Pain Phenotypes and Associated Clinical Risk Factors Following Traumatic Amputation: Results from Veterans Integrated Pain Evaluation Research (VIPER).
Abstract
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.
Type
Journal articleSubject
HumansNeuroma
Phantom Limb
Amputation, Traumatic
Pain Measurement
Analgesia
Amputation
Risk Factors
Cross-Sectional Studies
Depression
Adult
Veterans
Female
Male
Young Adult
Surveys and Questionnaires
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https://hdl.handle.net/10161/19638Published Version (Please cite this version)
10.1111/pme.12848Publication Info
Buchheit, Thomas; Van de Ven, Thomas; Hsia, Hung-Lun John; McDuffie, Mary; MacLeod,
David B; White, William; ... Shaw, Andrew D (2016). Pain Phenotypes and Associated Clinical Risk Factors Following Traumatic Amputation:
Results from Veterans Integrated Pain Evaluation Research (VIPER). Pain medicine (Malden, Mass.), 17(1). pp. 149-161. 10.1111/pme.12848. Retrieved from https://hdl.handle.net/10161/19638.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Thomas Edward Buchheit
Associate Professor of Anesthesiology
Dr. Buchheit serves as Director of the Regenerative Pain Therapies Program in the
Duke Center for Translational Pain Medicine (CTPM), and practices Pain Medicine at
both Duke University and the Durham VAMC. His research focus is on the local and systemic
inflammatory mechanisms that drive pain in arthritis and nerve injury. He has led
and participated in several multicenter research projects that have studied patients
at Duke, the Durham VAMC, and Walter Reed National Military Medical Ce
Hung-Lun John Hsia
Assistant Professor of Anesthesiology
Francis Joseph Keefe
Professor in Psychiatry and Behavioral Sciences
I am Director of the Duke Pain Prevention and Treatment Research Program, an active
NIH funded clinical research program focused on developing new and more effective
ways of assessing and treating patients having acute and persistent pain. I have
been active in nationally and internationally in shaping the pain research agenda.
For the past 10 years I served as Editor in Chief of PAIN the premier journal in pain
research. I also have served as the Chair of a number of NIH Study
David Brett MacLeod
Associate Professor of Anesthesiology
Clinical Anesthesia My principal clinical interest is the use of peripheral nerve
blocks in primarily orthopedic joint replacement procedures. I am a member of the
Regional Division with responsibilities to spine, trauma & plastic surgery.
I was the co-director of the Carolina Cadaver Course, which was run annually in conjunction
with Wake Forest University School of Medicine. I have been involved in teaching the
use of ultrasound for the placement of
Thomas John Van de Ven
Associate Professor of Anesthesiology
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