Management of different types of postamputation residual limb pain amid full scale war

Abstract

Background. Up to 50–80 % of military service members suffer from postamputation pain. Residual limb pain significantly postpones prosthetic surgery, recovery, employability, negatively impacts rehabilitation and military duty performance. The purpose was to study residual limb pain types in military personnel after traumatic amputation and efficacy of methods for their treatment. Materials and methods. A randomized cross-sectional study was performed of 231 military service members with residual limb pain after combat traumatic amputation, who underwent surgical treatment in tertiary and quaternary level military medical center between 2022 and 2024 amid full-scale war. Results. Somatic residual limb pain was observed in 36.36 % of enrolled patients, which was mainly caused by heterotopic ossification (30.74 %). 41.13 % of amputees experienced neuropathic pain due to neuromas. Pain syndrome in 22.51 % of patients resulted from both somatic causes and neuromas. Prosthesis-associated pain as a type of somatic pain was observed in 17.32 % of individuals. This study found that the persistence or recurrence of neuropathic pain among patients from the group of lidocaine-alcohol injection for painful neuromas was significantly lower (Pα = 0.013) at 6-month follow-up compared to the simple neuroma resection group. During 3 months after regenerative peripheral nerve interface, which was performed for 25 terminal neuromas, no pain recurrence was observed. Conclusions. It is important to assume the presence of one or both pain types in a patient with residual limb pain: somatic and/or neuropathic. Simple neuroma resections lead to an undesirably high reoperation rate — 21.79 ± 4.86 % of persistent painful neuromas. Lidocaine-alcohol injections are sufficiently simple and effective (8.70 ± 3.26 % of reinjections) in the treatment of neuropathic pain caused by terminal neuromas. Regenerative peripheral nerve interface is promising in the treatment and prevention of symptomatic neuroma.