Chronic Post-amputation Pain: Peri-operative Management - Review

Overview

Journal Br J Pain

Date 2017 Nov 11

PMID 29123664

Citations 11

Authors

Devjit Srivastava

Affiliations

Soon will be listed here.

Abstract

Study Design: Narrative review.

Method: Eight bibliographic databases were searched for studies published in the (last five years up until Feb 2017). For the two database searches (Cochrane and DARE), the time frame was unlimited. The review involved keyword searches of the term 'Amputation' AND 'chronic pain'. Studies selected were interrogated for any association between peri-operative factors and the occurrence of chronic post amputation pain (CPAP).

Results: Heterogeneity of study populations and outcome measures prevented a systematic review and hence a narrative synthesis of results was undertaken. The presence of variation in two gene alleles (GCH1 and KCNS1) may be relevant for development of CPAP. There was little evidence to draw conclusions on the association between age, gender and CPAP. Pre-operative anxiety and depression influenced pain intensity post operatively and long-term post amputation pain (CPAP). The presence of pre-amputation pain is correlated to the development of acute and chronic post amputation pain while evidence for the association of post-operative pain with CPAP is modest. Regional anaesthesia and peri-neural catheters improve acute postoperative pain relief but evidence on their efficacy to prevent CPAP is limited. A suggested whole system pathway based on current evidence to optimize peri-operative amputation pain is described.

Conclusion: The current evidence suggests that optimized peri-operative analgesia reduces the incidence of acute peri-operative pain but no firm conclusion can be drawn on reducing risk for CPAP.

Citing Articles

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References

Roullet S, Nouette-Gaulain K, Biais M, Bernard N, Benard A, Revel P . Preoperative opioid consumption increases morphine requirement after leg amputation. Can J Anaesth. 2009; 56(12):908-13. DOI: 10.1007/s12630-009-9185-8. View

Hayes C, Armstrong-Brown A, Burstal R . Perioperative intravenous ketamine infusion for the prevention of persistent post-amputation pain: a randomized, controlled trial. Anaesth Intensive Care. 2004; 32(3):330-8. DOI: 10.1177/0310057X0403200305. View

Cleeland C, Reyes-Gibby C, Schall M, Nolan K, Paice J, Rosenberg J . Rapid improvement in pain management: the Veterans Health Administration and the institute for healthcare improvement collaborative. Clin J Pain. 2003; 19(5):298-305. DOI: 10.1097/00002508-200309000-00003. View

Ypsilantis E, Tang T . Pre-emptive analgesia for chronic limb pain after amputation for peripheral vascular disease: a systematic review. Ann Vasc Surg. 2010; 24(8):1139-46. DOI: 10.1016/j.avsg.2010.03.026. View

Janicki P, Alexander G, Eckert J, Postula M, Schwartzman R . Analysis of Common Single Nucleotide Polymorphisms in Complex Regional Pain Syndrome: Genome Wide Association Study Approach and Pooled DNA Strategy. Pain Med. 2016; 17(12):2344-2352. DOI: 10.1093/pm/pnw133. View

Montes A, Roca G, Sabate S, Lao J, Navarro A, Cantillo J . Genetic and Clinical Factors Associated with Chronic Postsurgical Pain after Hernia Repair, Hysterectomy, and Thoracotomy: A Two-year Multicenter Cohort Study. Anesthesiology. 2015; 122(5):1123-41. DOI: 10.1097/ALN.0000000000000611. View

Hanley M, Jensen M, Smith D, Ehde D, Edwards W, Robinson L . Preamputation pain and acute pain predict chronic pain after lower extremity amputation. J Pain. 2006; 8(2):102-9. DOI: 10.1016/j.jpain.2006.06.004. View

Humble S, Dalton A, Li L . A systematic review of therapeutic interventions to reduce acute and chronic post-surgical pain after amputation, thoracotomy or mastectomy. Eur J Pain. 2014; 19(4):451-65. PMC: 4405062. DOI: 10.1002/ejp.567. View

Schoeps A, Rudolph A, Seibold P, Dunning A, Milne R, Bojesen S . Identification of new genetic susceptibility loci for breast cancer through consideration of gene-environment interactions. Genet Epidemiol. 2013; 38(1):84-93. PMC: 3995140. DOI: 10.1002/gepi.21771. View

10.

Hoofwijk D, van Reij R, Rutten B, Kenis G, Buhre W, Joosten E . Genetic polymorphisms and their association with the prevalence and severity of chronic postsurgical pain: a systematic review. Br J Anaesth. 2016; 117(6):708-719. DOI: 10.1093/bja/aew378. View

11.

Fowkes F, Aboyans V, Fowkes F, McDermott M, Sampson U, Criqui M . Peripheral artery disease: epidemiology and global perspectives. Nat Rev Cardiol. 2016; 14(3):156-170. DOI: 10.1038/nrcardio.2016.179. View

12.

Young E, Lariviere W, Belfer I . Genetic basis of pain variability: recent advances. J Med Genet. 2011; 49(1):1-9. PMC: 3821734. DOI: 10.1136/jmedgenet-2011-100386. View

13.

Hekimoglu Sahin S, Colak A, Arar C, Tutunculer E, Sut N, Yilmaz B . A retrospective trial comparing the effects of different anesthetic techniques on phantom pain after lower limb amputation. Curr Ther Res Clin Exp. 2014; 72(3):127-37. PMC: 3957153. DOI: 10.1016/j.curtheres.2011.06.001. View

14.

Nikolajsen L, Ilkjaer S, Christensen J, Kroner K, Jensen T . Randomised trial of epidural bupivacaine and morphine in prevention of stump and phantom pain in lower-limb amputation. Lancet. 1997; 350(9088):1353-7. DOI: 10.1016/S0140-6736(97)06315-0. View

15.

Ong B, Arneja A, Ong E . Effects of anesthesia on pain after lower-limb amputation. J Clin Anesth. 2006; 18(8):600-4. DOI: 10.1016/j.jclinane.2006.03.021. View

16.

Elizaga A, Smith D, Sharar S, Edwards W, Hansen Jr S . Continuous regional analgesia by intraneural block: effect on postoperative opioid requirements and phantom limb pain following amputation. J Rehabil Res Dev. 1994; 31(3):179-87. View

17.

Ablin J, Buskila D . Update on the genetics of the fibromyalgia syndrome. Best Pract Res Clin Rheumatol. 2015; 29(1):20-8. DOI: 10.1016/j.berh.2015.04.018. View

18.

Kern U, Busch V, Muller R, Kohl M, Birklein F . Phantom limb pain in daily practice--still a lot of work to do!. Pain Med. 2012; 13(12):1611-26. DOI: 10.1111/j.1526-4637.2012.01494.x. View

19.

Lenggenhager B, Arnold C, Giummarra M . Phantom limbs: pain, embodiment, and scientific advances in integrative therapies. Wiley Interdiscip Rev Cogn Sci. 2015; 5(2):221-31. DOI: 10.1002/wcs.1277. View

20.

Pozek J, Beausang D, Baratta J, Viscusi E . The Acute to Chronic Pain Transition: Can Chronic Pain Be Prevented?. Med Clin North Am. 2015; 100(1):17-30. DOI: 10.1016/j.mcna.2015.08.005. View