Phantom Limb Pain and Painful Neuroma After Dysvascular Lower-Extremity Amputation: A Systematic Review and Meta-Analysis.

BACKGROUND: Phantom limb pain (PLP) and symptomatic neuroma can be debilitating and significantly impact the quality of life of amputees. However, the prevalence of PLP and symptomatic neuromas in patients following dysvascular lower limb amputation (LLA) has not been reliably established. This systematic review and meta-analysis evaluates the prevalence and incidence of phantom limb pain and symptomatic neuroma after dysvascular LLA. METHODS: Four databases (Embase, MEDLINE, Cochrane Central, and Web of Science) were searched on October 5th, 2022. Prospective or retrospective observational cohort studies or cross-sectional studies reporting either the prevalence or incidence of phantom limb pain and/or symptomatic neuroma following dysvascular LLA were identified. Two reviewers independently conducted the screening, data extraction, and the risk of bias assessment according to the PRISMA guidelines. To estimate the prevalence of phantom limb pain, a meta-analysis using a random effects model was performed. RESULTS: Twelve articles were included in the quantitative analysis, including 1924 amputees. A meta-analysis demonstrated that 69% of patients after dysvascular LLA experience phantom limb pain (95% CI 53-86%). The reported pain intensity on a scale from 0-10 in LLA patients ranged between 2.3 ± 1.4 and 5.5 ± .7. A single study reported an incidence of symptomatic neuroma following dysvascular LLA of 5%. CONCLUSIONS: This meta-analysis demonstrates the high prevalence of phantom limb pain after dysvascular LLA. Given the often prolonged and disabling nature of neuropathic pain and the difficulties managing it, more consideration needs to be given to strategies to prevent it at the time of amputation.

Preoperative indicators of the effectiveness of surgical release in de Quervain patients: a prospective cohort study.

BACKGROUND: A significant proportion of patients still report pain following a surgical release for de Quervain disease (DQ). This study aimed to investigate the effectiveness of a surgical release for DQ and to identify the preoperative factors associated with pain after a surgical release for DQ. METHODS: This prospective cohort study includes 707 patients who underwent a surgical release and completed the Visual Analog Scale Questionnaire (VAS, range 0-100). We used a paired t-test to analyse the effectiveness of the surgical release on pain at three months post-operatively compared to the pre-operatively measured outcome. A hierarchical multivariable linear regression model was created to investigate the contribution of the patient- and disease characteristics to post-operative pain. RESULTS: All VAS domains showed improvement after surgical release. On average, the mean VAS pain decreased by 44 points (95% CI 42; 46). Smoking (B=6.37; p<0.01), younger age (B=-0.35; p<0.01), longer duration of complaints (B=0.13; p<0.01), concomitant surgery (B=14.40; p<0.01) and higher VAS pain scores at intake (B=0.15; p<0.01) were associated with worse VAS pain scores post-operatively. Together, the variables explained 11% of the variance in mean VAS pain score at three months of follow-up. CONCLUSION: This study confirms that surgical treatment for patients with DQ significantly reduces patient-reported pain. Smoking, younger age, concomitant surgery, duration of complaints, and higher VAS pain scores at intake are associated with worse patient-reported pain three months after surgical release. However, the small effects suggest that these factors should not be considered the only important factors. LEVEL OF EVIDENCE: Therapeutic, II.

Surgical Treatment Outcome of de Quervain's Disease: A Systematic Review and Meta-analysis.

Background: Surgical release of the extensor retinaculum is performed as a treatment for de Quervain's (DQ) disease when conservative treatment fails. In the literature, there is no consensus about the effectiveness of a surgical release in patients with DQ, the complication rate, or which type of incision is superior. Therefore, a systematic review and meta-analysis were conducted. Methods: A systematic search was performed in Embase, Medline Ovid, Web of Science Core Collection, Cochrane, and Google Scholar. Articles regarding surgical treatment of DQ disease that reported outcome and complications were included. We extracted exact values of visual analog scale scores and percentages of patients who experienced pain at follow-up. Complications assessed were (sub) luxation, superficial radial nerve injuries, wound infections, and scar problems. Results: Twenty-one studies with a total of 939 patients were included. Five percent of these patients (95% CI 1%-18%) did not show complete remission of pain at follow-up. When pooled, the mean reduction in visual analog scale scores was 5.7 (95% CI 5.3-6.1) on a 0-10 scale. No difference in outcome between different types of surgery or incisions was seen. Based on the meta-analysis, the pooled complication rate was 11% (95% CI 5%-22%). Conclusions: Five percent of patients still have residual pain after surgical release of the first extensor compartment. Surgery type, as well as the type of incision, did not affect outcome or complication. Thus, surgical release of the extensor retinaculum for DQ disease is an effective treatment, regardless of the type of surgery.