References

Abbey J, Piller N, Bellis AD The Abbey pain scale: a 1-minute nerical indicator for people with end-stage dementia. Int J Palliat Nurs.. 2004; 10:(1)6-13 https://doi.org/10.12968/ijpn.2004.10.1.12013

Appelboom T. Calcitonin in reflex sympathetic dystrophy syndrome and other painful conditions. Bone. 2002; 30:84-86 https://doi.org/10.1016/S8756-3282(02)00702-0

Azria M. Possible mechanisms of the analgesic action of calcitonin. Bone. 2002; 30:80-83 https://doi.org/10.1016/S8756-3282(02)00701-9

Ballantyne JC, Sullivan MD. Intensity of chronic pain—the wrong metric?. N Engl J Med. 2015; 373:(22)2098-2099 https://doi.org/10.1056/NEJMp1507136

Case report. Use of calcitonin to treat phantom limb pain. 2003. https://tinyurl.com/yxmcrls3 (accessed 9 May 2019)

Borghi B, D'Addabbo M, White PF The use of prolonged peripheral neural blockade after lower extremity amputation: the effect on symptoms associated with phantom limb syndrome. Anesth Analg. 2010; 111:(5)1308-1315 https://doi.org/10.1213/ANE.0b013e3181f4e848

Opioids for persistent pain: summary of guidance on good practice from the British Pain Society. Br J Pain. 2012; 6:(1)9-10 https://doi.org/10.1177/2049463712436536

Clarke H, Soneji N, Ko DT, Yun L, Wijeysundera DN. Rates and risk factors for prolonged opioid use after major surgery: population based cohort study. BMJ. 2014; 348 https://doi.org/10.1136/bmj.g1251

Closs SJ, Barr B, Briggs M, Cash K, Seers K. A comparison of five pain assessment scales for nursing home residents with varying degrees of cognitive impairment. J Pain Symptom Manage. 2004; 27:(3)196-205 https://doi.org/10.1016/j.jpainsymman.2003.12.010

Closs SJ, Staples V, Reid I, Bennett MI, Briggs M. The impact of neuropathic pain on relationships. J Adv Nurs.. 2009; 65:(2)402-411 https://doi.org/10.1111/j.1365-2648.2008.04892.x

Cole E. Exorcising the ghost of phantom limb. Nurs Stand. 2014; 29:(11)20-22 https://doi.org/10.7748/ns.29.9.20.s25

Dertwinkel R, Heinrichs C, Senne I Prevention of severe phantom limb pain by perioperative administration of ketamine—an observational study. Acute Pain. 2002; 4:(1)9-13 https://doi.org/10.1016/S1366-0071(02)00004-9

Dijkstra PU, Geertzen JHB, Stewart R, van der Schans CP. Phantom pain and risk factors: a multivariate analysis. J Pain Symptom Manage. 2002; 24:(6)578-585 https://doi.org/10.1016/S0885-3924(02)00538-9

Dunn V. The holistic assessment of the patient in pain. Prof Nurse. 2000; 15:(12)791-793

Falch C, Vicente D, Häberle H Treatment of acute abdominal pain in the emergency room: A systematic review of the literature. Eur J Pain. 2014; 18:(7)902-913 https://doi.org/10.1002/j.1532-2149.2014.00456.x

Foell J, Bekrater-Bodmann R, Diers M, Flor H. Mirror therapy for phantom limb pain: brain changes and the role of body representation. Eur J Pain. 2014; 18:(5)729-739 https://doi.org/10.1002/j.1532-2149.2013.00433.x

Fiddler DS, Hindman BJ. Intravenous calcitonin alleviates spinal anesthesia-induced phantom limb pain. Anesthesiology. 1991; 74:(1)187-189 https://doi.org/10.1097/00000542-199101000-00029

Gordon DB. Acute pain assessment tools. Curr Opin Anaesthesiol.. 2015; 28:(5)565-569 https://doi.org/10.1097/ACO.0000000000000225

Grant AJ, Wood C. The effect of intra-neural local anaesthetic infusion on pain following major lower limb amputation. Scott Med J. 2008; 53:(1)4-6 https://doi.org/10.1258/RSMSMJ.53.1.4

Gudala K, Ghai B, Bansal D. Usefulness of four commonly used neuropathic screening questionnaires in patients with chronic low back pain: a cross-sectional study. Korean J Pain. 2017; 30:(1)51-58 https://doi.org/10.3344/kjp.2017.30.1.51

Hackworth RJ, Tokarz KA, Fowler IM, Wallace SC, Stedje-Larsen ET. Profound pain reduction after induction of memantine treatment in two patients with severe phantom limb pain. Anesth Analg. 2008; 107:(4)1377-1379 https://doi.org/10.1213/ane.0b013e31817f90f1

Hayes C, Armstrong-Brown A, Burstal R. Perioperative intravenous ketamine infusion for the prevention of persistent post-amputation pain: a randomized, controlled trial. Anaesth Intensive Care. 2004; 32:(3)330-338 https://doi.org/10.1177/0310057X0403200305

The Health Foundation. Quality improvement made simple. What everyone should know about healthcare quality improvement. 2013. https://tinyurl.com/y2fpxzmv (accessed 7 May June 2019)

Humble SR. Calcitonin for acute neuropathic pain associated with spinal cord injury. Anaesth Intensive Care. 2011; 39:(4)682-686 https://doi.org/10.1177/0310057X1103900425

Jaeger H, Maier C. Calcitonin in phantom limb pain: a double-blind study. Pain. 1992; 48:(1)21-27 https://doi.org/10.1016/0304-3959(92)90127-W

Jensen MP, Chen C, Brugger AM. Postsurgical pain outcome assessment. Pain. 2002; 99:(1)101-109 https://doi.org/10.1016/S0304-3959(02)00063-5

Karanikolas M, Aretha D, Tsolakis I Optimized perioperative analgesia reduces chronic phantom limb pain intensity, prevalence, and frequency: a prospective, randomized, clinical trial. Anesthesiology. 2011; 114:(5)1144-1154 https://doi.org/10.1097/ALN.0b013e31820fc7d2

Keele University. The Keele STarT Back Screening Tool. 2007. https://tinyurl.com/y4dlbs8k (accessed 16 May 2019)

Lambert AW, Dashfield AK, Cosgrove C, Wilkins DC, Walker AJ, Ashley S. Randomized prospective study comparing preoperative epidural and intraoperative perineural analgesia for the prevention of postoperative stump and phantom limb pain following major amputation. Reg Anesth Pain Med. 2001; 26:(4)316-321 https://doi.org/10.1097/00115550-200107000-00007

Lavand'homme P. Optimised perioperative analgesia reduces chronic phantom limb pain intensity, prevalence and frequency: a prospective, randomised control trial. Anaesthesiology. 2011; 114:(5)1144-1154 https://doi.org/10.1097/ALN.0b013e31820fc7d2

Lovatt P. Legal and ethical implications of non-medical prescribing. Nurse Prescribing. 2010; 8:(7)340-343 https://doi.org/10.12968/npre.2010.8.7.48941

Lyritis GP, Trovas G. Analgesic effects of calcitonin. Bone. 2002; 30:(5)71-74 https://doi.org/10.1016/S8756-3282(02)00714-7

Madabhushi L, Reuben SS, Steinberg RB, Adesioye J. The efficacy of postoperative perineural infusion of bupivacaine and clonidine after lower extremity amputation in preventing phantom limb and stump pain. J Clin Anesth. 2007; 19:(3)226-229 https://doi.org/10.1016/j.jclinane.2006.07.008

National Institute for Health and Care Excellence. The guidelines manual. Appendix H: methodology checklist for qualitative research. 2012. https://tinyurl.com/y4bxrjwc (accessed 13 May 2019)

Neil MJE, Dale MC, Gillespie G. Successful use of Memantine in the treatment of severe phantom limb pain: case report and literature review. Scott Med J. 2010; 55:(2) https://doi.org/10.1258/rsmsmj.55.2.58b

Development of a best practice guideline for the prevention and management of acute phantom limb pain. 2014. https://tinyurl.com/yxf25eol (accessed 9 May 2019)

NHS Quality Improvement Scotland. National Overview—September 2005 Anaesthesia—care before, during and after anaesthesia. 2005. https://tinyurl.com/y5k6n24d (accessed 13 May 2019)

NHS Quality Improvement Scotland. Postoperative pain management. Best practice statement. 2004. https://tinyurl.com/y4z7f8b2 (accessed 9 May 2019)

NHS Quality Improvement Scotland. The management of pain in patients with cancer. Best practice statement. 2009. https://tinyurl.com/y6lmey5c (accessed 9 May 2019)

NHS Quality Improvement Scotland. Pain management following acute stroke. Best practice statement. 2011. https://tinyurl.com/y3akvjcz (accessed 9 May 2019)

NHS Tayside pain management guidelines book.Dundee: NHS Tayside; 2018

Nikolajsen L, Gottrup H, Kristensen AGD, Jensen TS. Memantine (a N-methyl-D-aspartate receptor antagonist) in the treatment of neuropathic pain after amputation or surgery: a randomized, double-blinded, cross-over study. Anesth Analg. 2000; 91:(4)960-966 https://doi.org/10.1097/00000539-200010000-00036

Pain Management Network. 5 A's—opioid monitoring tool. 2015. https://https://tinyurl.com/yxvjlzbd (accessed 9 May 2019)

Qin H, Cai J, Yang FS. Could calcitonin be a useful therapeutic agent for trigeminal neuralgia?. Med Hypotheses. 2008; 71:(1)114-116 https://doi.org/10.1016/j.mehy.2008.01.018

Rakic AM, Golembiewski J. Low-dose ketamine infusion for postoperative pain management. J Perianesth Nurs.. 2009; 24:(4)254-257 https://doi.org/10.1016/j.jopan.2009.05.097

Royal College of Anaesthetists, Association of Anaesthetists of Great Britain and Ireland. Good practice. A guide for departments of anaesthesia, critical care and pain management. 2006. https://tinyurl.com/y5ddzd47 (accessed 7 May 2019)

Royal College of Anaesthetists Faculty of Pain Medicine. Core standards for pain management services in the UK. 2015. https://tinyurl.com/yyr9j27w (accessed 9 May 2019)

Royal College of Surgeons of England, College of Anaesthetists Great Britain and Ireland. Report on the working party on pain after surgery. 1990. https://tinyurl.com/y6hzjhpb (accessed 9 May 2019)

Schley M, Topfner S, Wiech K Continuous brachial plexus blockade in combination with the NMDA receptor antagonist memantine prevents phantom pain in acute traumatic upper limb amputees. Eur J Pain. 2007; 11:(3)299-308 https://doi.org/10.1016/j.ejpain.2006.03.003

Burning questions on pain management: part 2. 2014. https://tinyurl.com/y6ftatpv (accessed 9 May 2019)

Schofield P. The assessment of pain in older people: UK national guidelines. Age Ageing. 2018; 47:i1-i22 https://doi.org/10.1093/ageing/afx192

Schug SA, Palmer GM, Scott DA, Halliwell R, Trinca J. Acute pain management: scientific evidence, fourth edition, 2015. Med J Aust.. 2016; 204:(8)315-317 https://doi.org/10.5694/mja16.00133

Scottish Government Polypharmacy Model of Care group. Polypharmacy guidance. Realistic prescribing. 2018. https://tinyurl.com/ybnrdx4t (accessed 7 May 2019)

Scottish Intercollegiate Guidelines Network. SIGN 136. Management of chronic pain. A clinical guideline. 2013. https://www.sign.ac.uk/assets/sign136.pdf (accessed 7 May 2019)

Scottish Intercollegiate Guidelines Network. Critical appraisal notes and checklists (SIGN 50). 2019. https://tinyurl.com/yyzrcfwx (accessed 15 May 2019)

Shanthanna H, Huilgol M, Manivackam V. Early and effective use of ketamine for treatment of phantom limb pain. Indian J Anaesth. 2010; 54:(2)157-159 https://doi.org/10.4103/0019-5049.63632

Steeds CE. The anatomy and physiology of pain. Surgery Oxford. 2013; 31:(2)49-53 https://doi.org/10.1016/j.mpsur.2012.11.005

Vase L, Nikolajsen L, Christensen B Cognitive-emotional sensitization contributes to wind-up-like pain in phantom limb pain patients. Pain. 2011; 152:(1)157-162 https://doi.org/10.1016/j.pain.2010.10.013

Vickers A, Bali S, Baxter A Consensus statement on the anticipation and prevention of acute postoperative pain: multidisciplinary RADAR approach. Curr Med Res Opin. 2009; 25:(10)2557-2569 https://doi.org/10.1185/03007990903281059

Visser EJ. A review of calcitonin and its use in the treatment of acute pain. Acute Pain. 2005; 7:(4)185-189 https://doi.org/10.1016/j.acpain.2005.09.003

Visser EJ, Kwei PL. Salmon calcitonin in the treatment of post herpetic neuralgia. Anaesth Intensive Care. 2006; 34:(5)668-671 https://doi.org/10.1177/0310057X0603400505

Wall GC, Heyneman CA. Calcitonin in phantom limb pain. Ann Pharmacother. 1999; 33:(4)499-501 https://doi.org/10.1345/aph.18204

Weeks SR, Anderson-Barnes VC, Tsao JW. Phantom limb pain: theories and therapies. Neurologist. 2010; 16:(5)277-286 https://doi.org/10.1097/NRL.0b013e3181edf128

Weinrib AZ, Azam MA, Birnie KA, Burns LC, Clarke H, Katz J. The psychology of chronic post-surgical pain: new frontiers in risk factor identification, prevention and management. Br J Pain. 2017; 11:(4)169-177 https://doi.org/10.1177/2049463717720636

The nursing process: assesssing, planning, implementing, evaluating. In: Yura H, Walsh M (eds). New York (NY): Appleton and Lange; 1967

Zoëga S, Sveinsdottir H, Sigurdsson GH, Aspelund T, Ward SE, Gunnarsdottir S. Quality pain management in the hospital setting from the patient's perspective. Pain Pract. 2015; 15:(3)236-246 https://doi.org/10.1111/papr.12166

Pain management in new amputees: a nursing perspective

23 May 2019
Clinical
02 May 2019
Volume 28 · Issue 10

Abstract

Phantom limb pain (PLP) is a widespread and challenging neuropathic pain problem, occurring after both surgical and traumatic amputation of a limb. It may occur immediately after surgery or some months later, however, most cases it presents within the first 7 postoperative days. Patients report a range of pain characteristics in the absent limb, including burning, cramping, tingling and electric shock sensation. The incidence of PLP has been reported to be between 50% and 85% following amputation. Its management is notoriously difficult, with no clear consensus on optimal treatment. It is often resistant to classic balanced analgesia and typical neuropathic pain medications. Taking into account these issues, the authors aimed to improve the management of patients undergoing amputation at their institution, by ensuring accurate and holistic assessment, the selection of suitable interventions through critical analysis and synthesis of available evidence, and the appropriate evaluation and adaptation of treatment plans, to ensure patients achieved their individualised goals.

Pain after amputation is a distressing and difficult problem to treat. Patients may experience significant surgical wound pain and/or the challenging phenomenon of phantom limb pain (PLP). Individuals in this patient group often have preoperative ischaemic pain, require repeated revascularisation surgeries and display catastrophic behaviours regarding the change in their life and body image following amputation. These biopsychosocial factors predispose individuals to the risk of poorly controlled postoperative pain. Uncontrolled, acute pain following surgery further compounds the situation, with studies linking a higher postoperative pain score for stump pain with an increased presentation of PLP (Dijkstra et al, 2002).

Contemporary studies have highlighted the importance of acute pain management in the prevention of ongoing post-surgical pain, and this is especially relevant after amputation (Karanikolas et al, 2011; Lavand'homme, 2011; Schug et al, 2016).

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Phantom limb pain
Amputation
Pain management
Pain assessment
Nursing care
Post-amputation pain