Indigenous, Poorer and Rural Suffer More Amputation
Amputations are well known for causing chronic pain, with the majority of amputees experiencing some form of ongoing pain.
In Australia, some health gains have been made leading to rates of limb amputations stabilising as a result of early intervention of diabetes and peripheral cardiovascular disease.
Limb amputations are relatively uncommon. According to the report ‘Burden of Lower Limb Amputations Due to Diabetes in Australia’, in 2012-2013 4,190 patients with a diagnosis of either diabetes or peripheral vascular disease underwent lower limb amputations. Because of socioeconomic disadvantage there is a much higher rate of amputations occurring among people who live in rural and remote areas and especially among Indigenous Australians. In the Northern Territory amputations occur at four times the frequency than average across Australia. Rural and remote areas of Queensland, Western Australia and South Australia also have a higher frequency of amputations.
According to a study undertaken in Western Australia, rates of lower limb amputations caused by diabetes have declined considerably between 2000 and 2010. However, the rate of recurrent minor amputations has significantly increased among this group, suggesting that timely management of diabetes may help to reduce or prevent major amputations. However it should be noted that these state-based results may not be universal nationwide. Healthdirect, an Australian Government health advice organisation states that timely management of diabetes including healthy eating, an active lifestyle, regular foot checks and good blood sugar control reduces the risk of a need for limb amputation. Further, there is a need for more Indigenous telehealth and diabetes educators reaching into more rural and remote areas with culturally appropriate messages.
85% of people who undergo limb amputations experience Phantom Limb Pain (PLP), a neuropathic pain syndrome which can cause significant chronic pain. PLP is caused by the loss of signal or sensory feedback from the missing limb, where the brain increases the strength of its signal back to the peripheral nerves, causing pain. The loss of a limb can cause significant distress, and PLP can increase the level of distress and delay recovery. Specific surgical techniques used and the early use of prosthesis can help to minimise the chances of PLP developing. Additionally, there are numerous medical and therapy interventions available which can help to minimise PLP symptoms for those who suffer from them.
APMA has two educational brochures available about managing amputation-related pain, ‘Improving Pain Management for Amputees’ and ‘Phantom Pain – The Pain is Real’.
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Australian Institute of Health and Welfare, 2017, Burden of lower limb amputations due to diabetes in Australia: Australian Burden of Disease Study 2011. Australian Burden of Disease Study series no. 10. BOD 11. Canberra: AIHW
Healthdirect: Amputation (https://www.healthdirect.gov.au/amputation)
Kurowski JR, Nedkoff L, Schoen DE, Knuiman M, Norman PE & Briffa TG 2015. Temporal trends in initial and recurrent lower extremity amputations in people with and without diabetes in Western Australia from 2000 to 2010. Diabetes Research and Clinical Practice 108(2):280-7