Neuropathic postamputation residual limb pain after combat trauma: an evidence-based review of diagnosis and injection therapy

Background. The devastating nature of the russian-Ukrainian war has led to a dramatic increase in the incidence of limb amputations. The purpose was to analyze the available medical literature concerning neuropathic postamputation residual limb pain and injection therapy. Materials and methods. A comprehensive literature search of electronic databases MEDLINE/PubMed, Embase, and Scopus was conducted to identify primary studies. The evidence-based review was reported in accordance with the critical evaluation of published articles, PRISMA, and OCEBM. A total of 64 publications were included in the final quantitative analyses. Results. The estimated prevalence of residual limb pain after combat traumatic amputations is higher (61 %) than due to general diseases or civilian injuries (22–27 %). Recent Ukrainian data (63.6 %) correspond to this pooled combat-related residual limb pain prevalence. Pro-inflammatory mediators and symptomatic neuromas are determined to make significant contribution to the peripheral mechanisms of postamputation neuropathic pain. Given the distinct nature of combat trauma, further research of military populations is needed. Ultrasound-guided alcohol injections and radiofrequency ablation of neuromas have comparable efficacy profiles in the treatment for neuropathic residual limb pain. Conclusions. A standardized approach to the terminology and diagnosis of postamputation pain is essential for producing high-quality research. The injection therapy of symptomatic terminal neuromas is promising; however, given the insufficient number of high-quality studies including homogeneous groups of patients after amputations, further analysis of the pharmacological agent effectiveness is required.