Skip to main content
SpringerLink
Log in

Factors affecting phantom limb pain in patients undergoing amputation: retrospective study

  • Original Article
  • Published:
Journal of Anesthesia Aims and scope Submit manuscript

Abstract

Purpose

The efficacy of preemptive analgesia for prevention of phantom limb pain has been controversial although pain management before amputation is empirically important. The aim of this study was to determine the associated factors with perioperative phantom limb pain.

Methods

Following approval by the Medical Ethics Committee in our university, medical records of patients receiving limb amputation surgery in our hospital between April 1, 2013 and October 31, 2017 were retrospectively reviewed. To determine which pre-operative factors could affect the development of phantom limb pain, we performed univariate analysis to find candidate factors (p < 0.05), and then did multivariate regression analysis.

Results

Incidence of phantom limb pain was 50% (22/44). There was no difference between the groups in types of anesthesia and post-operative pain levels. The multivariate logistic regression including possible confounders suggested that diabetes mellitus and uncontrollable preoperative pain with non-steroidal anti-inflammatory drugs (NSAIDs) were independently associated with the development of phantom limb pain (Adjusted odds ratio (OR) 0.238 [95% confidential interval (CI) 0.0643–0.883], p = 0.032, Adjusted OR 6.360 [95% CI 1.280–31.50], p = 0.024, respectively).

Conclusion

The types of anesthesia and the degree of postoperative pain were not related to the development of phantom limb pain. The present data suggest that insufficient preoperative pain with NSAIDs and diabetes mellitus would give an impact on the development of phantom limb pain.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Nikolajsen L, Jensen TS. Phantom limb pain. Br J Anaesth. 2001;87:107–16.

    Article  CAS  PubMed  Google Scholar 

  2. Richardson C, Glenn S, Horgan M, Nurmikko T. A prospective study of factors associated with the presence of phantom limb pain six months after major lower limb amputation in patients with peripheral vascular disease. J Pain. 2007;8:793–801.

    Article  PubMed  Google Scholar 

  3. Subedi B, Grossberg GT. Phantom limb pain: mechanisms and treatment approaches. Pain Res Treat. 2011;2011:864605.

    PubMed  PubMed Central  Google Scholar 

  4. Stone PA, Flaherty SK, Aburahma AF, Hass SM, Jackson JM, Hayes JD, Hofeldt MJ, Hager CS, Elmore MS. Factors affecting perioperative mortality and wound-related complications following major lower extremity amputations. Ann Vasc Surg. 2006;20:209–16.

    Article  PubMed  Google Scholar 

  5. Bach S, Noreng MF, Tjéllden NU. Phantom limb pain in amputees during the first 12 months following limb amputation, after preoperative lumbar epidural blockade. Pain. 1988;33:297–301.

    Article  CAS  PubMed  Google Scholar 

  6. Yin Y, Zhang L, Xiao H, Wen CB, Dai YE, Yang G, Zuo YX, Liu J. The pre-amputation pain and the postoperative deafferentation are the risk factors of phantom limb pain: a clinical survey in a sample of Chinese population. BMC Anesthesiol. 2017;17:69.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Nikolajsen L, Ilkjaer S, Christensen JH, Krøner K, Jensen TS. Randomised trial of epidural bupivacaine and morphine in prevention of stump and phantom pain in lower-limb amputation. Lancet. 1997;350:1353–7.

    Article  CAS  PubMed  Google Scholar 

  8. Lambert AW, Dashfield AK, Cosgrove C, Wilkins DC, Walker AJ, Ashley S. Randomized prospective study comparing preoperative epidural and intraoperative perineural analgesia for the prevention of postoperative stump and phantom limb pain following major amputation. Reg Anesth Pain Med. 2001;26:316–21.

    Article  Google Scholar 

  9. Cadavid A, Mayungo T. Very early phantom limb pain following amputation of a lower extremity: case report. Rev Colomb Anestesiol. 2013;41:236–9.

    Article  Google Scholar 

  10. Ahmed A, Bhatnagar S, Mishra S, Khurana D, Joshi S, Ahmad SM. Prevalence of phantom limb pain, stump pain, and phantom limb sensation among the amputated cancer patients in India: a prospective, observational study. Indian J Palliat Care. 2017;23:24–35.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Wolff A, Vanduynhoven E, van Kleef M, Huygen F, Pope JE, Mekhail N. 21. Phantom pain. Pain Pract. 2011;11:403–13.

    Article  PubMed  Google Scholar 

  12. Spiegel DR, Lappinen E, Gottlieb M. A presumed case of phantom limb pain treated successfully with duloxetine and pregabalin. Gen Hosp Psychiatry. 2010;32:228.e5-7.

    PubMed  Google Scholar 

  13. McCormick Z, Chang-Chien G, Marshall B, Huang M, Harden RN. Phantom limb pain: a systematic neuroanatomical-based review of pharmacologic treatment. Pain Med. 2014;15:292–305.

    Article  PubMed  Google Scholar 

  14. Wössner S, Weber K, Steinbeck AC, Oberhauser M, Feuerecker M. Pregabalin as adjunct in a multimodal pain therapy after traumatic foot amputation—a case report of a 4-year-old girl. Scand J Pain. 2017;17:146–9.

    Article  PubMed  Google Scholar 

  15. Sahin SH, Colak A, Arar C, Tutunculer E, Sut N, Yılmaz B, Birtane M. A retrospective trial comparing the effects of different anesthetic techniques on phantom pain after lower limb amputation. Curr Ther Res Clin Exp. 2011;72:127–37.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Ong BY, Arneja A, Ong EW. Effects of anesthesia on pain after lower-limb amputation. J Clin Anesth. 2006;18:600–4.

    Article  PubMed  Google Scholar 

  17. Clark RL, Bowling FL, Jepson F, Rajbhandari S. Phantom limb pain after amputation in diabetic patients does not differ from that after amputation in nondiabetic patients. Pain. 2013;154:729–32.

    Article  PubMed  Google Scholar 

  18. Tesfaye S, Boulton AJ, Dyck PJ, Freeman R, Horowitz M, Kempler P, Lauria G, Malik RA, Spallone V, Vinik A, Bernardi L, Valensi P, Toronto Diabetic Neuropathy Expert Group. Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care. 2010;33:2285–93.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Iwase M, Fujii H, Nakamura U, Ohkuma T, Ide H, Jodai-Kitamura T, Sumi A, Komorita Y, Yoshinari M, Kitazono T. Incidence of diabetic foot ulcer in Japanese patients with type 2 diabetes mellitus: the Fukuoka diabetes registry. Diabetes Res Clin Pract. 2018;137:183–9.

    Article  PubMed  Google Scholar 

  20. Ypsilantis E, Tang TY. Pre-emptive analgesia for chronic limb pain after amputation for peripheral vascular disease: a systematic review. Ann Vasc Surg. 2010;24:1139–46.

    Article  PubMed  Google Scholar 

  21. Pisansky AJB, Brovman EY, Kuo C, Kaye AD, Urman RD. Perioperative outcomes after regional versus general anesthesia for above the knee amputations. Ann Vasc Surg. 2018;48:53–66.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

None.

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki, 036-8562, Japan

    Satoko Noguchi, Junichi Saito, Kishiko Nakai, Masato Kitayama & Kazuyoshi Hirota

Authors
  1. Satoko Noguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Junichi Saito
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kishiko Nakai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Masato Kitayama
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kazuyoshi Hirota
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SN designed the study, analyzed and interpreted the data, and drafted the manuscript. JS reviewed the analysis of the data and edited the manuscript. KN helped conduct the study. MK and KH made substantial contributions to the conception and design of the study, helped in writing the manuscript, and statistical analysis. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Satoko Noguchi.

Ethics declarations

Conflict of interest

The authors do not have any conflict of interests regarding the content of the paper.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Noguchi, S., Saito, J., Nakai, K. et al. Factors affecting phantom limb pain in patients undergoing amputation: retrospective study. J Anesth 33, 216–220 (2019). https://doi.org/10.1007/s00540-018-2599-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00540-018-2599-0

Keywords

Search

Navigation