbf). PRM reflexes had high thresholds (59.5±6.1 μ C) and low amplitudes, suggesting that in PLP, reflexes are hypoexcitable. After 5 days of tSCS, reflex thresholds decreased significantly (38.6±12.2 μ C; p<0.001). Overall, tSCS is a non-invasive neuromodulation method that can reduce PLP and modulate spinal reflexes.

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Section: Introductionmentioning

confidence: 99%

Transcutaneous Spinal Cord Stimulation to Reduce Phantom Limb Pain in People with a Transtibial Amputation

Dalrymple

Fisher

Weber

2023

Preprint

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A preliminary study exploring the effects of transcutaneous spinal cord stimulation on spinal excitability and phantom limb pain in people with a transtibial amputation

Dalrymple,

Fisher,

Weber

2024

J. Neural Eng.

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Objective: Phantom limb pain (PLP) is debilitating and affects over 70% of people with lower-limb amputation. Other neuropathic pain conditions correspond with increased spinal excitability, which can be measured using reflexes and F-waves. Spinal cord neuromodulation can be used to reduce neuropathic pain in a variety of conditions and may affect spinal excitability, but has not been extensively used for treating phantom limb pain. Here, we propose using a non-invasive neuromodulation method, transcutaneous spinal cord stimulation (tSCS), to reduce PLP and modulate spinal excitability after transtibial amputation.Approach: We recruited three participants, two males (5- and 9-years post-amputation, traumatic and alcohol-induced neuropathy) and one female (3 months post-amputation, diabetic neuropathy) for this 5-day study. We measured pain using the McGill Pain Questionnaire, visual analog scale (VAS), and pain pressure threshold test. We measured spinal reflex and motoneuron excitability using posterior root-muscle (PRM) reflexes and F-waves, respectively. We delivered tSCS for 30 minutes/day for 5 days. Main Results: After 5 days of tSCS, McGill Pain Questionnaire scores decreased by clinically-meaningful amounts for all participants from 34.0±7.0 to 18.3±6.8; however, there were no clinically-significant decreases in VAS scores. Two participants had increased pain pressure thresholds across the residual limb (Day 1: 5.4±1.6 lbf; Day 5: 11.4±1.0 lbf). F-waves had normal latencies but small amplitudes. PRM reflexes had high thresholds (59.5±6.1 µC) and low amplitudes, suggesting that in PLP, the spinal cord is hypoexcitable. After 5 days of tSCS, reflex thresholds decreased significantly (38.6±12.2 µC; p<0.001).Significance: These preliminary results in this non-placebo-controlled study suggest that, overall, limb amputation and PLP may be associated with reduced spinal excitability and tSCS can increase spinal excitability and reduce PLP.

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A Consensus Approach for Targeted Muscle Reinnervation in Amputees

Eberlin

Brown

Gaston

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Amputations have been performed with few modifications since the dawn of surgery. Blood vessels are ligated, bones are shortened, and nerves are cut. In a percentage of people, this can result in severe neuropathic, residual limb, and phantom limb pain. Targeted muscle reinnervation is a surgical procedure initially conceived to optimize function for myoelectric prostheses in amputees. Recently, it has been adopted more widely by surgeons for the prevention and treatment of neuropathic pain. Perhaps as a function of its relatively recent development, many authors perform this operation differently, and there has been no overall agreement regarding the principles, indications, technical specifics, and postoperative management guidelines. This article is written as a consensus statement by surgeons focused on the treatment of neuropathic pain and those with extensive experience performing targeted muscle reinnervation. It is designed to serve as a roadmap and template for extremity surgeons to consider when performing targeted muscle reinnervation.

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Risk Factors for Prolonged Opioid Consumption in Lower Extremity Amputees

Cited by 5 publications

References 18 publications

Transcutaneous Spinal Cord Stimulation to Reduce Phantom Limb Pain in People with a Transtibial Amputation

Transcutaneous Spinal Cord Stimulation to Reduce Phantom Limb Pain in People with a Transtibial Amputation

A preliminary study exploring the effects of transcutaneous spinal cord stimulation on spinal excitability and phantom limb pain in people with a transtibial amputation

A Consensus Approach for Targeted Muscle Reinnervation in Amputees

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