title: Pain Phenotypes and Associated Clinical Risk Factors Following Traumatic Amputation: Results from Veterans Integrated Pain Evaluation Research (VIPER).
abstract: OBJECTIVE
  To define clinical phenotypes of postamputation pain and identify markers of risk for the development of chronic pain.
  
  
  METHODS
  Cross-sectional study of military service members enrolled 3-18 months after traumatic amputation injury.
  
  
  METHODS
  Military Medical Center.
  
  
  METHODS
  124 recent active duty military service members.
  
  
  METHODS
  Study subjects completed multiple pain and psychometric questionnaires to assess the qualities of phantom and residual limb pain. Medical records were reviewed to determine the presence/absence of a regional catheter near the time of injury. Subtypes of residual limb pain (somatic, neuroma, and complex regional pain syndrome) were additionally analyzed and associated with clinical risk factors.
  
  
  RESULTS
  A majority of enrolled patients (64.5%) reported clinically significant pain (pain score ≥ 3 averaged over previous week). 61% experienced residual limb pain and 58% experienced phantom pain. When analysis of pain subtypes was performed in those with residual limb pain, we found evidence of a sensitized neuroma in 48.7%, somatic pain in 40.8%, and complex regional pain syndrome in 19.7% of individuals. The presence of clinically significant neuropathic residual limb pain was associated with symptoms of PTSD and depression. Neuropathic pain of any severity was associated with symptoms of all four assessed clinical risk factors: depression, PTSD, catastrophizing, and the absence of regional analgesia catheter.
  
  
  CONCLUSIONS
  Most military service members in this cohort suffered both phantom and residual limb pain following amputation. Neuroma was a common cause of neuropathic pain in this group. Associated risk factors for significant neuropathic pain included PTSD and depression. PTSD, depression, catastrophizing, and the absence of a regional analgesia catheter were associated with neuropathic pain of any severity.
authors.forename: Thomas
authors.initials: T
authors.lastname: Buchheit
authors.forename: Thomas
authors.initials: T
authors.lastname: Van de Ven
authors.forename: Hung-Lun John
authors.initials: HL
authors.lastname: Hsia
authors.forename: Mary
authors.initials: M
authors.lastname: McDuffie
authors.forename: David B
authors.initials: DB
authors.lastname: MacLeod
authors.forename: William
authors.initials: W
authors.lastname: White
authors.forename: Alexander
authors.initials: A
authors.lastname: Chamessian
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Keefe
authors.forename: Chester Trip
authors.initials: CT
authors.lastname: Buckenmaier
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Shaw
mesh_terms: D000328:Adult; D000671:Amputation, Surgical / Q000379:methods; D000673:Amputation, Traumatic / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology / Q000628:therapy; D000698:Analgesia / Q000009:adverse effects; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D009463:Neuroma / Q000150:complications / Q000628:therapy; D010147:Pain Measurement; D010591:Phantom Limb / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014728:Veterans; D055815:Young Adult