Background: The majority of traumatic amputations occur in low income countries (LIC) and lower-middle income countries (LMIC) resulting in debilitating injuries with serious physical and psychological consequences. Pain is one of the most significant impairments, affecting quality of life and rehabilitation and must be accurately measured for effective management. This review aims to determine how pain is currently measured in those who have suffered a traumatic amputation in LICs and LMICs.
Methods: The review comprised three stages: (i) Six electronic databases, PUBMED, COCHRANE, CINAHL, EMBASE, WEB OF SCIENCE and PSYCHINFO were searched using terms including pain measurement, outcome measure, traumatic amputation and a list of LICs and LMICs obtained from the World Bank. Inclusion criteria: English language, human participants, traumatic limb amputation and pain outcome measure completed in LIC and/or LMIC. (ii) Potentially relevant papers were independently reviewed by two reviewers. (iii) Relevant data were extracted and summarised. The quality of the included papers was also determined.
Results: Twenty-three studies were included involving 2782 patients.  The majority were conducted in India (n=7), with conflict the most common cause of the amputation. The Visual Analogue Scale (VAS) was the most commonly reported measure (n=11), followed by the Numerical Rating Scale (NRS) (n=6), 36-Item Short Form Health Survey (SF-36) (n=3), The Trinity Amputation and Prosthesis Experience Scale (TAPES) (n=2), Word Scale (n=2), Never/Always Scale (n=2), Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) (n=1), Result Assessment Scale (RAS) (n=1), Satisfaction with Prosthesis Questionnaire (SATPRO) (n=1), Short-form McGill Pain Questionnaire (SFMPQ) (n=1) and Universal Pain Score (n=1).
Conclusions: A range of outcome measures are used to measure pain following traumatic amputations in LICs and LMICs. Literacy influences the choice of outcome measure in this population, which along with cultural differences may compromise validity and outcomes. Pain measurement is under-reported in the acute stages of injury. Further research to determine the most appropriate method of measuring pain is warranted in this patient cohort due to the heterogeneity and lack of high-quality studies.

PAIN MEASUREMENT IN TRAUMATIC AMPUTATIONS IN LOW AND LOWER MIDDLE INCOME COUNTRIES; A SYSTEMATIC REVIEW