New Study Probes Phantom-Limb Pain Relief

Wounded veterans and others facing limb amputations may avoid long-lasting phantom-limb pain through aggressive pain management before and after surgery, according to a study in The Journal of Pain.

Researchers at the University of Washington examined the impact of intense pre-amputation pain and acute pain following amputation as predictors of long- term pain. It was assumed pain before amputation can produce pain 'memories' in the nervous system that persist after limb loss. The condition is known as phantom-limb pain. Fifty-seven patients with lower-limb amputations were evaluated. The average age was 44 and 70 percent required amputation from a traumatic injury.

"Publication of this study is very timely, as the VA and other providers are dealing with severe pain in veterans who have lost limbs in combat," said Mark P. Jensen, PhD, a co-author of the study and an American Pain Society director. "The data clearly show that higher levels of pre-amputation pain predict acute pain, and acute post-amputation pain intensity predicts chronic phantom-limb pain after one year. These findings could help identify patients at greatest risk for chronic pain problems who will need early and aggressive pain interventions," Jensen explained.

Phantom-limb pain can be excruciating and occurs following amputation as the patient continues to feel sensations from the missing limb. This suggests limb perceptions may be hard wired in the brain and, therefore, contribute to pain sensations that last long after limb loss.

The authors noted there is some evidence that nerve-block anesthesia before amputation reduced the incidence of chronic phantom-limb pain, but this finding has not been replicated in further studies. Jensen said their results support further investigation to the efficacy of early interventions that can prevent or manage amputation-related pain.

APS President Judith Paice, PhD, RN, said the multidisciplinary organization will continue to promote further research to help control chronic pain problems in injured war veterans. "Our focus as pain care researchers and clinicians is on fostering greater understanding of how to most effectively treat serious pain in combat-wounded and other soldiers returning from Iraq and Afghanistan," she said.

The Journal of Pain is the monthly peer-review publication of the American Pain Society (APS). Based in Glenview, Ill., APS is a multidisciplinary community of approximately 3,200 members that brings together a diverse group of scientists, clinicians and other professionals to increase the knowledge of pain and transform public policy and clinical practice to reduce pain-related suffering.

American Pain Society
http://www.ampainsoc.org/