Neuropathic pain after major limb amputation: a cross-sectional study

Abstract

Background & Objective: Residual limb pain (RLP) and phantom pain can arise following amputation and may require additional treatment or surgery. This study aimed to determine the prevalence of neuropathic RLP following limb amputation and identify prognostic factors for the development of neuropathic RLP. Methods: A cross-sectional study was performed of patients who underwent upper or lower extremity amputation between 1990 and 2021 with a minimum of twelve months follow-up. The primary outcome was the prevalence of neuropathic RLP, defined as a 0-10 NRS pain score in the residual limb of ≥4, in combination with a score ≥4 on the short form DN4 questionnaire (s-DN4), validated for discriminating between nociceptive and neuropathic pain. The secondary outcome was quality of life for amputees with and without (neuropathic) RLP. A multivariable linear regression model was used to identify prognostic factors for neuropathic RLP development. Results: A total of 121 patients were included: 87 with lower extremity amputations, 29 with upper extremity amputations, and 5 with both. Neuropathic RLP was experienced by 21.5%, while 10.7% reported non-neuropathic RLP. Smoking status and Complex Regional Pain Syndrome as indication for limb amputation were associated with more severe neuropathic pain symptoms. Patients experiencing neuropathic RLP reported a significantly lower quality of life compared to patients without neuropathic RLP. Conclusions: This study demonstrates that neuropathic RLP is common after limb amputation and impacts daily functioning. The absence of numerous manageable prognostic factors associated with neuropathic pain development emphasizes the importance of the consideration of prophylactic interventions at the time of amputation.