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Dr Carolyn Arnold - Director/Consultant In Pain Medicine, Caulfield Pain Management & Research

Background/Objectives:

Previous work suggests that in the year after amputation, approx. 60-70% of amputees will experience phantom limb pain (PLP). Factors that may contribute to the development of PLP include the intensity of pre-amputation pain and various psychological factors, although much of this evidence comes from descriptive, retrospective studies. As a result, less is known about the time course of phantom pain and those clinical characteristics associated with an improvement or worsening of phantom pain over time. The aim of the present study was to examine presenting clinical differences in amputees with ongoing, new onset or related phantom pain as well as those who never developed phantom pain over a 6-month longitudinal follow up period.

Method/Design:

All post amputation admissions to Caulfield General Medical Centre were asked to complete a comprehensive battery of psychometric questionnaires, including measures of pain, depression, anxiety, anger, coping, self efficacy, and self rated interference with activity, walking, sleep and enjoyment of life. Data was collected on initial medical assessment in the amputeee ward, at discharge (usually 12 weeks after admission) and at 3-month follow-up. The convenience sample comprised a total of 57 amputees (aged=67.3+/-12.7, 65% male, 81% with a transtibial below knee amputation).

Results/Conclusions:

Almost 21% of the sample had moderate-strong phantom pain on admisssion, discharge and at follow-up, whereas 40% of patients had no evidence of PLP at any time over a 6 month period. There was also a group(16%of patients) with no PLP on admission or discharge, but who develop severe pain by 3 months and a group(23%) in whom PLP had resolved by this time. A comparison of the 4 groups using ANOVA revealed significantly higher levels of pre-amputation pain, depression, anxiety and interference with enjoyment of life in amputees with ongoing PLP as well as reduced time wearing the prosthesis. Of interest, patients who were pain free on admission but subsequently developed new PLP after discharge also had significantly higher levels of anger, depression and anxiety than on admission. Conversely, the group with resolved phantom pain by follow up was less mood disturbed on admission than all other groups including those with no pain at any time. These findings emphasize the important role of psychological status at the time of amputation as a contributing factor to the eventual development or resolution of PLP over the longer term.

Time of Presentation:

Saturday 3 May 2003 - 1624-1637

Additional Authors:

• Dr Felicia Groves - Caulfield Pain Management and research Centre, Victoria
• Dr Kathryn Garland - Caulfield Pain Management and research Centre, Victoria
• Dr Michael Chou - Amputee Rehabilitation Unit, Caulfield General Medical Centre, Victoria
• Dr Stephen Gibson - Caulfield Pain Management and research Centre, Victoria

Biography:

Carolyn Arnold is a Rehabilitation Physician with extensive experience in chronic pain management. She holds the position of Director at Caulfield Pain Management & Research Centre and Consultant to the Amputee Unit at Caulfield General Medical Centre in Melbourne. She is president elect for the Australian Pain Society, and a fellow of Faculty of Pain Medicine ANZCA.