Background and Aims:
Post-amputation pain contributes to increased distress and delayed discharged. In our UK secondary care trust, amputees referred to the inpatient pain team frequently declined physical therapies due to pain. We aimed to implement multidisciplinary (MDT) working between specialist pain nursing, clinical psychology, physiotherapy and occupational therapy (OT) to better support those with post-amputation pain. This was achieved by collaboratively making treatment plans and MDT patient reviews since June 2018. We will continue service evaluation until August 2019.

Method:
All patients with pain that complicated progress with physical therapies were discussed as an MDT with specialist pain clinical psychology, specialist pain nursing, physiotherapy and OT. Number of therapy sessions declined due to pain before and after MDT interventions were collated. Clinicians completed the 19 item Team Decision Making Questionnaire (TDMQ; Batorowicz & Tracy, 2008) which comprises ratings from 6 (to a vast extent) to 0 (not at all) on the degree to which multidisciplinary working enabled them to achieve potential benefits.   

Results:
To date, six patients to date were provided with specialist pain MDT treatment for managing pain-related-distress. Before intervention four patients declined 45% of the physical therapy sessions   due to pain, reducing to 24% following MDT intervention. TDMQ (4 collected) showed “develop effective problem solving” as the highest rated benefit. Patient feedback highlighted the benefits of a biopsychosocial understanding of their needs.

Conclusion:
The MDT approach involving specialist pain input can support ward staff to improve the post-operative care for amputees with complex pain in secondary care.

BIOSPSYCHOSOCIAL APPROACHES TO SUPPORT AMPUTEES POST-OPERATIVELY: MULTIDISCIPLINARY INPUT WITH SPECIALIST PAIN SERVICES