Neuropathic Pain Adversely Impacts Quality of Life in Patients with Lower Extremity Amputations
Carrie A Kubiak, MD1, Jennifer B Hamill, MPH1, Hyungjin M Kim, ScD1, Randy S Roth, MD, PhD1, Melissa J Tinney, MD1, Paul S Cederna, MD2, Stephen WP Kemp, PhD1, Michael E Geisser, MD, PhD1 and Theodore A Kung, MD3, (1)University of Michigan, Ann Arbor, MI, (2)Plastic Surgery, University of Michigan, Ann Arbor, MI, (3)Section of Plastic & Reconstructive Surgery, University of Michigan, Ann Arbor, MI
Introduction
Neuropathic pain is a debilitating condition that significantly impacts both rehabilitation and quality of life. While the pathophysiology of neuropathic pain following limb amputation has been described in the literature, its contribution to pain interferences and impact on overall quality of life has not been extensively studied.
Materials and Methods
Subjects in this study were patients with lower extremity amputations who were enrolled in a research study examining the impact of regenerative peripheral nerve interfaces for the treatment of painful neuromas. Subjects were divided into neuropathic and non-neuropathic pain groups based on self-reported neuropathic pain assessed 4-months after lower extremity amputation using the PROMIS Neuropathic Pain Quality scale and recommended cut-offs proposed by the original authors.
Results
Thirty-six subjects were examined and 11 (30.6%) subjects were classified as having neuropathic pain at 4 months using the recommended cut-off of a t-score greater than 50. Subjects with neuropathic pain reported having more intense pain on the PROMIS Pain Intensity scale and the McGill Pain Questionniare-2 (p's < .001) compared to their non-neuropathic pain counterparts. They also reported greater pain interference on the PROMIS Pain Interference scale (p < .001). Subjects with neuropathic pain reported significantly greater catastrophizing on the Pain Catastrophizing Scale (p = .01), and greater depression and anxiety on the Patient Health Questionnaire-9 (p < .001) and the Generalized Anxiety Disorder-7 Scale (p = .01), respectively. Of the individuals using a prosthesis at 4-months (n=12), patients without neuropathic pain tended to report improved prosthetic use compared to prosthetic users with neuropathic pain, but this test had lower power as only 2 subjects with neuropathic pain reported regular prosthetic use. There was also a trend for subjects who had neuropathic pain to be more likely to be taking opioids, but this trend was not statistically significant.
Conclusions
Results from this study suggest that patients with limb loss and neuropathic pain present with significantly greater pain interference, overall pain and poorer quality of life compared to patients without neuropathic pain. This highlights the need to identify neuropathic pain in the population as they appear to be at greater risk for poor pain management and quality of life.
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