Jan H.B. Geertzen, Jelmer Scheper, Ernst Schrier, Pieter U. Dijkstra
Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, 9713GZ Groningen, The Netherlands. E-mail: j.h.b.geertzen@umcg.nl
DOI: 10.2340/16501977-2718

Objective: To assess long-term outcomes of amputation in patients with long-standing therapy-resistant complex regional pain syndrome type I (CRPS-I).
Design: Partly cross-sectional, partly longitudinal study.
Subjects: Patients who had amputation of a limb due to long-standing, therapy-resistant CRPS-I, at the University Medical Centre Groningen, The Netherlands, between May 2000 and September 2015 (n = 53) were invited to participate.
Methods: Participants were interviewed in a semi-structured way regarding mobility, pain, recurrence of CRPS-I, quality of life, and prosthesis use. Those who reported recurrence of CRPS-I underwent physical examination.
Results: A total of 47 patients (median age at time of amputation, 41. 0 years; 40 women) participated. Longitudinal evaluation was possible in 17 participants. Thirty-seven participants (77%) reported an important improvement in mobility (95% confidence interval (95% CI) 63; 87%). An important reduction in pain was reported by 35 participants (73%; 95% CI 59; 83%). CRPS-I recurred in 4 of 47 participants (9%; 95% CI 3; 20%), once in the residual limb and 3 times in another limb. At the end of the study of the 35 participants fitted with a lower limb prosthesis, 24 were still using the prosthesis. Longitudinal evaluation showed no significant deteriorations.
Conclusion: Amputation can be considered as a treatment for patients with long-standing, therapy-resistant CRPS-I. Amputation can increase mobility and reduce pain, thereby improving the quality of patients’ lives. However, approximately one-quarter of participants reported deteriorations in intimacy and self-confidence after the amputation.

Amputation is a mutilating treatment for persons with a life-threatening disease in an arm or leg. In patients with long-standing, therapy-resistant complex regional pain syndrome type I (CRPS-I), which is a poorly understood condition, amputation is sometimes performed; however, this treatment is controversial. This study evaluated the long-term outcomes of amputation in these patients, with respect to quality of life, pain, recurrence of CRPS-I, and functioning. In the last 15 years, 53 patients have undergone amputation at our hospital. A total of 48 patients participated in the study and were interviewed and, if indicated, physically examined. Thirty-seven patients reported an important improvement in mobility, and 35 reported an important reduction in pain. CRPS-I recurred in one out of 12 patients. Deterioration in intimacy and self-confidence were reported by 13 and 11 patients, respectively. Amputation can be considered as a treatment for these patients, because it can increase mobility and reduce pain, and thereby improve the quality of patients’ lives; however, the possibility of deteriorations such as intimacy problems or less self-confidence should be carefully considered in the decision-making process.

Commentary on: Outcomes of amputation due to long-standing therapy-resistant complex regional pain syndrome type I