УДК:616-001.32-001.45-007.286-06:616.833-009.7]-085.2/.3
Біль після бойової травми пов’язаний з більш інтенсивним проявом посттравматичного стресового розладу та депресії у понад 35% ветеранів. Вплив психологічних факторів у результатах лікування після ампутації все більше визнається, проте зв’язок між нейропатичним болем кукси та симптомами розладів ментального здоров’я в ранньому відновному періоді після бойового поранення залишається недостатньо вивченим. Мета роботи — оцінити характер зв’язку між типами постампутаційного болю та ПТСР, депресією у військовослужбовців внаслідок бойових ампутацій у російсько-українській війні. Проаналізовано 145 військовослужбовців. Частка пацієнтів із клінічно вираженим нейропатичним болем кукси становила 64,8%; виявлено прямий помірний зв’язок болю із симптомами ПТСР та депресії. Встановлено двонаправлений зв’язок і значну коморбідність розладів ментального здоров’я з нейропатичним болем кукси. Для ефективнішого лікування постампутаційного болю терапія повинна включати корекцію посттравматичних психічних розладів.
Background. Pain following combat trauma has been shown to be associated with in creased rates of posttraumatic stress disorder and depression in over 35% of veterans. The role of psychological factors on outcomes after combat related amputation is increas ingly acknowledged, the association between neuropathic residual limb pain and symp toms of mental health disorders in the early rehabilitation period after combat trauma re
mains poorly analyzed. Purpose – To assess the relationship between postamputation pain phenotypes and both
PTSD and depressive disorder among military servicemembers after combat-related am
putation during the Russian-Ukrainian war.
Materials and Methods. 145 servicemembers with combat related limb loss, treated at the 3rd-4th level Military Clinical Center of the Western Region during the period 2022–2026, were included in the analysis. Pain types assessed were neuropathic residual limb pain (nRLP) and phantom limb pain (PLP) with NRS, DN-4. Psychological distress parameters evaluated were PTSD and depressive symptoms with PCL-M, PHQ-9 questionnaires. Two
groups were formed for analysis: a control group (N=51) with a neuropathic pain level of 0–3, and a research group (N=94) with a pain level of 4–10. A correlation, log-binomial analyses of postamputation pain and mental health issues were conducted.
Results. The prevalence of clinically significant nRLP (moderate-to-severe) was 64.8% [95% CI: 60.8–68.8] in the cohort of patients with mean 5 months after amputation. Co morbidity of PTSD was identified in 46.8% [95% CI: 41.7–51.9] of patients with clinically significant postamputation pain, while depressive disorder was observed in 59.6% [95% CI: 54.5–64.7] of pain cases. Across the entire cohort of patients after combat-related limb
amputation, clinical signs of probable PTSD were present in 31.7% [95% CI: 27.8–35.6] of individuals, and depressive disorder in 44.8% [95% CI: 40.7–48.9] of cases. A direct mod erate correlation was observed between neuropathic RLP and symptoms of both PTSD (r = 0.5±0.1, P level < 0.001) and depression (r = 0.5±0.2, P level < 0.001). PLP demonstrat ed the weakest association with mental health disorders. Individuals with clinical signs of
PTSD experienced nRLP level of 6,0 (5,0-7,0) that was 1.9 times higher [95% CI: 1.5–2.3] (P level < 0.05) than those without PTSD. The relative risk of exacerbating nRLP in patients with depressive symptoms was 1.8 [95% CI: 1.4–2.3] (P level < 0.05). Furthermore, the presence of neuropathic RLP was found to aggravate the severity of PTSD symptoms by RR of 12.1 [95% CI: 3.1–47.6] and depressive disorders by 3.4 [95% CI: 1.8–6.3]. Notably,
the comorbidity of neuropathic RLP and phantom limb pain did not further increase the risk of mental health disorder.
Conclusions. A bidirectional relationship and high comorbidity rates between neuropathic residual limb pain and mental health issues confirmed to be significant in early rehabili tation period for servicemembers after combat injury. Nearly twofold increase in the risk of clinically significant nRLP among patients following combat-related psychotrauma un derscores the mutual aggravation between nRLP chronification and mental health issues
5 months after combat-related amputation. For more effective postamputation pain man agement followed by successful social readaptation, therapy should include methods and medications for posttraumatic mental health issues.