Pharmacological and Psychosocial Interventions in Patients with Limb Amputations in Sri Lanka: a Case Series
C. Costa, N. Fonseka, P. Vidyatilake, C. WijesingheIntroduction
Limb amputation is often followed by phantom limb pain and grief -both of which frequently go underdiagnosed in busy clinical settings. These difficulties compound physical disability and hinder recovery (Flor et al., Lancet Neurol 2002;1:182–189; Bhayana et al., Injury 2024;55:111828). While phantom limb pain has been extensively studied globally, the psychosocial impact of limb loss, particularly grief, has not been systematically assessed in Sri Lanka since the stigma associated with expressing grief, often discourages patients from seeking help. Integrating pharmacological and psychosocial interventions in a multidisciplinary framework enhances recovery and well-being.
Objectives
To examine the clinical profiles, psychosocial challenges, and treatment outcomes of patients with limb amputations managed at the Pain Management Clinic, Colombo North Teaching Hospital, Sri Lanka.
Methods
Methods:
Five patients (3 males, 2 females; aged 31–61 years) with limb amputations were reviewed at the Pain Management Clinic, Colombo North Teaching Hospital. Purposive sampling was used. Data were collected via structured questionnaire and clinical records. Management included pharmacotherapy and psychotherapy. Pain was rated on a numerical scale before and after intervention. Quantitative data were analyzed using descriptive statistics, paired t-test, Wilcoxon signed-rank test, and Cohen’s d; qualitative data were thematically analyzed.
Results
All patients reported phantom limb pain with associated grief, anger, sleep disturbance, or depressive symptoms. Pre-treatment pain ranged 5–9/10 (mean 7.1 ± 1.1). Interventions included neuropathic agents (e.g., pregabalin, amitriptyline, carbamazepine, sertraline) and psychotherapies (CBT for pain, grief counselling, mirror therapy, relaxation, family therapy). Post-treatment scores ranged 1–5/10 (mean 3.2 ± 1.6), reflecting a significant reduction (p = 0.013; Cohen’s d = 1.91).
Patients also reported improved mood, coping, and social functioning. This is the first documented assessment in Sri Lanka of grief related to limb loss measured pre- and post-grief therapy in amputees.
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