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Concordance between different subsets of the post-amputation population is the rule: An analysis of psychophysical variables
Garner Nelson Arnold, MD1, Oscar C. Wille, MD2, R. Norman Harden, MD2, and Christine Gagnon, PhD2. (1) The Center for Pain Studies, Rehabilitation Institute of Chicago, 446 E. Ontario Suite 1011, Chicago, IL 60611, (2) Department of Physical Medicine and Rehabilitation, Northwestern UniversityFeinberg School of Medicine, 345 East Superior St, Chicago, IL 60611
Post-amputation pain (PAP) is clinically relevant, sometimes dramatic and often difficult to treat. There are many hypotheses as to pathophysiology, with the discussion evolving from a lightly regarded psychogenic phenomenon to complex mechanisms involving both the central and peripheral nervous system. Furthermore, much has been speculated about the various subsets regarding pathophysiology, even though little is certain. Our data shows that when subsets are analyzed many psychophysical variables show no difference. Psychophysical similarity and concordance between empirical subsets is the apparent rule. Side to side thermal Quantitative Sensory Testing of 36 unilateral amputees shows little variation within subsets as to temperature perception or thermal pain thresholds, specifically when grouping patients into traumatic vs. non-traumatic pathology, sex, or race. Quantitative infrared telethermography showed significant side to side differences (p <.05), but did not differ between the above empiric subsets or by time since amputation. The data set is small and cannot dispel definitively certain hypothesis regarding the nature of subsets of PAP. However our data supports the hypothesis that in subsets defined by sex, race, and traumatic vs. non-traumatic pathology that there is no distinction in temperature perception, thermal pain threshold, or telethermographic side to side differences. This data has hypothetical relevance, e.g. dysvascular amputees have no greater relative coolness of residual limbs than post traumatic amputees, suggesting that the side to side coolness seen is possibly due to sympathetic asymmetry rather than underlying hypoperfusion. Larger samples are needed to see if these hypotheses are supported.
