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Final Program


Final Program

Pain

1441 - Prioritizing Functional Recovery: A Systematic Review of Opioids Versus NSAIDs for Pain Management in Post-Amputation Rehabilitation

Thursday, February 19, 2026
5:00 PM - 6:30 PM AST

    Presenting Author(s)

  • KN

    Kevin J. Noorda, MD

    Resident Physician
    HCA Healthcare Sunrise Health GME/ Mountainview Physical Medicine & Rehabilitation Residency Program
    North Las Vegas, Nevada, United States

    • Co-Author(s)

  • EN

    Eric T. Nguyen, DO

    Resident Physician
    Charles R. Drew University of Medicine and Science Physical Medicine & Rehabilitation Residency Program
    Huntington Beach, California, United States

  • EA

    Eric Aguila, MD

    Associate Chief of Staff for Education, Medical Director of the Amputee Clinic
    Veterans Affair Southern Nevada Healthcare System
    Las Vegas, Nevada, United States

    • Submitter(s)

  • EN

    Eric T. Nguyen, DO

    Charles R. Drew University Physical Medicine & Rehabilitation Residency Program
    Huntington Beach, California, United States

Objectives: Effective pain management is essential in post-amputation rehabilitation to reduce barriers to therapy participation and to optimize functional recovery. While both NSAIDs and opioids are commonly used, their comparative impact on functional outcomes, such as mobility, prosthetic use, and therapy engagement, remains unclear. This study systematically reviews the literature to evaluate the effects of opioids versus NSAIDs on functional recovery in adults undergoing post-amputation rehabilitation.

Design: A systematic review was conducted using PubMed and Cochrane databases (2000–2025) with the keywords: opioids, NSAIDs, amputation, rehabilitation, prosthetic training, residual limb pain, and functional outcomes. Inclusion criteria included randomized controlled trials, systematic reviews, and clinical guidelines reporting on pain management and functional outcomes in post-amputation populations. Studies focusing exclusively on pain intensity or opioid consumption without functional endpoints were excluded. Functional outcomes were defined using validated measures like the Amputee Mobility Predictor, 6-minute walk test, Functional Independence Measure, and patient-reported outcome measures.

Results:

Of the 1,243 articles screened, only 27 met inclusion criteria. A majority of studies focused on pain intensity, with only a minority  reporting functional outcomes. No high-quality, direct comparative studies of opioid versus NSAID use on validated functional endpoints in post-amputation rehabilitation were identified. Indirect evidence gathered from other surgical and chronic pain populations suggests no functional superiority of opioids over NSAIDs, and highlights an increased risk of adverse effects with opioids. Recent guidelines emphasize multimodal, individualized pain management and request further research linking analgesic choice to functional recovery.

Conclusions: There is a critical gap in the literature regarding the comparative effectiveness of opioids versus NSAIDs on functional recovery in post-amputation rehabilitation. Current evidence does not support the functional superiority of opioids or NSAIDs and underscores the need for prospective studies using validated functional measures. These findings support a patient-centered, multimodal approach and identify a key area for future research.