AOCPMR 2024 Mid-Year Meeting-Pain Management in the Amputee

Video Transcription

Video Summary

This comprehensive presentation addressed pain management in amputees, highlighting the complexity and variability of their pain experiences. Pain is a subjective symptom, not a diagnosis, and varies widely among individuals. Types of amputee pain include acute postoperative pain, phantom limb pain (experienced by 50-90% of amputees), neuropathic, inflammatory, ischemic, prosthetic-related, and musculoskeletal pain. Phantom limb pain arises from maladaptive neuroplasticity in the brain and spinal cord sensitization, making treatment challenging.<br /><br />Treatment approaches are multifaceted ("kitchen sink" approach), including medications like gabapentin and amitriptyline, topical agents (e.g., capsaicin), and less common drugs like calcitonin and ketamine. Non-pharmacologic therapies such as mirror therapy, graded motor imagery, and virtual reality show promise, with mirror therapy having strong evidence. Interventional options include peripheral nerve blocks, botulinum toxin, nerve ablations, and peripheral nerve stimulators, although results vary.<br /><br />Addressing prosthesis-related pain involves assessing fit using tests like the "lipstick test" and managing complications like neuromas, bursitis, heterotopic ossification, and contractures. Musculoskeletal pain arises from imbalances and overuse, requiring rehabilitation to restore symmetry and strength.<br /><br />Overall, a multimodal, individualized, and interdisciplinary approach involving pain management, therapy, prosthetics, surgery, and psychological support is essential. Early intervention and ongoing patient engagement are key to improving function and quality of life in amputees.

Keywords

shoulder anatomy

wheelchair users

physical medicine

sports medicine

shoulder pathology diagnosis

musculoskeletal structure

wheelchair propulsion

ergonomic wheelchairs

nerve stimulation pain relief

amputee pain management

phantom limb pain

neuropathic pain

gabapentin

mirror therapy

peripheral nerve blocks

prosthesis-related pain

musculoskeletal rehabilitation

multimodal pain treatment