Elsevier

Journal of Veterinary Behavior

Volume 22, November–December 2017, Pages 24-28
Journal of Veterinary Behavior

Canine Research
2017 Journal of Veterinary Behavior Early Career Scientist Award in Behavioral Medicine
Approaching phantom complex after limb amputation in the canine species

https://doi.org/10.1016/j.jveb.2017.09.010Get rights and content

Abstract

The objective of this study was to describe the presence, prevalence, clinical manifestations, and risk factors of phantom complex and its effect on the quality of life for dogs that underwent amputation of a limb. An online questionnaire was developed containing 3 sections with a total of 69 questions. Clinical cases were recruited from a web site for 3-legged dog owners. Data were acquired from February to March 2015. Descriptive statistics and frequency distribution analyses were performed on the collected data. Chi-squared test or Fisher's exact test were used for assessment of the associations between categorical variables. One hundred seven questionnaires were completed by owners of dogs with limb amputation. The most frequent reason for amputation was related to neoplasia (54%). Pain after limb amputation was commonly experienced by dogs, and the time of onset and clinical manifestations of pain after limb amputation were found to resemble those of phantom complex. The duration of pre-amputation pain and time between diagnosis and amputation were identified as risk factors for a higher frequency of post-amputation pain episodes. This pilot study introduces previously unreported signs that may be interpreted as expressions of pain in amputee dogs.

Introduction

The phantom complex (PC) is a multifaceted syndrome that includes (1) phantom limb sensation, which is defined as any sensation other than pain perceived as originating from an absent limb; (2) stump pain (SP) defined as pain localized to the remaining stump; and (3) phantom limb pain (PLP), which is defined as pain perceived from the area of the former limb that is not physically part of the body anymore (Hill, 1999, Fainsinger et al., 2000, Flor, 2002). PLP has been reported to occur in 60%-80% of patients within the first 2 years after amputation and, in up to 10%, may persist throughout life (Melzack, 1971, Nikolajsen et al., 1997, Probstner et al., 2010).

Clinically, PLP may be confused or overlap with common postsurgical SP. However, SP usually subsides with healing, whereas PLP persists in 5%-10% of cases and may worsen over time evolving into a chronic and neuropathic type of pain (Jensen et al., 1985, Nikolajsen and Jensen, 2001).

The amputation of a limb is a procedure commonly performed on small animals. The degree of adaptation, presence of risk factors associated with a poor quality of life, and owner satisfaction have been the topics of several veterinary studies during the past years (Withrow and Hirsch, 1979, Carberry and Harvey, 1987, Kirpensteijn et al., 1999, Dickerson et al., 2015, Raske et al., 2015, Galindo-Zamora et al., 2016). However, none of those studies have specifically addressed the occurrence of pain and pain-related behaviors after amputation that could account for PC. Hence, we evaluated a client-owned population of dogs with limb amputation through the use of an online survey sought to document the prevalence of PC by identifying signs and behaviors suggestive of neuropathic pain, evaluate risk factors associated with PC occurrence, and determine the owners' perceptions of the quality of life (QoL) of their 3-legged pets.

Section snippets

Questionnaire design and description

A trial questionnaire was designed based on the experience of veterinary specialists, published questionnaires for dogs with limb amputation and/or chronic pain (Withrow and Hirsch, 1979, Carberry and Harvey, 1987, Kirpensteijn et al., 1999, Hielm-Bjorkman et al., 2009), and a pediatric model for chronic pain measurement (http://www.deutsches-kinderschmerzzentrum.de/fileadmin/media/PDF-Dateien/englisch/parents_initial_3.0.pdf).

A first draft of the questionnaire was independently evaluated and

Descriptive data

One hundred seven completed questionnaires were available for data analysis; of these questionnaires, 56% (60/107) referred to 32 breeds of purebred dogs, with golden retrievers (17%; 10/60) and Labrador retrievers (15%; 9/60) being most highly represented. Mixed-breed dogs accounted for 44% (47/107) of the population. Among the dogs, the mean age at the time of the survey was 7.6 years (median 8 years, range 0.6–16 years). With respect to sex distribution, 56% (60/107) of the dogs were male

Discussion

The present investigation represents a preliminary step approaching PC in dogs after amputation of a limb. According to our survey, 14% of owners felt that their dogs experiencing pain from 1 to 6 months after surgery with and without accompanying behavioral changes. Similarly in human amputees, 5%-10% of patients report persistence and worsening of pain beyond the stage of postsurgical healing, leading to the development of a debilitating and neuropathic type of pain (Nikolajsen et al., 1997,

Conclusions

Our pilot study introduces previously unreported signs and behaviors that may be interpreted as expressions of pain in amputee dogs. These manifestations may be particularly revealing for those dogs that experienced post-amputation pain initiating at least 1 month after surgery. The ability to recognize behavioral signs that may indicate the presence of unpleasant sensations related to neuropathic pain would be of great interest, to prevent and treat it.

Aknowledgments

The authors sincerely thank Dr. Michael Petty, Rene Agredano and the Tripawd community for their assistance in, support of and advertisement of this study.

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