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Early Aggressive Treatment Advised for Painful Limb Salvage
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Posted on: 11/30/1999
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Soldiers returning from the field with battle wounds often have severe trauma affecting the leg. All efforts are made to save the leg but constant severe pain may lead the soldier to opt for amputation. The two topics highlighted in this article are: 1) what causes pain during limb salvage and 2) what can be done about it.
First, what is the etiology or cause of this type of chronic pain? Most likely there isn't a single cause. Instead, there can be multiple different reasons why pain develops and persists. Just the damage to the soft tissues alone is enough to cause severe suffering.
Things happen during the course of healing that can contribute to the pain as well. For example, sometimes the body forms bits of bone in damaged muscles called ossification. The bone embedded in the muscle decreases its flexibility and alters muscle function as it can no longer contract-relax normally.
Joints that have been injured in traumatic accidents, explosions, or other combat-related injuries often develop painful posttraumatic arthritis. Nerve pain from pressure placed on it by scar tissue or ossification can be a big factor in chronic pain for these wounded warriors.
You may have heard of phantom limb pain -- the leg (or arm) has been amputated but the patient still feels it and it hurts! The remaining stump can also be extremely painful. Physicians think that failure to control pain early on when surgeries are being done to save the limb may be a contributing factor in stump and phantom pain.
Soldiers with severe battlefield injuries involving the limbs experience two other significant problems. The first is a condition called complex regional pain syndrome (CRPS). CRPS can occur anytime soft tissues are damaged, cut, or injured.
The affected patient has severe burning pain along with a host of other symptoms. There are often skin temperature changes, change in hair growth patterns, numbness or hypersensitive skin, swelling (edema), and stiffness. All of these symptoms create an impaired limb.
And for amputees who use a leg prosthetic (artificial leg), chronic low back pain becomes an issue. Using extra energy and effort to hold, lift, and carry the prosthetic all day everyday takes its toll on the rest of the body.
What can be done to prevent this painful suffering or at least manage it for our returning soldiers? Pain relieving medications are the first line of treatment. Sometimes more than one drug is used in combination called multimodal pharmacology. Tylenol still remains a very effective nonnarcotic pain reliever.
Nonsteroidal antiinflammatory drugs (NSAIDs), antineuropathic (nerve pain) medications, antidepressants, along with opioids (narcotics) are available tools used for pain control. The idea of getting early control over pain is to prevent chronic pain from imprinting nerve pathways with a permanent pain signal.
Other management tools for chronic pain in this group of combat casualties can include physical and occupational therapy, biofeedback therapy, relaxation training, and counseling. Complex regional pain syndrome has its own treatment protocol prescribed and supervised by the physical therapist.
Various methods are used in an effort to stop the pain signals at the level of the nerve. Injections of numbing agents and steroids may be helpful. Nerve blocks, pulsed radio waves to the nerve plexus (place where nerves converge together), and various types of electrical stimulation have been used with varying levels of success.
Many times it takes a concentrated effort of many team members to help suffering soldiers find the right mix of medications and management techniques to gain control of their pain. This type of program is referred to as a comprehensive interdisciplinary pain protocol.
Experts in pain medicine work together using any and all tools that might help the soldier or veteran. Complementary modalities such as acupuncture, Reiki, touch, BodyTalk, massage, hypnosis, as well as many other alternative approaches are often tried and incorporated into the program.
In conclusion, it's clear now from the many wounded soldiers coming back from Iraq with traumatic limb injuries that early pain control is essential. Pain clinics staffed by pain experts near the battle zone have helped improve outcomes. Pain conditions treated early and aggressively result in fewer cases of chronic pain, disability, and amputation.
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References:
MAJ Brandon J. Goff, DO, et al. Painful Sequelae Following Limb Salvage: Etiology and Management. In Journal of the American Academy of Orthopaedic Surgeons. Vol. 19. Supplement 1. Pp. S23-S27.
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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