A College of Cape City (UCT) doctoral examine by Katleho Limakatso has damaged new floor on ache administration for amputees experiencing phantom limb ache. Katleho accomplished his doctorate in solely three years. And when he’s capped on 22 July, he’ll develop into UCT’s first black PhD in Anaesthesia and Perioperative Drugs.

Will probably be a high-five second for Katleho, his household and supporters (flocking to the Mom Metropolis from so far as Lesotho) and his “superb” supervisor, Professor Romy Parker, of the division’s Power Ache Administration Unit. Collectively, that they had deliberate this milestone with Professor Parker championing his improvement from day one in all his postgraduate research in 2016, Katleho stated.

He additionally had excessive reward for Professor Justiaan Swanevelder, the top of the UCT Division of Anaesthesia and Perioperative Drugs, and the enabling analysis workforce he labored with.

“They gave me alternatives to develop. They confirmed care and that they have been not simply in my skilled improvement however my well-being too.”

Katleho Limakatso
PhD graduand Katleho Limakatso deliberate his tutorial journey along with his supervisor, Prof Romy Parker, way back to 2016. It took dedication, consistency and creativity.

Ache and mirrors

Katleho first got here throughout phantom limb ache some years in the past as an undergraduate scholar coaching at Victoria Hospital in Wynberg. He’d rushed to a affected person who was experiencing insufferable ache in his left foot. However after discovering that the affected person’s left leg had been amputated, Katleho was left bewildered. How might he nonetheless really feel ache the place there was nothing?

Amputation is commonly a final resort for diabetics who expertise lengthy durations of debilitating ache, the results of poorly managed well being. However amputees usually nonetheless really feel ache in a limb that’s not there. The situation impacts roughly seven in each 10 amputees, stated Katleho.

Supervised by Parker, he devoted his grasp’s examine to investigating the efficacy of a brand new remedy for the situation. The remedy known as graded motor imagery. It makes use of a software program utility and a mirror to ‘retrain the mind’, by activating the areas that after managed the actions of the amputated limb.

A-ha moments

Spurred by the remedy’s success, Katleho developed this work in a PhD. His doctoral thesis is constructed on 4 novel research with two already in publication.

The primary is a scientific overview and meta-analysis on all the info on prevalence of phantom limb ache globally. The second is a cross-sectional examine on the prevalence and threat elements for phantom limb ache in African amputee contributors. These have been sufferers recruited at Groote Schuur Hospital.

As a result of they need an even bigger pattern dimension and the demographic is comparable, they’re operating one other examine within the Japanese Cape. However preliminary outcomes present that prevalence within the Western Cape is much like the worldwide figures.

The third examine is an knowledgeable Delphi examine on remedy suggestions for phantom limb ache. Of the 37 therapies proposed within the first spherical, solely seven have been endorsed within the remaining spherical. (Briefly, a Delphi examine is a proper, in-depth, systematic qualitative methodology. It’s a forecasting course of primarily based on a number of rounds of questionnaires despatched to a panel of specialists.)

“Fascinating is that six of the seven have been non-pharmacological therapies. That is in step with the literature which at the moment favours non-pharmacological therapies for phantom limb ache administration,” stated Katleho.

Graded motor imagery was among the many two prime therapies.


“If I can assist to cut back [a] affected person’s ache, I really feel like a superhero.”

“Within the subsequent 12 months or two we’ll be conducting a bigger examine on a remedy for phantom limb ache with worldwide collaborators,” he added.

The fourth examine is a Delphi examine with sufferers with decrease limb amputations, recognized from the Groote Schuur Hospital registry. This checked out care priorities amongst these sufferers.

It was this examine that produced the really “a-ha” second for Katleho.

Interviews with sufferers confirmed a discrepancy between what clinicians need to obtain with their sufferers and the result sufferers need.

“If I can assist to cut back [a] affected person’s ache, I really feel like a superhero. I’m completely happy. I’ve performed my job,” he stated.

However sufferers don’t at all times take into account this as their precedence.

Katleho Limakatso
Katleho Limakatso’s PhD provides new Africa-generated information to the examine of therapies for phantom limb ache.

Psychological priorities

Amputation brings different ache: melancholy and nervousness, lack of hope and motivation, lowered self- esteem and dignity. This stems from misplaced mobility and entry, job losses and sufferers’ wrestle to regulate to new methods of dwelling and being.

“Some prioritise psychological well being, and easy issues like water, sanitation and getting lodging on the bottom flooring, for instance,” stated Katleho. “We had contributors from the Cape Flats who stay on the primary, second or third flooring. They don’t have elevators, so it turns into difficult for them to stay a traditional life.

“A number of the sufferers I handled stated, ‘If solely I might get meals to eat, to stay a good life, I don’t care a lot concerning the ache. Meals is a precedence as a result of I misplaced my job after the amputation’. We realised that dwelling in South Africa, with its enormous financial and social disparities, our wants are completely different.”

Sufferers additionally wished pre- and post-operative schooling: What would occur within the working theatre? What might they anticipate afterwards? Others wanted psychological assist to deal with the trauma of shedding a limb and their struggles to navigate society and isolation. They want long-term psychological care to guide regular, purposeful lives and reintegrate into society.

These under-diagnosed situations and desires have to be introduced into the multi-sectoral system of care and administration, Katleho stated. This calls for a holistic method.

“The sufferers gave us an enormous image of what they need on this context. And it was actually humbling.”

Katleho will go to the World Congress on Ache in Canada later this 12 months to get suggestions on the examine previous to publication.

Crew effort

The outcomes of his PhD examine will probably be used to inspire for change within the method to care of amputees. One of many papers deliberate for publication highlights the necessity for interdisciplinary care the place all stakeholders, sufferers, medical doctors, physios, social employees, household practitioners, group employees and policymakers are concerned in sufferers’ care and administration.


“I name them the forgotten cohort.”

“We’re nonetheless to understand the significance of such teamwork within the administration of sufferers with amputation. The outcomes of this examine make clear that. It exhibits the extent to which we want collaboration, not solely throughout the medical system however with folks past the medical system.”

The commencement can even be a chance to thank the sufferers who participated within the analysis.

“I name them the forgotten cohort. You not often see them within the malls; they don’t have transport to get to the locations or entry to the issues we get pleasure from.

“With out them we might by no means generate new information.”

Katleho is thrilled to be celebrating this milestone, accomplished in solely 36 months based on a recipe of equal elements of consistency, dedication and creativity. The journey modified him in a number of methods.

“I learnt methods to reinforce my strengths and enhance my weaknesses. I additionally learnt concerning the worth of significant groups {and professional} relationships. And resilience. I really feel harder than I used to be earlier than as a result of the PhD journey is characterised by problem after problem and downside after downside. Not solely research-based issues, however life issues too. So, I’ve learnt to assume extra creatively. I’m a greater problem-solver than I used to be.”

UCT’s first black PhD in Anaesthesia and Perioperative Drugs additionally has a message for youthful college students: your background and your previous don’t outline your future.

“I come from a really humble background. It’s doable.”

He’s prouder nonetheless of getting contributed to new information from Africa – with the hope that spells for sufferers by way of improved medical practices and outcomes.

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