The Prevalence of Residual Limb Pain and Symptomatic Neuromas Following Lower Extremity Amputation: A Systematic Review and Meta-analysis

Abstract

Introduction: Residual Limb Pain (RLP) is associated with (partial) extremity amputations and is defined as pain felt in the remaining part of the amputated limb. A common cause of RLP is neuroma formation after nerve transections. Neuromas can turn into very painful and severely debilitating pathologies, preventing prosthetic use, reducing quality of life and requiring medication. RLP and symptomatic neuromas are often not properly recognized by physicians explaining the varying prevalence in literature. This systematic review and meta-analysis aim to provide a comprehensive overview of published literature on prevalence of RLP and symptomatic neuroma following lower extremity amputation. Materials and Methods: Studies reporting the prevalence of RLP and symptomatic neuroma pain in patients who have had a lower extremity amputation published between 2000 and 2020, were identified in PubMed and Embase. Random-effects meta-analyses of proportions were performed to quantify the prevalence of RLP and symptomatic neuroma. Subgroups were identified and analysed. Results: Twenty-four articles were selected for this meta-analysis including data of 6716 patients in 13 different countries: 17 studies reported RLP prevalence, 4 studies reported symptomatic neuromas prevalence, and 3 studies reported both. For RLP, the pooled prevalence was 59% (95% CI: 51-67). For symptomatic neuromas, the pooled prevalence was 15% (95% CI: 7-28). RLP subgroup analysis showed statistically significant higher prevalence in patients aged >50 years, with geographic location within the United States, follow up >2 years, and in studies using a self-administered questionnaire for data collection. Conclusion: RLP occurs in 59% of patients who have had a lower extremity amputation and symptomatic neuromas among 15%. Physicians should be aware that a higher prevalence of RLP may occur among older patients, American populations, and after longer follow-up. Knowledge of their high prevalence may result in better awareness among physicians, in turn providing timely and adequate treatment.