Association between phantom limb complex and the level of amputation in lower limb amputee

Area of Science:

• Rehabilitation Medicine
• Pain Management
• Prosthetics and Orthotics

Background:

• Phantom limb complex (PLC) is a common post-amputation phenomenon.
• Understanding the natural course of PLC is crucial for effective patient management.
• Limited data exists on the untreated progression of PLC following lower limb amputation.

Purpose of the Study:

• To evaluate the natural course of phantom limb complex without intervention after lower limb amputation.
• To assess the incidence and intensity of stump pain (SP) and phantom limb pain (PLP) at different amputation levels.
• To compare pain scores in the early postoperative period (EPP) and six months after surgery (ASM).

Main Methods:

• A Level III prognostic study combining retrospective review and cross-sectional interviews.
• 101 patients with lower limb amputation were categorized into three groups based on amputation level (hip/knee disarticulation, transtibial, below-ankle).
• Data collected included amputation details, stump pain, phantom limb pain, and phantom sensations, assessed at EPP and ASM using Visual Analog Scale (VAS).

Main Results:

• Higher VAS scores for SP and PLP were observed in the above-knee amputation group during the EPP.
• Statistically significant differences in pain intensity (VAS) were found between groups for SP (p < 0.001) and PLP (p = 0.036) at EPP.
• These significant differences in SP and PLP between groups diminished by the ASM assessment (p = 0.242 for SP, p = 0.580 for PLP).

Conclusions:

• Above-knee amputations showed higher initial VAS scores for both SP and PLP.
• Phantom limb pain and stump pain intensity decreased significantly over time, suggesting a natural resolution.
• Management strategies for pain should be prioritized in the early postoperative period, particularly for patients with above-knee amputations.