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Chronic and interventional pain
Prevalence and risk factors for chronic postamputation pain requiring analgesia or nerve interventions: a population-based study in East Asia
  1. Wen-Chih Liu1,2,
  2. Fu-Wei Su3,
  3. Sheng-You Su4,
  4. Chen-Hao Chiang5,
  5. Shu-Hsin Yao5,
  6. Chia-Lung Shih4 and
  7. Kyle R Eberlin6,7
  1. 1Department of Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
  2. 2School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
  3. 3Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
  4. 4Clinical Research Center, Ditmanson Medical Foundation Chiayi Christian Hospital, Chia-Yi, Taiwan
  5. 5Department of Orthopedics, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan
  6. 6Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
  7. 7Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Chia-Lung Shih; stone770116{at}gmail.com

Abstract

Background Postamputation pain (PAP) is underexplored in East Asian populations, with most data originating from Western countries. This study aimed to investigate the prevalence and risk factors of PAP in East Asian individuals who underwent surgical amputation, particularly those requiring subsequent analgesia or nerve interventions.

Materials and methods The study used data from the Longitudinal Health Insurance Database, encompassing claims from 2 million randomly selected individuals out of 23.5 million enrolled in Taiwan’s National Health Insurance Research Database from 2000 to 2019. The risk factors for PAP were analyzed using multivariable regression, considering criteria such as chronic postamputation pain, symptomatic neuroma treatment, chronic analgesia use, and nerve interventions.

Results Among the 7287 amputees (mean age 59.5 years; 65.1% male), 18.1% (95% CI 17.2%, 19.0%) (1318 patients) experienced PAP requiring intervention. Significant risk factors included cancer (OR 2.20 (95% CI 1.27, 3.68)), peripheral artery disease (OR 2.11 (95% CI 1.66, 2.69)), infection (OR 1.93 (95% CI 1.55, 2.40)), diabetes mellitus (OR 1.85 (95% CI 1.45, 2.37)), and a higher Elixhauser Comorbidity Index (OR 1.04 (95% CI 1.02, 1.06)). Prior radiculopathy (OR 1.30 (95% CI 1.13, 1.51)) and myelopathy (OR 1.33 (95% CI 1.14, 1.55)) also increased pain odds, while age showed a slight inverse association (OR 0.99 (95% CI 0.98, 0.99)).

Conclusion The prevalence of PAP requiring subsequent analgesia or nerve interventions in this East Asian population is 18.1%. Identified risk factors include multiple medical comorbidities and pre-existing radiculopathy or myelopathy. These findings highlight the important considerations for both clinical practice and future research directions.

  • Analgesics, Opioid
  • Orthopedic Procedures
  • Pain Management
  • Epidemiology
  • Surgery, Plastic

Data availability statement

Data are available upon reasonable request. This paper has no linked research data sets. Data from the National Health Insurance Research Database, administered by Taiwan’s Ministry of Health and Welfare (MOHW), are subject to stringent data protection laws and cannot be openly disclosed. Requests for data access must adhere to a formal application process outlined at http://dep.mohw.gov.tw. Please contact the staff of MOHW (Email: stdlwu@mohw.gov.tw) for assistance.

https://doi.org/10.1136/rapm-2024-105982

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    Data availability statement

    Data are available upon reasonable request. This paper has no linked research data sets. Data from the National Health Insurance Research Database, administered by Taiwan’s Ministry of Health and Welfare (MOHW), are subject to stringent data protection laws and cannot be openly disclosed. Requests for data access must adhere to a formal application process outlined at http://dep.mohw.gov.tw. Please contact the staff of MOHW (Email: stdlwu@mohw.gov.tw) for assistance.

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    Footnotes

    • S-HY and C-LS contributed equally.

    • Collaborators The study was not conducted by a working group.

    • Contributors Conceptualization: W-CL. Data curation: S-YS. Formal analysis: S-YS and C-LS. Funding acquisition: S-HY. Investigation: W-CL, F-WS, S-YS, and C-LS. Methodology: W-CL, F-WS, and KRE. Software: S-YS. Validation: S-YS. Supervision: KRE. Writing—original draft: W-CL and C-LS. Writing—review and editing: S-YS, C-HC, S-HY, and KRE. C-LS is responsible for the overall content as guarantor.

    • Funding This study was supported by the Ditmanson Medical Foundation Chia-Yi Christian Hospital (R112-035).

    • Competing interests KRE is a consultant for AxoGen Inc., Checkpoint Surgical Inc., Integra Lifesciences Inc., Tulavi Therapeutics Inc., and Biocircuit. Other coauthors have nothing to disclose.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.