Mioton Lauren M, Dumanian Gregory A, Fracol Megan E, Apkarian A Vania, Valerio Ian L, Souza Jason M, Potter Benjamin K, Tintle Scott M, Nanos George P, Ertl William J, Ko Jason H, Jordan Sumanas W
Division of Plastic Surgery, Northwestern Feinberg School of Medicine, Chicago, Ill.
The Department of Physiology, Northwestern Feinberg School of Medicine, Chicago, Ill.
Plast Reconstr Surg Glob Open. 2020 Jul 15;8(7):e2977. doi: 10.1097/GOX.0000000000002977. eCollection 2020 Jul.
More than 75% of major limb amputees experience chronic pain; however, data on severity and experience of pain are inconsistent. Without a benchmark using quantitative patient-reported outcomes, it is difficult to critically assess the efficacy of novel treatment strategies. Our primary objective is to report quantitative pain parameters for a large sample of amputees using the validated Patient-reported Outcomes Measurement System (PROMIS). Secondarily, we hypothesize that certain patient factors will be associated with worse pain.
PROMIS and Numerical Rating Scales for residual limb pain (RLP) and phantom limb pain (PLP) were obtained from a cross-sectional survey of upper and lower extremity amputees recruited throughout North America via amputee clinics and websites. Demographics (gender, age, race, and education) and clinical information (cause, amputation level, and time since amputation) were collected. Regression modeling identified factors associated with worse pain scores ( < 0.05).
Seven hundred twenty-seven surveys were analyzed, in which 73.4% reported RLP and 70.4% reported PLP. Median residual PROMIS scores were 46.6 [interquartile range (IQR), 41-52] for RLP Intensity, 56.7 (IQR, 51-61) for RLP Behavior, and 55.9 (IQR, 41-63) for RLP Interference. Similar scores were calculated for PLP parameters: 46.8 (IQR, 41-54) for PLP Intensity, 56.2 (IQR, 50-61) for PLP Behavior, and 54.6 (IQR, 41-62) for PLP Interference. Female sex, lower education, trauma-related amputation, more proximal amputation, and closer to time of amputation increased odds of PLP. Female sex, lower education, and infection/ischemia-related amputation increased odds of RLP.
This survey-based analysis provides quantitative benchmark data regarding RLP and PLP in amputees with more granularity than has previously been reported.
超过75%的主要肢体截肢者经历慢性疼痛；然而，关于疼痛严重程度和体验的数据并不一致。如果没有使用患者报告的定量结果作为基准，就很难严格评估新治疗策略的疗效。我们的主要目标是使用经过验证的患者报告结果测量系统（PROMIS）报告大量截肢者的定量疼痛参数。其次，我们假设某些患者因素将与更严重的疼痛相关。
通过截肢者诊所和网站对北美各地招募的上肢和下肢截肢者进行横断面调查，获取PROMIS以及残肢疼痛（RLP）和幻肢疼痛（PLP）的数字评分量表。收集人口统计学信息（性别、年龄、种族和教育程度）和临床信息（病因、截肢水平和截肢后时间）。回归模型确定与更差疼痛评分相关的因素（<0.05）。
分析了727份调查问卷，其中73.4%报告有RLP，70.4%报告有PLP。RLP强度的PROMIS中位数分数为46.6[四分位间距（IQR），41 - 52]，RLP行为为56.7（IQR，51 - 61），RLP干扰为55.9（IQR，41 - 63）。PLP参数计算出类似的分数：PLP强度为46.8（IQR，41 - 54），PLP行为为56.2（IQR，50 - 61），PLP干扰为54.6（IQR，41 - 62）。女性、低教育程度、创伤相关截肢、更近端的截肢以及更接近截肢时间会增加PLP的几率。女性、低教育程度以及感染/缺血相关截肢会增加RLP的几率。
这项基于调查的分析提供了关于截肢者RLP和PLP的定量基准数据，其粒度比以前报告的更大。
