Neuromuscular electrical stimulation for pain management in combat-related transtibial amputees during rehabilitation and prosthetic training

Military members with war-related lower limb amputation experience a range of acute and chronic pain symptoms. The purpose of this study was to evaluate pain during 12 weeks of a military amputee rehabilitation program (MARP) pre- and post-prosthesis. The data for this study were drawn from a randomized clinical trial comparing MARP supplemented with neuromuscular electrostimulation (MARP + NMES, n = 23) to MARP alone (n = 21) for service members with unilateral transtibial amputation. The McGill Pain Questionnaire (MPQ) and phantom limb pain/sensations were assessed at baseline, 3, 6, 9, and 12 weeks. Changes within- and between-groups were analyzed with generalized mixed models. Participants reported mild-to-moderate pain at all visits, and improved significantly on the MPQ and frequency of phantom limb pain/sensations (p < .001 for effect of time). Group by time interactions were not significant, indicating both groups showed similar improvement. Univariate tests showed the NMES + MARP group had lower pain intensity than MARP-only group at weeks 3 and 6. Participants in MARP demonstrated good overall pain control and reported reduced pain and fewer days with phantom limb pain/sensations over 12 weeks. Adding NMES to MARP may be beneficial in early rehabilitation, and NMES could potentially enhance physical therapy participation by decreasing pain.