Long-term outcomes of amputation in patients with complex regional pain syndrome (CRPS): a mixed-methods study.

Introduction: Amputation in patients with complex regional pain syndrome (CRPS) remains controversial, with variable outcomes in quality of life (QoL), disability, pain reduction, and complications. This study aims to evaluate long-term outcomes in CRPS patients who underwent amputation.

Methods: We conducted a single-center retrospective observational study combined with a cross-sectional survey of all CRPS patients who underwent limb amputation between 2003 and 2023 at the Erasmus MC University Medical Center. Preamputation and short-term postamputation outcomes were extracted from medical records, with short-term pain scores reflecting measurements within the first year after amputation. Long-term outcomes, including QoL, disability, pain, and satisfaction, were assessed through patient-reported questionnaires. Subgroup analyses were performed based on the presence of a neurostimulator implant.

Results: A total of 39 patients with a median CRPS Severity Score of 12 (IQR 11-13) were included. 34 patients (87%) completed the survey a median of 6.4 years (IQR 3.0-11.7) after amputation. The 36-Item Short Form Health Survey yielded mean physical and mental health summary scores of 45.4 (±26.1) and 67.7 (±22.3), respectively. The mean Pain Disability Index score was 29.3 (±15.1). Pain decreased by a mean of 3.54 points (95% CI: 2.46 to 4.62) at short-term follow-up (median 5 months, IQR 2-6) and 2.71 points (95% CI: 1.76 to 3.65) at long-term follow-up. Residual limb pain occurred in 77%, phantom limb pain in 85%, and CRPS recurrence in the stump in 10%. Overall, 94% of respondents were satisfied and would choose amputation again. Neurostimulator status did not influence measured outcomes.

Conclusions: In this cohort of severe, therapy-resistant CRPS, amputation was associated with meaningful improvements in QoL, disability, and pain in carefully selected cases, although complications remained common. Amputation should, therefore, be reserved as a last-resort intervention, offered only in specialized multidisciplinary centers.