Project title: PAIN-P1 – Post Amputation Incidence of Neuroma and Neuropathic Pain

Grant Holder: Chane Kulenkampff

Position: Plastic Surgery Registrar ST3

Date of award

27^th September 2023

Date of report

August 2024

Grant Awarded (i.e. £10,000)

£9,945.42

Is this an interim, or final, report

Interim

Lay Summary (approx. 100 words)

Formation of neuroma and the occurrence of neuropathic pain can have a profoundly negative impact on the function of patients and have implications for societal costs for treatment and work absenteeism. This project will aid in establishing the incidence and impact of neuroma and neuropathic pain and how this can be identified and managed effectively. The study will longitudinally follow patients following digital amputation and establish the occurrence and incidence of neuroma and neuropathic pain. The study will also serve as preliminary work to support a future application for an appropriate NIHR funding stream to further investigate preventative solutions in this cohort.

Summary of progress /findings (approx 300 words)

Following the grant award, the study underwent some further protocol development and refinement and additional PPI/E work to ensure patients remained receptive and felt that the question remained relevant and important to patients.

There was a minor delay that occurred due to long term sickness within the team and the study was submitted for sponsorship review in early December. The study is currently in the final phase of the sponsorship review process, and it is anticipated that approvals will be received imminently. The study will then be submitted for ethical review, with a view to commence recruitment as soon as ethics is received.

During this time, a further survey regarding national practice has been completed to establish the common methods utilised to manage digital nerves at the time of amputation in both traumatic and non-traumatic injuries. This established that practice nationally appears to be predominantly traction neurectomy with some surgeons opting to diathermy nerves at time of amputation. A further preliminary prospective audit of patient outcomes has also been completed highlighting that the incidence of intrusive neuropathic pain was 59% at 3 months following amputation.

We feel that each of these projects strengthens our current proposed research study and establishes the need to further investigate this common issue and establish pathways to effective diagnosis and treatment.

What is the relevance/value of this research to hand surgery

Digital neuroma is a common sequela following digital amputation with significant impact on quality of life. There is a paucity of evidence in this area.

If final report, please provide bullet point list of conclusions/important findings

• Not applicable

Please list presentations based on work performed in this study

• An abstract has been submitted based on the multi-centre audit of neuropathic pain prevalence has been submitted for consideration for presentation at the BSSH autumn meeting.

Please list publications based on work performed in this study

• No publications to date.

Please state what additional research this study has/is leading to

• A national audit of digital nerve management at the time of amputation was conducted at BSSH with a relatively small response.
• A literature review is currently underway to investigate the lived experience of patients following digital amputation.

Please list any further funding or grant applications (with outcome), which have resulted from the award of this grant

• The proposed study will form the basis of a further application for a national multi-centre trial exploring preventative intervention at the time of digital amputation. A further update to this will be submitted in the final report.

How has this grant awards helped your career development?

• This work has change my practice personally as it has made me re-consider my surgical management and follow-up outcomes in these patients
• It has also given me the basis on which to educate those around me in neuroma prevention
• The hope is that this work once disseminated will further improve the quality of management of these patients at a larger scale
• While this grant has not directly altered the course of my career at this early stage in my training, it is likely to have a positive impact in developing my experience in research which will impact on the projects I am able to deliver on during my training as well as my job prospects when applying for fellowships