Browsing by Subject "Phantom Limb"

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Open Access
Differential expression of systemic inflammatory mediators in amputees with chronic residual limb pain.
(Pain, 2017-01) Chamessian, Alexander; Van de Ven, Thomas; Buchheit, Thomas; Hsia, Hung-Lun; McDuffie, Mary; Gamazon, Eric R; Walsh, Colin; Bruehl, Stephen; Buckenmaier, Chester 'Trip'; Shaw, Andrew
Chronic postsurgical pain impacts most amputees, with more than half experiencing neuralgic residual limb pain. The transition from normal acute postamputation pain to chronic residual limb pain likely involves both peripheral and central inflammatory mechanisms. As part of the Veterans Integrated Pain Evaluation Research study, we investigated links between systemic inflammatory mediator levels and chronic residual limb pain. Subjects included 36 recent active duty military traumatic amputees with chronic residual limb pain and 40 without clinically significant pain. Blood samples were obtained and plasma concentrations of an array of inflammatory mediators were analyzed. Residual limb pain intensity and pain catastrophizing were assessed to examine associations with inflammatory mediators. Pro-inflammatory mediators including tumor necrosis factor (TNF)-α, TNF-β, interleukin (IL)-8, ICAM-1, Tie2, CRP, and SAA were elevated in patients with chronic residual limb pain. Across all patients, residual limb pain intensity was associated positively with levels of several proinflammatory mediators (IL-8, TNF-α, IL-12, TNF-β, PIGF, Tie2, SAA, and ICAM-1), and inversely with concentrations of the anti-inflammatory mediator IL-13, as well as IL-2 and Eotaxin-3. Pain catastrophizing correlated positively with IL-8, IL-12, TNF-β, PIGF, and ICAM-1, and inversely with IL-13. Significant associations between catastrophizing and residual limb pain intensity were partially mediated by TNF-α, TNF- β, SAA, and ICAM-1 levels. Results suggest that chronic postamputation residual limb pain is associated with excessive inflammatory response to injury or to inadequate resolution of the postinjury inflammatory state. Impact of pain catastrophizing on residual limb pain may be because of part to common underlying inflammatory mechanisms.
Open Access
Pain Phenotypes and Associated Clinical Risk Factors Following Traumatic Amputation: Results from Veterans Integrated Pain Evaluation Research (VIPER).
(Pain medicine (Malden, Mass.), 2016-01) Buchheit, Thomas; Van de Ven, Thomas; Hsia, Hung-Lun John; McDuffie, Mary; MacLeod, David B; White, William; Chamessian, Alexander; Keefe, Francis J; Buckenmaier, Chester Trip; Shaw, Andrew D
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.
Open Access
Residual limb pain is not a diagnosis: a proposed algorithm to classify postamputation pain.
(The Clinical journal of pain, 2013-06) Clarke, Collin; Lindsay, David R; Pyati, Srinivas; Buchheit, Thomas
BACKGROUND: Although postamputation pain (PAP) syndromes have been described since the 16th century, taxonomy of these conditions remains ill-defined. The term "Residual Limb Pain" fails to distinguish between distinct diagnostic entities such as neuroma, complex regional pain syndrome, and somatic pathology. Even phantom limb pain (PLP), although easily distinguished from residual limb pain (RLP), has not been consistently delineated from other PAP syndromes. METHODS: A systematic review of the literature was conducted to identify the degree of delineation of various post amputation pain states and what diagnostic criteria were utilized if any. Furthermore, papers that involved treatment modalities were reviewed to determine efficacy of treatment. RESULTS: Of the 151 papers reviewed, none further categorized RLP into more specific diagnostic criteria. Furthermore, the literature contains numerous case reports, case series, letters to the editors, and grossly underpowered studies demonstrating significant positive results, yet few high-quality randomized controlled trials. CONCLUSIONS: Describing and defining the distinct clinical entities, intuitively, is a prerequisite to developing optimal treatments. The reported variation in the incidence of PAP phenomena may well represent inconsistency in assessment tools and diagnostic categories rather than variation in prevalence of these conditions. In this paper, we review the historical evolution of the current understanding of these syndromes and propose an algorithm for uniform classification.