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Date of Award
Spring 2021
Degree Name
Master of Medical Science (Physician Assistant)
Department
Physician Assistant; College of Health Sciences
First Advisor
Erin Wolf BSN, M.S., PA-C
Abstract
Introduction: Chronic pain following limb loss is a rapidly growing morbidity that reduces quality of life. Many treatment types exist, but none have proved efficacious so there is no gold standard. Considering the added risks of surgical interventions, determining if improved pain reduction results could guide treatment decisions. This paper addresses the question: In adults suffering from chronic post major lower limb amputation pain, would surgical interventions when compared with non-surgical lead to improved pain reduction?
Methods: A literature search was completed through Academic Search Ultimate and Pubmed in November 2019. Of the 31 articles found using the search terms, 7 remained after exclusion criteria was applied.
Results: Analysis of the literature showed all interventions, surgical and non-surgical, found statistically significant reductions in pain. Six studies found decreased pain from baseline. One found >50% reduction in >50% of subjects. Two studies found reduction of pain with prosthesis use. And one study found a reduction in pain medication use. Many limitations were present throughout. All provided Level IV evidence.
Discussion: All studies had positive results and similar study designs. However, variance in follow-up and outcome measures made comparison of results difficult. The use of case series study design weakened power of results. Measurement instruments, analysis, and bias added validity concerns. Comparison of significant results for surgical vs. non-surgical interventions found no differences in pain decrease from baseline, more surgical interventions showed prosthesis pain decreases, and more non-surgical interventions showed decreased pain medication use.
Conclusion: Current efficacy of chronic post major lower limb amputation pain treatments evidence is inadequate to determine whether surgical or non-surgical interventions lead to improved pain reduction. More research on efficacy, consisting of RCTs, plus studies directly comparing the two modalities are necessary. Clinicians should continue utilizing scientific evidence and clinical judgment when making treatment decisions.
Recommended Citation
Chong, Julia, "Surgical vs. Non-surgical Pain Reduction Interventions for Adults Suffering From Chronic Post Major Lower Limb Amputation Pain" (2021). Capstone Showcase. 83.
https://scholarworks.arcadia.edu/showcase/2021/pa/83
Surgical vs. Non-surgical Pain Reduction Interventions for Adults Suffering From Chronic Post Major Lower Limb Amputation Pain
Introduction: Chronic pain following limb loss is a rapidly growing morbidity that reduces quality of life. Many treatment types exist, but none have proved efficacious so there is no gold standard. Considering the added risks of surgical interventions, determining if improved pain reduction results could guide treatment decisions. This paper addresses the question: In adults suffering from chronic post major lower limb amputation pain, would surgical interventions when compared with non-surgical lead to improved pain reduction?
Methods: A literature search was completed through Academic Search Ultimate and Pubmed in November 2019. Of the 31 articles found using the search terms, 7 remained after exclusion criteria was applied.
Results: Analysis of the literature showed all interventions, surgical and non-surgical, found statistically significant reductions in pain. Six studies found decreased pain from baseline. One found >50% reduction in >50% of subjects. Two studies found reduction of pain with prosthesis use. And one study found a reduction in pain medication use. Many limitations were present throughout. All provided Level IV evidence.
Discussion: All studies had positive results and similar study designs. However, variance in follow-up and outcome measures made comparison of results difficult. The use of case series study design weakened power of results. Measurement instruments, analysis, and bias added validity concerns. Comparison of significant results for surgical vs. non-surgical interventions found no differences in pain decrease from baseline, more surgical interventions showed prosthesis pain decreases, and more non-surgical interventions showed decreased pain medication use.
Conclusion: Current efficacy of chronic post major lower limb amputation pain treatments evidence is inadequate to determine whether surgical or non-surgical interventions lead to improved pain reduction. More research on efficacy, consisting of RCTs, plus studies directly comparing the two modalities are necessary. Clinicians should continue utilizing scientific evidence and clinical judgment when making treatment decisions.