Lower limb amputation for chronic pain and/or functional impairment
DOI:
https://doi.org/10.2340/16501977-2873Keywords:
Amputation, chronic pain, functional impairment, complex regional pain syndromsAbstract
Objective: To evaluate the impact of a lower limb amputation for chronic pain and/or functional impairment on pain and participation in daily living activities and to assess the use of prostheses. To improve decision-making for this controversial treatment.
Design: Survey.
Setting: University hospital.
Subjects: Patients who had an amputation of a lower limb for chronic pain and/or functional impairment.
Results: Eighty-one percent of the patients were satisfied with the amputation and would decide to undergo an amputation again under the same conditions. Sixty-nine percent of the patients reported an improvement in pain, 69% an improvement in mobility, 75% in daily living activities, and 56% an improvement in sleep. Seventy-five percent of the patients used their prosthesis on a daily basis.
Conclusion: Most patients who underwent an amputation in our hospitals for chronic pain and/or functional impairment of a lower limb were satisfied and reported an improvement in function and pain.
Lay abstract
Therapeutic decision-making for chronic pain and/or functional loss in a lower limb is a complex problem. Many articles have been devoted to chronic pain, and current guidelines mention a lot of treatment options. However, patients can still experience a lot of pain and/or functional loss after having tried many treatments. Some of these patients request an amputation. Most physicians refrain from this treatment, since it is very drastic, irreversible, and there is a lack of evidence regarding the outcome. To our knowledge only a few case reports and a select number of case series have been published to date about amputation for chronic pain and/or functional loss in a lower limb, and these show variable results. This study followed a small group of patients in University Hospitals Leuven, Belgium, who underwent a lower limb amputation for this complex problem. Most of these patients were satisfied with their amputation. They reported an improvement in function and pain, and would decide to undergo an amputation again under the same conditions.
Downloads
References
American Society of Anesthesiologists. Practice guidelines for chronic pain management: an updated report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine. Anesthesiology 2010; 112: 810-833.
https://doi.org/10.1097/ALN.0b013e3181c43103
Krans-Schreuder HK, Bodde MI, Schrier E, Dijkstra PU, van den Dungen JA, den Dunnen WF, et al. Amputation for long-standing, therapy-resistant type-I complex regional pain syndrome. J Bone Joint Surg Am 2012; 94: 2263-2268
https://doi.org/10.2106/JBJS.L.00532
Skevington SM, Lotfy M, O'Connell KA; WHOQOL Group. The World Health Organization's WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group. Qual Life Res 2004; 13: 299-310.
https://doi.org/10.1023/B:QURE.0000018486.91360.00
Bodde MI, Dijkstra PU, den Dunnen WF, Geertzen JH. Therapy-resistant complex regional pain syndrome type I: to amputate or not? J Bone Joint Surg Am 2011; 93: 1799-1805.
https://doi.org/10.2106/JBJS.J.01329
Ayyaswamy B, Saeed B, Anand A, Chan L, Shetty V. Quality of life after amputation in patients with advanced complex regional pain syndrome: a systematic review. EFORT Open Rev 2019; 533-540.
https://doi.org/10.1302/2058-5241.4.190008
Dielissen PW, Claassen AT, Veldman PH, Goris RJ. Amputation for reflex sympathetic dystrophy. J Bone Joint Surg Br 1995; 77: 270-273.
https://doi.org/10.1302/0301-620X.77B2.7706345
Midbari A, Suzan E, Eisenberg E, Adler T, Vulfsons S, Melamed E, et al. Amputation in patients with complex regional pain syndrome: a comparative study between amputees and nonamputees with intractable disease. Bone Joint J 2016; 98-B: 548-554.
https://doi.org/10.1302/0301-620X.98B4.36422
Bodde MI, Dijkstra PU, Schrier E, Van Den Dungen JJ, Den Dunnen WF, Geertzen JH. Informed decision-making regarding amputation for complex regional pain syndrome type I. J Bone Joint Surg Am 2014; 96: 930-934.
https://doi.org/10.2106/JBJS.M.00788
Bodde MI, Dijkstra PU, Schrier E, van den Dungen J, van den Dunnen JA, den Dunnen WF, et al. [Informed decision-making in CRPS-I and amputation.] 2014; 4: 162-167. (In Dutch).
Schrier E, Dijkstra PU, Zeebregts CJ, Wolff AP, Geertzen JHB. Decision making process for amputation in case of therapy resistant complex regional pain syndrome type-I in a Dutch specialist centre. Med Hypotheses 2018; 121: 15-20.
https://doi.org/10.1016/j.mehy.2018.08.026
Schrier E, Geertzen JHB, Scheper J, Dijkstra PU. Psychosocial factors associated with poor outcomes after amputation for complex regional pain syndrome type-I. PLoS One 2019; 14: e0213589
https://doi.org/10.1371/journal.pone.0213589
Geertzen JHB, Scheper J, Schrier E, Dijkstra PU. Outcomes of amputation due to long-standing therapy-resistant complex regional pain syndrome type-I. J Rehabil Med 2020; 52: jrm00087
https://doi.org/10.2340/16501977-2718
Honkamp N, Amendola A, Hurwitz S, Saltzman CL. Retrospective review of eighteen patients who underwent transtibial amputation for intractable pain. J Bone Joint Surg Am 2001; 83: 1479-1483.
https://doi.org/10.2106/00004623-200110000-00003
Quon DL, Dudek NL, Marks M, Boutet M, Varpio L. A qualitative study of factors influencing the decision to have an elective amputation. J Bone Joint Surg Am 2011; 93: 2087-2092.
https://doi.org/10.2106/JBJS.J.01998
Bodde MI, Schrier E, Krans HK, Geertzen JH, Dijkstra PU. Resilience in patients with amputation because of complex regional pain syndrome type I. Disabil Rehabil 2014; 36: 838-843.
https://doi.org/10.3109/09638288.2013.822023
Goebel A. Complex regional pain syndrome in adults: UK guidelines for diagnosis, referral and management in primary and secondary care. London: Royal College of Physicians; 2018.
Published
How to Cite
License
Copyright (c) 2021 Evelyne Linden, Koen Peers, Carlotte Kiekens
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All digitalized JRM contents is available freely online. The Foundation for Rehabilitation Medicine owns the copyright for all material published until volume 40 (2008), as from volume 41 (2009) authors retain copyright to their work and as from volume 49 (2017) the journal has been published Open Access, under CC-BY-NC licences (unless otherwise specified). The CC-BY-NC licenses allow third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
From 2024, articles are published under the CC-BY licence. This license permits sharing, adapting, and using the material for any purpose, including commercial use, with the condition of providing full attribution to the original publication.
