Assessment of pain factor at the stages of prosthetics after lower limb amputation

Authors:

Smirnova Ludmila Mikhailovna – Grand PhD in Medical sciences (Dr. Med. Sci.), leading researcher of the Department of Biomechanical Studies of the Musculoskeletal System of Institute of Prosthetics and Orthotics, Albrecht Federal Scientific and Educational Centre of Medical and Social Expertise and Rehabilitation, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; Professor of Department of Biomedical Engineering, St. Petersburg Electrotechnical University, 5 Professora Popova Street, 197376 St. Petersburg, Russian Federation; e-mail: info@diaserv.ru; https://orcid.org/0000-0003-4373-9342.

Artyushkova Ludmila Vasilievna – junior researcher of the Department of Biomechanical Studies of the Musculoskeletal System of Institute of Prosthetics and Orthotics, Albrecht Federal Scientific and Educational Centre of Medical and Social Expertise and Rehabilitation, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; e-mail: semart0217@inbox.ru.

Suslyaev Vadim Gennadievich – PhD in Medical sciences (Cand. Med. Sci.), leading researcher of the Department of Expert Rehabilitation Diagnostics, Federal government institution “Main Bureau of Medical and Social Expertise for the City of St. Petersburg”, 58A Liteiny Ave, 191014 St. Petersburg, Russian Federation; leading researcher of Department of innovative technology for technical means of rehabilitation of Institute of Prosthetics and Orthotics, Albrecht Federal Scientific and Educational Centre of Medical and Social Expertise and Rehabilitation, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; e-mail: vadims1964@yandex.ru; https://orcid.org/0000-0003-0651-5497.

Ivanov Oleg Vladimirovich—Head ofthe Department of Expert Rehabilitation Diagnostics, Federal government institution “Main Bureau of Medical and Social Expertise for the City of St. Petersburg”, 58A, Liteiny Ave, 191014 St. Petersburg, Russian Federation; e-mail: digitalis2@yandex.ru; https://orcid.org/0009-0002-9242-5868.

Belyanin Oleg Leonidovich  –  leading researcher of the Department of biomechanical research of the musculoskeletal system of Institute of Prosthetics and Orthotics, Albrecht Federal Scientific and Educational Centre of Medical and Social Expertise and Rehabilitation, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; e-mail: belynin.oleg41@bk.ru; https://orcid.org/0000-0001-6019-8053.

Annotation:

Introduction. The requirements for the characteristics of the prosthesis and its functional units are based on taking into account many indicators of the state of the functions of various body systems, including pain. According to GOST ISO 8548-2-2021, when describing the amputation stump of the lower limb, the presence of severe pain or tenderness in the amputated limb should be recorded indicating the location, frequency, duration and intensity of pain, but it is not indicated what methods should be used to assess pain and how to use results obtained during prosthetics.

Aim. The purpose of the work is to substantiate an algorithm for taking into account the pain factor in a truncated limb during prosthetics.

Materials and methods. The work uses methods of system analysis, synthesis and analogy. The information and empirical basis for the study was the regulatory legal acts of the Russian Federation that define the rules for providing disabled people with prosthetic limbs, as well as reference and analytical data in this applied area.

Results. In order to identify the nature of the pain syndrome in order to develop an algorithm of actions to relieve or reduce it at the stages of prosthetics, a classification of nociceptive, neuropathic, nociplastic and displaced types of pain, phantom pain syndrome. A brief review of methods for assessing pain characteristics is carried out and those that are advisable to use at various stages of prosthetics are identified. A table has been developed that defines medical and technical recommendations for a prosthesis for nociceptive and neuropathic pain, phantom pain syndrome. An algorithm for the actions of specialists has been developed to take into account the pain factor in a truncated limb during prosthetics.

Discussion. It is known that in order to make a decision on the establishment of disability, it is legally required to take into account only persistent violations of body functions. For this reason, the presence of pain syndrome is not always indicated in the referral from a medical organization for a medical and social examination, unlike phantom pain syndrome (as a chronic condition). However, since 2023, the responsibilities of the Bureau of medical and social expertise began to include the definition of varieties of prosthetic components, which requires information about the characteristics of the pain syndrome experienced by the patient, and not only chronic. Another problem of forming reasonable recommendations for the characteristics of the prosthesis is the absence in regulatory documents of some types of components, the choice of which is necessary taking into account the presence of various types of pain.

Conclusion. An algorithm of specialists’ actions has been developed to account for and reduce the pain factor in the prosthetic limb at various stages of prosthetics. In order to ensure the maximum possible reduction of the pain factor in a patient with prosthetics, it is advisable to pay more attention to the description of the pain syndrome in the direction of medical and social expertise, and it is advisable to expand the list of names of components and their varieties in regulatory documents used in the formation of requirements for a prosthesis, taking into account the developed recommendations for it with nociceptive and neuropathic pain, phantom pain syndrome.

List of cited literature:

1. Smirnova LM, Ponomarenko GN, Suslyaev VG. Metodologiya i informacionno-izmeritel’naya sistema dlya personificirovannogo sinteza protezov nizhnix konechnostej [Methodology and information-measuring system for personalized synthesis of lower limb prostheses]. Informacionno-upravlyayushhie sistemy [Information and Control Systems].2021;115(6):64-74. DOI:10.31799/1684-
8853-2021-6-64-74. (In Russian).

2. Klinicheskie rekomendacii. Xronicheskij bolevoj sindrom (XBS) u vzrosly’x pacientov, nuzhdayushhixsya v palliativnoj medicinskoj pomoshhi [Clinical recommendations. Chronic pain syndrome (CBS) in adult patients in need of palliative care]. 2023. Available at: https:// cr.minzdrav.gov.ru/recomend/400_2. (accessed 03.05.2024). (In Russian).

3. Kukushkin Ml, Yakhno NN, Churyukanov MV, Davydov OS, et al. Notsiplasticheskaya bol’ – novyi deskriptor ili uproshchennyi vzglyad na problemu boli? [Nociplastic pain is a new descriptor or a simplified view of the problem of pain]. Rossiiskii zhurnal boli [Russian Journal of Pain]. 2018;2:269-70. (In Russian).

4. Flor H, Birbaumer N. Phantom-limb pain: cortical plasticity and novel therapeutic approaches. Curr. Opin. Anaesthesiol. 2000;13(5):561-4. DOI: 10.1097/00001503-200010000-00013.

5. Chegurov OK, Kolesnikov SV, Kolesnikova E’S, Skripnikov AA, et al. Fantomno-bolevoj sindrom: patogenez, lechenie, profilaktika (obzor literatury’) [Phantom pain syndrome: pathogenesis, treatment, prevention (literature review)]. Genij Ortopedii [Orthopedic Genius]. 2014;1:89-93. (In Russian).

6. Osipova NA, Sobchenko LA. Postamputacionny’j fan-tomny’j bolevoj sindrom: medicinskie i social’ny’e problemy’ [Post-amputation phantom pain syndrome: medical and social problems]. Anesteziologiya i reanimatologiya [Russian Journal of Anesthesiology and Reanimatology]. 2011;6:41-43. (In Russian).

7. Giummarra MJ, Moseley GL. Phantom limb pain and bodily awareness: current concepts and future directions. Curr. Opin. Anaesthesiol. 2011;24(5):524-31. DOI: 10.1097/ACO.0b013e32834a105f.

8. Manchicant L, Singh V. Managing phantom pain. Pain Physician. 2004;7(3):365-75.

9. Baxtadze MA, Bolotov DA, Kuz’minov KO, Zaxarova OB, et al. Lingvisticheskaya adaptaciya vtoroj sokrashhennoj formy’ Mak-Gillovskogo bolevogo oprosnika [Linguistic adaptation of the second abbreviated form of the McGill Pain Questionnaire]. Rossiiskii zhurnal boli [Russian Journal of Pain].2015;2:26-9. (In Russian).

10. GOST R ISO 8548-2-2021. Protezirovanie i ortezirovanie. Defekty’ konechnostej. Chast’ 2. Metod opisaniya amputacionnoj kul’ti nizhnej konechnosti [Prosthetics and orthotics. Limb deficiencies. Part 2. Method of describing lower limb amputation stumps]. Moskva: Standartinform [Moscow: Standartinform], 2021. 21 p. (In Russian).

11. Ob utverzhdenii Poryadka organizacii i deyatel’nosti federal’ny’x uchrezhdenij mediko-social’noj e’kspertizy [On approval of the Procedure for the organization and activities of federal institutions of medical and social expertise]. Prikaz Ministerstva truda i social’noj zashhity’ Rossijskoj Federacii ot 30.12.2020 N 979n [The Order of Ministry of Labor of Russian Federation N 979n of December 30, 2020]. Available at: https://www.garant.ru/products/ipo/prime/
doc/400751882/. (accessed 03.05.2024). (In Russian).

12. O priznanii licza invalidom (vmeste s “Pravilami priznaniya licza invalidom”) [On recognizing a person as a disabled person (together with the “Rules for recognizing a person as a disabled person”)]. Postanovlenie Pravitel’stva RF N 588 ot 5 aprelya 2022 g. (red. ot 24.01.2023) [Decree of the Government of the Russian Federation N 588 of April 5, 2022 (edit. Of January 24, 2023)]. Available at: https://www. consultant.ru/document/cons_doc_LAW_413991/ (data obrashheniya: 03.05.2024). (In Russian).

13. Smirnova LM, Suslyaev VG, Yankovsky VM, Bolshakov VA. Personificirovannyj sintez proteza nizhnej konechnosti: trebovaniya k naznacheniyu amortizacionnyh modulej so strategiej na importozameshchenie [Personalized synthesis of lower prosthesis limbers: requirements for the purpose of shock absorber modules with a strategy for import substitution]. Fizicheskaya i reabilitacionnaya medicina [Physical and Rehabilitation Medicine]. 2023;5(3):8-19. DOI: 10.26211/2658-4522-2023-5-38-19. (In Russian).

14. Ob utverzhdenii perechnya pokazanii i protivopokazanii dlya obespecheniya invalidov tekhnicheskimi sredstvami reabilitatsii [On approval of the list of indications and contraindications for providing disabled people with technical means of rehabilitation]. Prikaz Mintruda Rossii ot 27.04.2023 N 342n [The Order of Ministry of Labour of Russia of April 27, 2023 N 342n]. Available at: http://publication. pravo.gov.ru/document/0001202306080006. (accessed 03.05.2024). (In Russian).

15. Zoloev GK. Obliteriruyushhie zabolevaniya sosudov [Obliterating vascular diseases]. Medicina, 2015. 480 p. (In Russian).

16. Xoxlova OI, Vasil’chenko EM, Berman AM. Rol’ klassicheskix faktorov riska osteoartrita kolennogo sustava pri odnostoronnej transtibial’noj amputacii [The role of classical risk factors for osteoarthritis of the knee joint in unilateral transtibial amputation]. Kazanskij medicinskij zhurnal [Kazan Medical Journal]. 2021;102(6):893-901. (In Russian).

17. Chegurov OK, Kolesnikov SV, Kolesnikova E’S, Skripnikov AA. Fantomno-bolevoj sindrom: patogenez, lechenie, profilaktika [Phantom pain syndrome: pathogenesis, treatment, prevention]. Genij ortopedii [Orthopedic Genius].2014;1:89-92. (In Russian).

18. Murray CD, Pettifer S, Howard T, Patchick EL, et al. The treatment of phantom limb pain using immersive virtual reality: three case studies. Disabil Rehabil. 2007;29(18):1465-9. DOI: 10.1080/09638280601107385.

19. Reinersmann A, Haarmeyer GS, Blankenburg M, Frettloh J, et al. Vergleichbare Storung des Korperschemas bei Patienten mit komplexem regionalem Schmerzsyndrom (CRPS) oder Phantomschmerz [Comparable disorder of the body schema in patients with complex regional pain syndrome (CRPS) and phantom pain]. Schmerz. 2011;25(5):558-62. German. DOI: 10.1007/ s00482-011-1048-x.

20. Sajko AV. Sovremennoe sostoyanie problemy’ fantomnoj boli [The current state of the problem of phantom pain]. Mizhnarodnij nevrologichnij zhurnal [International neurological journal].2018;98(4):84-95. DOI: 10.22141/22240713.4.98.2018.139430. (In Russian).

21. O napravlenii spravochnikov parametrov texnicheskix sredstv reabilitacii, v tom chisle protezov verxnix i nizhnix konechnostej [On the direction of reference books of parameters of technical means of rehabilitation, including upper and lower limb prostheses]. Pis’mo FB MSE’ ot 01.08.2023 N 44372 FB.77/2023 rukovoditelyam – glavny’m e’kspertam po mediko-social’noj e’kspertize po sub”ektam Rossijskoj Federacii (po spisku) [The Letter from Federal Burau of Medical and Social Expertise to heads-chief experts of medical and social expertise by subjects of Russian Federation N 44372 FB.77/2023 of August 1, 2023 (by list)]. Available at: https://www. invalidnost.com/MSE/FB/2023/TSR/pismoft_44372. ft.77_2023full.pdf . (accessed: 03.05.2024). (In Russian).