Complementary pain intervention pilot study in the acute hospitalization phase after lower extremity amputation surgery

Abstract

Complementary pain intervention pilot study in the acute hospitalization phase after lower extremity amputation surgery. The national prevalence of limb loss is approximately 1.7 million people. Leading causes of this type of loss are diabetes and peripheral vascular disease. Diabetics are more likely than non-diabetics to have an amputation. Sixty percent of non-traumatic amputations occur in diabetics. Although preventive care measures are improving for diabetics, the epidemiological rate of increase in diabetes will continue over the next thirty years. The rate increase is projected to have an equal increase in the amputation rate. Along with amputation, comes a pain sequela that becomes chronic in nature. Pain management after amputation requires a specific regimen of pain control for the amputee. Primary pain management in the acute hospitalization phase focuses on pharmacologic management. To date, no studies have examined a complementary intervention along with pharmacologic measures immediately after surgery. The purpose of this study was to investigate the feasibility and efficacy of a desensitization protocol in the immediate postoperative period for patients who had a major lower limb amputation, along with the impact of demographic factors, clinical factors and treatment fidelity on pain level, use of pain medication, anxiety and depression. Roy's Adaptation Theory and Melzack's Neuromatrix Theory of Pain provide the framework for this study. Using a prospective repeated measure design with convenience sampling, data was collected from twelve patients after lower limb amputation surgery in a large medical facility in the southeastern United States. This study found that in the acute hospital setting after amputation surgery continuous, intermittent and neuropathic pain is present. Total pain intensity mean scores decreased during repeated measurement periods for each pain type. Several correlations were noted in this study. Continuous pain and intermittent pain showed a significant correlation during all time periods of the study. By the last day of the study, present pain, SF-MPQ-2 total score, continuous pain, intermittent pain and neuropathic pain showed a strong correlation with medication dosing. A number of other strong correlations were noted among the measures. Feasibility of the desensitization protocol showed that all participants felt the protocol was easy to use. The majority felt it helped their pain. During self-administration of desensitization the participants recorded each intervention with a numerical pain score before and after intervention. During postoperative days two through five, a large effect size was noted in paired comparisons of pain for each day that reached statistical significance. This study supports previous studies that multiple types of pain are present after amputation surgery. Overall, pain intensity scores decreased during the study. Desensitization was supported as being feasible and efficacious as a complementary therapy for this sample. Nurses provide pain control measures to patients daily. Finding ways to modulate the pain using self-administer techniques such as used in this study provides improved patient outcomes. Further studies need to be conducted in a larger sample on complementary pain measures