Prevalence and risk factors for chronic postamputation pain requiring analgesia or nerve interventions: a population-based study in East Asia

Background: Postamputation pain (PAP) is underexplored in East Asian populations, with most data originating from Western countries. This study aimed to investigate the prevalence and risk factors of PAP in East Asian individuals who underwent surgical amputation, particularly those requiring subsequent analgesia or nerve interventions.

Materials and methods: The study used data from the Longitudinal Health Insurance Database, encompassing claims from 2 million randomly selected individuals out of 23.5 million enrolled in Taiwan's National Health Insurance Research Database from 2000 to 2019. The risk factors for PAP were analyzed using multivariable regression, considering criteria such as chronic postamputation pain, symptomatic neuroma treatment, chronic analgesia use, and nerve interventions.

Results: Among the 7287 amputees (mean age 59.5 years; 65.1% male), 18.1% (95% CI 17.2%, 19.0%) (1318 patients) experienced PAP requiring intervention. Significant risk factors included cancer (OR 2.20 (95% CI 1.27, 3.68)), peripheral artery disease (OR 2.11 (95% CI 1.66, 2.69)), infection (OR 1.93 (95% CI 1.55, 2.40)), diabetes mellitus (OR 1.85 (95% CI 1.45, 2.37)), and a higher Elixhauser Comorbidity Index (OR 1.04 (95% CI 1.02, 1.06)). Prior radiculopathy (OR 1.30 (95% CI 1.13, 1.51)) and myelopathy (OR 1.33 (95% CI 1.14, 1.55)) also increased pain odds, while age showed a slight inverse association (OR 0.99 (95% CI 0.98, 0.99)).

Conclusion: The prevalence of PAP requiring subsequent analgesia or nerve interventions in this East Asian population is 18.1%. Identified risk factors include multiple medical comorbidities and pre-existing radiculopathy or myelopathy. These findings highlight the important considerations for both clinical practice and future research directions.