Nicholas Suteu
Background
Phantom limb pain (PLP) affects up to 80% of patients following major limb amputation and can develop within days post-operatively. Poor early recognition and management may result in chronic pain syndromes, impairing rehabilitation, prosthesis use, and psychological recovery. Despite national guidelines recommending early neuropathic assessment and treatment, post-operative care often prioritizes wound management over this.
Aim
To assess compliance with national standards for PLP management on the vascular ward, focusing on:
- Frequency of PLP assessments
- Timely initiation of neuropathic agents
- Continuity of care, including discharge planning and dose review
Methods
A retrospective and prospective audit of patients undergoing knee amputations was conducted using documentation and prescribing records. Cycle 1 established baseline compliance (n=48). An intervention consisting of targeted education for resident doctors was implemented. A re-audit (Cycle 2, n=27) evaluated changes.
Results
Compliance with key standards remained suboptimal across both cycles.
- PLP assessment within 48 hours decreased - 44% to 33%
- Neuropathic agent initiation decreased - 42% to 37%
- Pain team referrals improved - 52% to 67%
- Discharge planning - minimal improvement (21% to 22%)
Notably, numerical pain scoring demonstrated 0% compliance in both cycles. Overall, education alone failed to produce meaningful improvement.
Discussion
This audit highlights a significant gap between guidelines and clinical practice. Reliance on clinician memory represents a low-reliability intervention, particularly on high-pressure wards. Failures in pain assessment and medication continuity suggest systemic rather than individual shortcomings.
Conclusion
Current practice does not meet national standards for PLP management. Educational interventions alone are insufficient to drive sustained improvement
Authors
Nicholas Suteu, Zainab Akbar, Callum Sefton
Royal Preston Hospital, Preston, United Kingdom