Regional differences in pain threshold and tolerance of the transtibial residual limb: Including the effects of age and interface material

Lee, Winson C.C., Zhang, Ming, & Mak, Arthur F. (2005) Regional differences in pain threshold and tolerance of the transtibial residual limb: Including the effects of age and interface material. Archives of Physical Medicine and Rehabilitation, 86(4), pp. 641-649.

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Objectives To compare the pain threshold (the minimum pressure inducing pain) and pain tolerance (the maximum tolerable pressure) of different regions of the residual limbs of amputees by the indentation method and to evaluate the interface pressure distribution and distortion of the skin surface on indentation by finite element (FE) analysis.

Design Crossover trial.

Setting Rehabilitation engineering center.

Participants Eight transtibial amputees for indentation test and 1 for FE analysis.

Interventions The load applied to the residual limbs using a Pelite or polypropylene indenter attached to a force transducer was increased until subjects could no longer tolerate the load. An FE model was built to simulate the indentation process with the experimentally recorded pain threshold used to load the indenters against the soft tissues.

Main outcome measures Pain threshold and tolerance and interface pressure and distortion of soft tissues.

Results The patellar tendon and distal end of the fibula were the best and the worst load-tolerant regions, respectively. Some regions with a thicker layer of soft tissue had lower pain thresholds and tolerance than those with a thinner tissue layer. There was a trend for pain threshold and tolerance to decrease with age. The FE model showed that the peak pressure at the skin surface was very close when both indenters were loaded against the soft tissue at pain threshold limit.

Conclusions Contrary to common beliefs, regions with a thicker layer of soft tissue did not have a higher load-tolerant ability than thin-skinned regions. Pain threshold and tolerance could be age dependent. The FE model suggests that pain is triggered when peak pressure is applied to the residual limb exceeding a certain limit.

Impact and interest:

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21 citations in Web of Science®

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ID Code: 2929
Item Type: Journal Article
Refereed: Yes
Keywords: pain threshold, pain tolerance, prosthetics, prosthesis, prosthetic design, indentation, finite element analysis
DOI: 10.1016/j.apmr.2004.08.005
ISSN: 0003-9993
Subjects: Australian and New Zealand Standard Research Classification > ENGINEERING (090000) > BIOMEDICAL ENGINEERING (090300) > Rehabilitation Engineering (090305)
Divisions: Past > QUT Faculties & Divisions > Faculty of Built Environment and Engineering
Copyright Owner: Copyright 2005 Elsevier
Copyright Statement: Reproduced in accordance with the copyright policy of the publisher.
Deposited On: 19 Dec 2005 00:00
Last Modified: 10 Aug 2011 18:37

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