Pain Phenotypes and Associated Clinical Risk Factors Following Traumatic Amputation: Results from Veterans Integrated Pain Evaluation Research (VIPER)

• Published in: Pain medicine (Malden, Mass.) Vol. 17; no. 1; pp. 149 - 161
• Main Authors: Buchheit, Thomas, Van de Ven, Thomas, Hsia, Hung-Lun John, McDuffie, Mary, MacLeod, David B., White, William, Chamessian, Alexander, Keefe, Francis J., Buckenmaier, Chester “Trip”, Shaw, Andrew D.
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.01.2016
• Subjects: ACUTE & PERIOPERATIVE PAIN SECTION; Adult; Amputation; Amputation - methods; Amputation, Traumatic - diagnosis; Amputation, Traumatic - physiopathology; Amputation, Traumatic - psychology; Amputation, Traumatic - therapy; Analgesia; Analgesia - adverse effects; Catheters; Chronic pain; Clinical significance; Complex regional pain syndrome; Cross-Sectional Studies; Depression - psychology; Female; Health risks; Humans; Male; Medical records; Mental depression; Military service; Neuralgia; Neuroma - complications; Neuroma - therapy; Pain; Pain Measurement; Pain perception; Phantom Limb - diagnosis; Phantom Limb - psychology; Phantom Limb - therapy; Phenotypes; Post traumatic stress disorder; Risk Factors; Surveys and Questionnaires; Veterans; Young Adult; Residual Limb Pain; Phantom Pain; Catastrophizing; Amputation; Nerve Injury; Depression; Neuroma; Post-traumatic Stress Disorder; Regional Catheter
• ISSN: 1526-2375; 1526-4637; 1526-4637
• DOI: 10.1111/pme.12848

Abstract Objective. To define clinical phenotypes of postamputation pain and identify markers of risk for the development of chronic pain. Design. Cross-sectional study of military service members enrolled 3-18 months after traumatic amputation injury. Setting. Military Medical Center Subjects. 124 recent active duty military service members Methods. Study subjects completed multiple pain and psychometric questionnaires to assess the qualities of phantom and residual limb pain. Medical records were reviewed to determine the presence/absence of a regional catheter near the time of injury. Subtypes of residual limb pain (somatic, neuroma, and complex regional pain syndrome) were additionally analyzed and associated with clinical risk factors. Results. A majority of enrolled patients (64.5%) reported clinically significant pain (pain score ≥3 averaged over previous week). 61% experienced residual limb pain and 58% experienced phantom pain. When analysis of pain subtypes was performed in those with residual limb pain, we found evidence of a sensitized neuroma in 48.7%, somatic pain in 40.8%, and complex regional pain syndrome in 19.7% of individuals. The presence of clinically significant neuropathic residual limb pain was associated with symptoms of PTSD and depression. Neuropathic pain of any severity was associated with symptoms of all four assessed clinical risk factors: depression, PTSD, catastrophizing, and the absence of regional analgesia catheter. Conclusions. Most military service members in this cohort suffered both phantom and residual limb pain following amputation. Neuroma was a common cause of neuropathic pain in this group. Associated risk factors for significant neuropathic pain included PTSD and depression. PTSD, depression, catastrophizing, and the absence of a regional analgesia catheter were associated with neuropathic pain of any severity.