The impact of immunological parameters on the development of phantom pain after major amputation.
OBJECTIVE
To investigate the relationship between local and systemic inflammatory markers and phantom limb pain.


METHODS
In 39 consecutive patients undergoing major amputations nerve biopsies, serum and clinical data was collected. Patients were followed up for 12 months to report on the incidence and severity of phantom limb pain.


RESULTS
After 12 months, 78% of the surviving patients had phantom pain, the symptom usually commencing within 14 days of operation. The severity of macrophage infiltration within the nerve biopsy was negatively correlated to the inception of phantom pain ( P = 0.026). While serum TNF-alpha concentration was positively correlated to mortality ( P = 0.021).


CONCLUSIONS
The immune status existing before the amputation and the local immunological milieu influence the onset of phantom pain.
Stremmel
C
C
Section of Vascular surgery, Department of Surgery, Friedrich Alexander Universität Erlangen-Nürnberg, Erlangen, Germany. stremmel@ch11.ukl.uni-freiburg.de
Horn
C
C
Eder
S
S
Dimmler
A
A
Lang
W
W
D000671:Amputation, Surgical / Q000009:adverse effects*; D015703:Antigens, CD / Q000276:immunology* / Q000378:metabolism; D015214:Antigens, Differentiation, Myelomonocytic / Q000276:immunology* / Q000378:metabolism; D001402:B-Lymphocytes / Q000276:immunology; D015415:Biomarkers / Q000378:metabolism; D001706:Biopsy; D017252:CD3 Complex / Q000276:immunology* / Q000378:metabolism; D004797:Enzyme-Linked Immunosorbent Assay; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D007249:Inflammation / Q000276:immunology / Q000378:metabolism / Q000473:pathology; D008264:Macrophages / Q000276:immunology / Q000473:pathology; D010525:Peripheral Nerves / Q000473:pathology; D010591:Phantom Limb / Q000276:immunology* / Q000378:metabolism / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D013601:T-Lymphocytes / Q000276:immunology; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism*; D000097382:CD68 Molecule
D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D015415:Biomarkers; D017252:CD3 Complex; D014409:Tumor Necrosis Factor-alpha; C067980:CD68 antigen, human; D000097382:CD68 Molecule