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Amputation for complex regional pain syndrome: A systematic review
Yannick L Gilanyi1, Michael C Ferraro1, Andreas Goebel2
1School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.
The Journal of Pain
|October 5, 2025
Summary
Amputation for complex regional pain syndrome (CRPS) lacks clear evidence of benefit and carries significant risks like phantom pain. More high-quality research is needed to understand its true outcomes for CRPS patients.
Area of Science:
- Pain Medicine
- Surgical Outcomes
- Systematic Review
Background:
- Complex regional pain syndrome (CRPS) is a debilitating condition often treated with limb amputation for refractory cases.
- The efficacy and safety of amputation for CRPS remain incompletely understood.
Purpose of the Study:
- To systematically review the benefits and harms of limb amputation in patients with treatment-resistant CRPS.
- To evaluate pain intensity and adverse events following amputation for CRPS.
Main Methods:
- Systematic review of 67 studies (1 comparative, 24 case series, 42 case studies) including 249 patients undergoing 263 amputations.
- Searched multiple databases for published and grey literature up to September 2024.
- Assessed study quality using Joanna Briggs Institute tools; synthesized data without meta-analysis.
Main Results:
- Limited evidence suggests potential pain reduction, but study designs were heterogeneous and of critically low quality.
- Common adverse events included phantom pain (67%), residual limb pain (66%), and CRPS recurrence (47%).
- No clear evidence demonstrated amputation superiority over non-amputation for pain relief in CRPS.
Conclusions:
- The current evidence base is insufficient to support amputation for CRPS due to unclear benefits and significant potential harms.
- High-quality, controlled prospective studies are essential to guide clinical decision-making regarding amputation for CRPS.
