title: Amputation in patients with complex regional pain syndrome: a comparative study between amputees and non-amputees with intractable disease.
abstract: OBJECTIVE
  Amputation in intractable cases of complex regional pain syndrome (CRPS) remains controversial. The likelihood of recurrent Complex Regional Pain Syndrome (CRPS), residual and phantom limb pain and persistent disability after amputation is poorly described in the literature. The aims of this study were to compare pain, function, depression and quality of life between patients with intractable CRPS who underwent amputation and those in whom amputation was considered but not performed.
  
  
  METHODS
  There were 19 patients in each group, with comparable demographic details. The amputated group included 14 men and five women with a mean age of 31 years (sd 12) at the time of CRPS diagnosis. The non-amputated group consisted of 12 men and seven women and their mean age of 36.8 years (sd 8) at CRPS diagnosis. The mean time from CRPS diagnosis to (first) amputation was 5.2 years (sd 4.3) and the mean time from amputation to data collection was 6.6 years (sd 5.8). All participants completed the following questionnaires: Short-Form (SF) 36, Short Form McGill Pain questionnaire (SF-MPQ), Pain Disability Index (PDI), the Beck Depression Inventory (BDI) and a clinical demographic questionnaire.
  
  
  RESULTS
  The amputation group showed consistently better results compared to the non-amputation group in the following parameters: median pain intensity (VAS): 80 (inter-quartile range (IQR) 13 to 92) vs 91 (IQR 85 to 100); p = 0.007; median SF-MPQ score 28 (IQR 9 to 35) vs 35 (IQR 31 to 38), p = 0.025; median PDI: 42 (IQR 11 to 64) vs 58 (IQR 50 to 62), p = 0.031; median BDI: 19 (IQR 5 to 28) vs 27 (IQR 21 to 32), p = 0.061 (borderline significant) and in six of the eight SF-36 domains.
  
  
  CONCLUSIONS
  Amputation should be considered as a form of treatment for patients with intractable CRPS.
authors.affiliation: Institute of Pain Medicine, Pain Research Unit, Rambam Health Care Campus, P.O. Box 9602, Haifa 3109601, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Midbari
authors.affiliation: Institute of Pain Medicine, Pain Research Unit, Rambam Health Care Campus, P.O. Box 9602, Haifa 3109601, Israel.
authors.forename: E
authors.initials: E
authors.lastname: Suzan
authors.affiliation: Institute of Pain Medicine, Rambam Health Care Campus, Haifa, Israel.
authors.forename: T
authors.initials: T
authors.lastname: Adler
authors.affiliation: Rambam Health Care Campus, Department of Orthopedics Haifa, Israel.
authors.forename: E
authors.initials: E
authors.lastname: Melamed
authors.affiliation: Rambam Health Care Campus, Department of Orthopedics, Haifa, Israel.
authors.forename: D
authors.initials: D
authors.lastname: Norman
authors.affiliation: Institute of Pain Medicine, Rambam Health Care Campus, Haifa, Israel.
authors.forename: S
authors.initials: S
authors.lastname: Vulfsons
authors.affiliation: Institute of Pain Medicine, Pain Research Unit, Rambam Health Care Campus, P.O. Box 9602, Haifa 3109601, Israel.
authors.forename: E
authors.initials: E
authors.lastname: Eisenberg
mesh_terms: D000328:Adult; D000671:Amputation, Surgical; D000674:Amputees; D020918:Complex Regional Pain Syndromes / Q000209:etiology* / Q000534:rehabilitation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010147:Pain Measurement; D011788:Quality of Life; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
keywords: Complex regional pain syndrome (CRPS); Reflex sympathetic dystrophy (RSD);amputation; depression; Intractable pain; Disability