Prevalence of chronic pain after severe lower limb injury (SLLI): A systematic review and meta-analysis

Abstract text (incl. references and figure legends)

Background

Severe lower limb injuries (SLLIs) threaten limb viability and patients" lives. In many cases, either emergency salvage or amputation is required. Chronic pain is a major cause of morbidity following SLLI, but the prevalence of this is not clearly understood. The aims are to 1) determine overall prevalence of chronic pain following SLLI, 2) report the prevalence of chronic pain in patients who have undergone salvage and amputation, 3) report the prevalence of residual and phantom limb pain in amputated patients, and 4) report the prevalence of chronic pain in civilian and military patients.

Methods

This was a systematic literature review using the PRISMA checklist and protocol. Search results from the Medline, Embase, Ovid and Web of Science databases were imported, and data was extracted into Microsoft excel. Meta-analyses of proportions and binomial prevalence were completed.

Results

Forty-three studies that reported outcomes of 5601 patients were included in this review. Estimated overall prevalence of pain was 63% (0.63 [0.55, 0.70], I2= 95%). The prevalence of chronic pain in amputees was similar to those who underwent limb reconstruction on proportional (OR 1.22 [0.70, 2.11], p= 0.48, I2 = 60%) and binomial ((Amputation 0.64 [0.55, 0.73], I2 = 93%) versus (Salvage 0.56 [0.44, 0.67], I2 = 94%)) analyses. There was a higher prevalence of chronic pain in civilian (0.70 [0.63, 0.77], I2 = 87%) versus military (0.51 [0.35, 0.66], I2 = 97%) populations. There was no difference between residual and phantom limb pain prevalence in amputees (OR 1.06 [0.64, 1.78], p= 0.81, I2= 92%).

Conclusions

There is a high prevalence of chronic pain following SLLI. There is no difference in prevalence of pain after amputation compared with salvage, and no difference in residual versus phantom pain prevalence in amputees. There is a higher prevalence of pain in civilian versus military populations. This review has identified targets for intervention and further research.

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