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

Published

Journal Article

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.

Full Text

Duke Authors

Cited Authors

  • Buchheit, T; Van de Ven, T; Hsia, H-LJ; McDuffie, M; MacLeod, DB; White, W; Chamessian, A; Keefe, FJ; Buckenmaier, CT; Shaw, AD

Published Date

  • January 2016

Published In

Volume / Issue

  • 17 / 1

Start / End Page

  • 149 - 161

PubMed ID

  • 26177330

Pubmed Central ID

  • 26177330

Electronic International Standard Serial Number (EISSN)

  • 1526-4637

International Standard Serial Number (ISSN)

  • 1526-2375

Digital Object Identifier (DOI)

  • 10.1111/pme.12848

Language

  • eng