Risk Factors for Neuropathic Pain in Digital Amputations

TL;DR

This study found that personality traits like neuroticism are linked to neuropathic pain after finger amputations, suggesting psychological factors play a role in recovery.

Contribution

The study is the first to show a correlation between neuroticism and neuropathic pain after digital amputation.

Findings

Neuroticism was significantly correlated with neuropathic pain and cold intolerance after finger amputation.

Work-related injuries and psychiatric disorders increased the risk of neuropathic pain.

Infection and delayed treatment were linked to higher revision rates, but surgical technique did not affect pain outcomes.

Abstract

Background/Objectives: Finger amputation is frequently followed by complications, with reported revision rates of up to 20%. One of the most disabling sequelae is the formation of painful neuromas, occurring in approximately 3–9% of cases. Several biological and mechanical risk factors have been proposed, but the potential influence of psychological traits remains poorly understood. This study aimed to investigate whether a correlation exists between patients’ personality traits and the development of neuropathic pain or related symptoms. Methods: A retrospective study was conducted at a Level II Hand Trauma Center, including patients who underwent digital amputation between 2021 and 2023. Neuropathic pain and cold intolerance were assessed using the S-DN4 and CISS questionnaires, respectively. Personality traits were evaluated using the BFI-10 scale. Demographic data and other clinical risk factors, including work-related injuries, psychiatric history, infection, treatment delay, and surgical technique, were also analyzed. Results: A total of 54 patients were included. Neuropathic pain, defined by an S-DN4 score ≥ 4, was identified in 10 patients (18.5%). A significant correlation was found between the occurrence of neuropathic pain, cold intolerance, and the “neuroticism” personality trait. Patients with work-related injuries or psychiatric disorders also showed a higher risk of neuropathic pain and cold intolerance. Conversely, infection and delayed treatment were associated with an increased risk of revision procedures, whereas the type of surgical technique used for nerve stump management was not significantly correlated with pain outcomes. Conclusions: The study demonstrated a meaningful association between the neurotic personality trait and both neuropathic pain and cold intolerance after finger amputation. Additionally, work-related injuries and psychiatric comorbidities were identified as potential risk factors. Patients exhibiting these characteristics may benefit from early psychological assessment and multidisciplinary management to prevent further complications and improve postoperative outcomes.

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