Role of myofascial trigger points in post-amputation pain: causation and management.
BACKGROUND
Post-amputation pain is a multifactorial issue and thus necessitates multiple treatment strategies. Myofascial trigger points-related pain remains under diagnosed and hence not addressed. This study investigates causation and management.


OBJECTIVE
To identify the presence and role of myofascial trigger points in post amputation pain.


METHODS
Post-amputation pain clinic review and recruitment.


METHODS
Twenty one identified patients in the post-amputation pain clinic with myofascial trigger points were recruited, of which 13 were transtibial and eight transfemoral and all had phantom limb pain and stump pain. The trigger points were identified and injected with long-acting local anaesthetic on a weekly basis and patients were followed up on an ongoing basis.


RESULTS
There was significant resolution of pain on the Visual Analogue Scale in the majority of these patients within five weeks, though some of the transtibial cohort needed further eight injections on a weekly basis for resolution of the pain.


CONCLUSIONS
Identification of myofascial trigger points in amputation stumps and their role in post-amputation pain, followed by appropriate intervention is an important facet of management of this complex chronic pain. Clinical relevance Myofascial trigger points in amputation stumps can lead to ongoing chronic post-amputation pain and our results indicate that identification and intervention of these trigger points does lead to notable resolution of this pain.
University Hospitals of South Manchester, Manchester, UK. jai.kulkarni@uhsm.nhs.uk
Finn
F
Reiestad
Jai
J
Kulkarni
D000672:Amputation Stumps / Q000503:physiopathology; D000779:Anesthetics, Local / Q000627:therapeutic use; D015331:Cohort Studies; D019468:Disease Management; D005260:Female; D005269:Femur / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009209:Myofascial Pain Syndromes / Q000188:drug therapy* / Q000503:physiopathology*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000503:physiopathology*; D010591:Phantom Limb / Q000188:drug therapy / Q000503:physiopathology; D013977:Tibia / Q000601:surgery; D016896:Treatment Outcome
D000779:Anesthetics, Local