Pharmacological treatment of postamputation pain – A six-year review in Ramathibodi Hospital’s pain relief unit
Keywords:
pharmacological, treatment, postamputation, painAbstract
Background: Postamputation pain is highly
prevalent after limb amputation. It remains an
extremely challenging pain condition to treat.
Although multidisciplinary pain management is
recommended, prescription of pain medication only
is more preferred. Objective: The aim of this study
was to retrospectively analyse type and dosage of
analgesics, the pain intensity before and after
medical treatment, and to review their side effects.
Methods: Medical records of all postamputation
pain patients whose pain was managed in our pain
relief unit from January 2010 to December 2015 were
reviewed. The pain intensity before treatment and
at the time lowest pain intensity achieved was
reviewed as well as analgesics and their side effects.
Results: Eighty patients were included. Half of
the patients (53.75%) were diagnosed with peripheral
vascular disease. Stump pain was reported in majority
of the patients (82.5%), while phantom limb pain
was found in 67.5% of the patients. Pain intensity
was reduced significantly at the time of lowest score
recorded (p<0.001). The median time to achieve
maximum pain reduction was 30 days (IQR 7-74.75).
Gabapentin was the main medication prescribed in
82.5% of the patients at a maximum dosage of 900
mg/day (IQR 500-1500). Long term use of opioids
was found in 13.75% of the patients at a maximum
dosage of 80 mg oral morphine/day (IQR 60-100).
Most common side effect was constipation, found in
28.75% of the patients. Conclusions: Postamputation
pain could be managed effectively by pain medications
with a significantly decrease in pain intensity. No
serious side effect was reported.
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