FEATURES OF PHANTOM PAIN IN PATIENTS WITH LIMB AMPUTATIONS DUE TO GUNSHOT WOUNDS IN THE EARLY AND LATE TREATMENT PERIODS

Summary. The task in the field of anesthesiology and pain medicine becomes even more important and complex in the context of veterans who suffered amputations during the war with Russia. Amputations caused by gunshot wounds have not only physical and medical consequences, but also deep-rooted psychological and emotional challenges. Soldiers who lose their limbs experience more than just the loss of a part of their body – they undergo physical and mental restructuring and are forced to deal with the problems of self-identification and ordering their new reality. War not only disrupts their physical integrity, but also incurably affects their psyche, leaving traces that can take the form of physical and emotional pain. Leaving the military arena, they plunge into a new battle – with the pain that accompanies physical suffering and uncertainty of the future. In addressing this issue, we need to perceive amputation not only as a medical case, but also as a socio-cultural phenomenon that combines the interaction of pain, traumatic experiences and mental resilience. Therefore, the ability to control phantom pain by the patient is an important component of the treatment process. Objective. To compare the efficacy of opioid analgesics in the complex therapy of pain relief in servicemen with phantom pain at the specialized stage of medical care in Main Military Medical Clinical Center «GVKG». Materials and methods. The results of treatment of phantom pain among military personnel who lost limbs because of gunshot wounds were evaluated using the visual analog scale, the neuropathic pain questionnaire, the Mississippi Scale for Posttraumatic Stress Disorders (military version), and the DEPS Depressive Disorder Scale. The study involved 175 patients with amputated limbs because of combat trauma. Results of the study. According to the VAS, a significant statistical difference was found between group 1 and 2 (p<0.05). The data of the DN4 questionnaire indicate that group 1 had statistically better results than group 2 (p<0.05). Patients in both groups had a high risk of post-traumatic and depressive disorders, but despite the decrease in these indicators at the end of inpatient treatment in the conditions of the NMMCG «GVKG», no statistical difference between groups 1 and 2 was found (p<0.05). Conclusions. A qualitative approach to the treatment of patients with phantom pain and psycho-emotional disorders who have lost limbs due to gunshot wounds should primarily include patient awareness of methods and strategies for achieving pain control. Such injuries are accompanied not only by physical pain but also by post-traumatic and depressive disorders, which significantly impact treatment outcomes for this patient category. Patients who were informed about methods of controlling pain and psycho-emotional disorders demonstrated better treatment outcomes at the inpatient stage during the period between staged surgical procedures, at discharge from the hospital or transfer to another medical facility, as well as in the long-term period.