Prevalence of chronic pain after severe lower limb injury (SLLI): A systematic review and meta-analysis

Shareef Mahdi; Rebecca Stoner; James Wyatt; Henry De'Ath; Zane Perkins

doi:10.1016/j.injury.2024.111495

Prevalence of chronic pain after severe lower limb injury (SLLI): A systematic review and meta-analysis

Injury. 2024 Mar 12;55(6):111495. doi: 10.1016/j.injury.2024.111495. Online ahead of print.

Authors

Shareef Mahdi¹, Rebecca Stoner², James Wyatt³, Henry De'Ath², Zane Perkins²

Affiliations

¹ Centre for Trauma Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom. Electronic address: shareefmahdi@doctors.org.uk.
² Centre for Trauma Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom.
³ University of Liverpool, United Kingdom.

PMID: 38490051
DOI: 10.1016/j.injury.2024.111495

Abstract

Background: Globally, severe lower limb injuries (SLLIs) are the predominant cause of long-term injury related disability and poor functional outcomes. Chronic pain is a major source of this morbidity, but the magnitude of the contribution is not clearly understood. The aim of this systematic review and meta-analysis was to determine the prevalence of chronic pain following SLLIs in civilian and military patients.

Method: This systematic review was prospectively registered with The International Prospective Register of Systematic Reviews (PROSPERO) with study ID CRD42022313615. A systematic literature search (Medline, Embase, Ovid, and Web of Science) was performed to identify original studies that reported chronic pain outcomes for adults who underwent surgical treatment for SLLIs in a civilian or military setting. Risk of bias in included studies was assessed using the ROBINS-E tool, and quality assessment was reported at study level using the Newcastle-Ottawa Scale, and at outcome-level using the GRADE framework. Absolute (proportional) and relative (odds ratio) outcome measures were calculated and pooled using a random effects model.

Results: Forty-three studies reporting the outcomes of 5601 patients were included. Estimated overall prevalence of pain was 63 % (CI 55-70 %). The prevalence of chronic pain in amputees (64 % (CI 55-73 %)) was similar to those who underwent limb salvage (56 % (CI 44-67 %)). The prevalence of chronic pain in civilian populations was 70 % (CI 63-77 %) compared to military populations (51 % (CI 35-66 %)). In amputees, the prevalence of residual limb pain was similar to phantom limb pain (OR 1.06 [0.64-1.78], p = 0.81, I² = 92 %).

Conclusion: Most people who sustain a SLLI will suffer from chronic pain. Healthcare systems must continue to research interventions that can reduce the incidence and severity of long-term pain and ensure adequate resources are allocated for this common and debilitating complication.

Keywords: Lower limb; Outcome; Pain; Trauma.