SURGICAL TREATMENT OF POSTAMPUTATION RESIDUAL LIMB PAIN AFTER GUNSHOT WOUNDS AND COMBAT TRAUMA

Abstract

Abstract. Background. Up to 50-80 % of military service members after amputation suffer from postamputation pain. Residual limb pain significantly postpones prosthetics, recovery, employability, negatively impacts on rehabilitation and military duty performance. Objective. To study residual limb pain types in military service members after traumatic amputation and efficacy of surgical treatment methods. Methods. Randomized cross-sectional study of 231 active duty military service members with residual limb pain after combat traumatic amputation, who underwent surgical treatment in Military Medical Clinical Center of Western Region in 2022-2023. Results. Somatic stump pain was observed in 36.36 % of enrolled patients, which was mainly caused by osteophytes (30,74 %). 41.13 % of patients experienced neuropathic residual limb pain. Pain syndrome of 22.51 % amputees was resulted from both somatic causes and neuromas. Prosthesis-associated pain, as a type of somatic pain, was observed in 17.32 % of individuals. In contrast to simple resections, lidocaine-alcohol injections of painful terminal neuromas demonstrated significantly lower retention or recurrence of neuropathic pain (P value=0.013) during the period of 3–6 months. During 1-2 months after RPNI, which was performed for 25 terminal neuromas, no pain retention 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 painful neuromas. In order to treat neuropathic pain caused by terminal neuromas, lidocaine-alcohol injections are sufficiently simple and effective ()8.70±6.77) % of reinjections). Regenerative peripheral nerve interface is promising in symptomatic neuromas treatment and prevention.