Long-term outcomes of amputation in patients with complex regional pain syndrome (CRPS): a mixed-methods study

Amputation in patients with complex regional pain syndrome (CRPS) remains controversial, with variable outcomes in quality of life (QoL), disability, pain reduction, and complications. This study aims to evaluate long-term outcomes in CRPS patients who underwent amputation.

We conducted a single-center retrospective observational study combined with a cross-sectional survey of all CRPS patients who underwent limb amputation between 2003 and 2023 at the Erasmus MC University Medical Center. Preamputation and short-term postamputation outcomes were extracted from medical records, with short-term pain scores reflecting measurements within the first year after amputation. Long-term outcomes, including QoL, disability, pain, and satisfaction, were assessed through patient-reported questionnaires. Subgroup analyses were performed based on the presence of a neurostimulator implant.

A total of 39 patients with a median CRPS Severity Score of 12 (IQR 11-13) were included. 34 patients (87%) completed the survey a median of 6.4 years (IQR 3.0-11.7) after amputation. The 36-Item Short Form Health Survey yielded mean physical and mental health summary scores of 45.4 (±26.1) and 67.7 (±22.3), respectively. The mean Pain Disability Index score was 29.3 (±15.1). Pain decreased by a mean of 3.54 points (95% CI: 2.46 to 4.62) at short-term follow-up (median 5 months, IQR 2-6) and 2.71 points (95% CI: 1.76 to 3.65) at long-term follow-up. Residual limb pain occurred in 77%, phantom limb pain in 85%, and CRPS recurrence in the stump in 10%. Overall, 94% of respondents were satisfied and would choose amputation again. Neurostimulator status did not influence measured outcomes.

In this cohort of severe, therapy-resistant CRPS, amputation was associated with meaningful improvements in QoL, disability, and pain in carefully selected cases, although complications remained common. Amputation should, therefore, be reserved as a last-resort intervention, offered only in specialized multidisciplinary centers.