Differential expression of systemic inflammatory mediators in amputees with chronic residual limb pain.
Abstract
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.
Type
Journal articleSubject
HumansPhantom Limb
Inflammation Mediators
Pain Measurement
Statistics, Nonparametric
Case-Control Studies
Psychometrics
Up-Regulation
Adolescent
Adult
Amputees
Female
Male
Young Adult
Catastrophization
Chronic Pain
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https://hdl.handle.net/10161/19642Published Version (Please cite this version)
10.1097/j.pain.0000000000000728Publication Info
Chamessian, Alexander; Van de Ven, Thomas; Buchheit, Thomas; Hsia, Hung-Lun; McDuffie,
Mary; Gamazon, Eric R; ... Shaw, Andrew (2017). Differential expression of systemic inflammatory mediators in amputees with chronic
residual limb pain. Pain, 158(1). pp. 68-74. 10.1097/j.pain.0000000000000728. Retrieved from https://hdl.handle.net/10161/19642.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
Thomas John Van de Ven
Associate Professor of Anesthesiology
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