Journal of Rehabilitation Research & Development (JRRD)

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Volume 52 Number 4, 2015
   Pages 441 — 448

Abstract — Cross-sectional study of alteration of phantom limb pain with visceral stimulation in military personnel with amputation

Michael Rafferty, MRCS;1* Thomas M. Bennett Britton, MRCGP;1 Benjamin T. Drew, MCSP;2 Rhodri D. Phillip, FRCP1

1Defence Medical Rehabilitation Centre Headley Court, Headley, Epsom, Surrey, United Kingdom; 2Musculoskeletal Physiotherapy Services, Friarage Hospital, South Tees Hospitals National Health Service Foundation Trust,
Northallerton, North Yorkshire, United Kingdom

Abstract — While phantom limb pain is a well-recognized phenomenon, clinical experience has suggested that the augmentation of phantom limb pain with visceral stimulation is an issue for many military personnel with amputation (visceral stimulation being the sensation of the bowel or bladder either filling or evacuating). However, the prevalence of this phenomenon is not known. The aim of this study was to investigate the prevalence of the alteration in phantom limb pain and the effect that visceral stimulation has on phantom limb pain intensity. A cross-??sectional study of 75 military personnel who have lost one or both lower limbs completed a questionnaire to assess the prevalence of the alteration of phantom limb pain with visceral stimulation. Included in the questionnaire was a pain visual analog scale (VAS) graded from 0 to 10. Patients recorded the presence and intensity of phantom limb pain. They also recorded whether and how this pain altered with a need to micturate or micturition, and/or a need to defecate or defecation, again using a pain VAS. Time since amputation, level of amputation, and medications were also recorded. Patients reported a phantom limb pain prevalence of 85% with a mean VAS of 3.6. In all, 56% of patients reported a change in the severity of phantom limb pain with visceral stimuli. The mean increase in VAS for visceral stimulation was 2.5 +/– 1.6 for bladder stimulation and 2.9 +/– 2.0 for bowel stimulation. Of the patients questioned, 65% reported an improvement in symptoms over time. VAS scores were highest in the subgroup less than 6 mo postamputation. An increase in phantom limb pain with visceral stimulation is a common problem for military personnel with amputation.

Key words: amputation, bladder function, bowel function, defecation, micturition, military, phantom limb, phantom pain, phantom sensation, pain.


View HTML ¦ View PDF ¦ Contents Vol. 52, No.4

This article and any supplementary material should be cited as:
Rafferty M, Bennett Britton TM, Drew BT, Phillip RD. Cross-sectional study of alteration of phantom limb pain with visceral stimulation in military personnel with amputation. J Rehabil Res Dev. 2015;52(4):441–48.
http://dx.doi.org/10.1682/JRRD.2014.04.0114
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