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Back pain as a secondary disability in persons with lower limb amputations☆,☆☆,★

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Abstract

Ehde DM, Smith DG, Czerniecki JM, Campbell KM, Malchow DM, Robinson LR. Back pain as a secondary disability in persons with lower limb amputations. Arch Phys Med Rehabil 2001;82:731-4. Objective: To evaluate the frequency, duration, intensity, and interference of back pain in a sample of persons with lower limb amputations. Design: Retrospective, cross-sectional survey. Setting: Community-based survey from clinical databases. Participants: Participants who were 6 or more months post lower limb amputation (n = 255). Intervention: An amputation pain survey that included several standardized pain measures. Main Outcome Measures: Frequency, duration, intensity, and interference of back pain. Results: Of the participants who completed the survey (return rate, 56%), 52% reported experiencing persistent, bothersome back pain. Of these, 43% reported average back pain intensity in the mild range (1-4 on 0-10 rating scale) and 25% reported pain of moderate intensity (5-6 on 0-10 scale). Most respondents with back pain rated the interference of their pain on function as none to minimal. However, nearly 25% of those with back pain described it as frequent, of severe intensity (≥7 on 0-10 scale), and as severely interfering with daily activities including social, recreational, family, and work activities. Conclusions: Back pain may be surprisingly common in persons with lower limb amputations, and, for some who experience it, may greatly interfere with function.

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Participants

Participants were recruited from the patients who had undergone lower limb amputation at 2 Seattle-area hospitals: Harborview Medical Center, a level 1 trauma center, and the Veterans Administration Puget Sound Health Care System. Inclusion criteria included: (1) 6 or more months post lower limb amputation, (2) 18 years of age or older, and (3) ability to read and write English. The University of Washington Human Subjects Committee approved the study protocol.

Measures

As part of a larger study on

Description of participants

We mailed surveys to 798 individuals who were randomly selected from the larger pool of potential participants. Of those mailed, 189 were returned by the US Postal Service as undeliverable, 83 were returned as addressee deceased, and 73 were returned as inappropriate (<6mo since amputation, person did not have a lower limb amputation, <18yr of age). Thus, a maximum of 453 surveys theoretically could have been completed. Twenty-three potential subjects indicated that they did not want to

Discussion

Similar to 2 previous studies,3, 4 the results of the present study suggest that back pain is surprisingly common among persons with lower limb amputations. Fifty-two percent of our sample reported that they experienced persistent, bothersome back pain. This rate is considerably higher than in the general population, in which it has been estimated that the point prevalence of back pain is 15% to 25% (for a review of the epidemiology of back pain, see Andersson et al5). Of those with back pain

Conclusion

Chronic back pain may be a secondary disability for many persons with lower limb amputations. Besides being common in this sample, back pain was reported to affect significantly the functioning of a notable minority of respondents. It is essential for physicians to look more broadly than the amputated limb when assessing the effects of lower limb amputation.

Acknowledgements

The authors thank the data collection team of Amy Hoffman (project coordinator), Bridget Bjork, Beth Gerrard, Catherine McClellan, Erica Tyler, and Jinbo Chen for their invaluable assistance in data collection, entry, and analysis.

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Supported by the National Institute of Child Health and Human Development and the National Institute of Neurological Disorders and Stroke (grant no. PO1 HD/NS33988).

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No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are assocaited.

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Reprint requests to Dawn M. Ehde, PhD, Dept of Rehabilitation Medicine, University of Washington School of Medicine, 325 Ninth Ave, Box 359740, Seattle, WA 98104-2499; e-mail: [email protected].

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Copyright © 2001 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.