A systematic review on the treatment of phantom limb pain with spinal cord stimulation (original) (raw)
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Practice points • The history of phantom limb pain (PLP) and how over the years spinal cord stimulation (SCS) has played a role in management for clinicians. • The incidence and prevalence rates of PLP and importance of recognizing the pain and properly treating it. • The paper goes into extensive detail with neurophysiological background the mechanisms and pathways of PLP, and how SCS neurologically plays a role in mitigating this pain neurologically. • The aim of this systematic review is to provide evidence and well-established researched data on the efficacy of SCS for PLP. Methods • The authors utilized keyword searches in PubMed to ensure that a thorough, extensive search of the literature was carried out. • Inclusion and exclusion criteria were used for this systematic review to help provide a more defined, focused systematic review. • After using PRISMA method, and adequate analysis of the selected studies, a total of 12 research articles was decided on to be included in this systematic review. Results • The results of this review indicate that out of 12 studies, seven showed clinically significant results for pain relief, five did not show any pain relief.
Evidence for the Optimal Management of Acute and Chronic Phantom Pain: A Systematic Review
The Clinical Journal of Pain, 2002
Objectives: The objective was to examine the evidence to determine the optimal management of phantom limb pain in the preoperative and postoperative phase of amputations. Methods: Trials were identified by a systematic search of MEDLINE, review articles, and references of relevant trials from the period 1966-1999, including only English-language articles. Included trials involved a control group, any intervention, and reported phantom pain as an outcome. Results: Twelve trials were identified, including 375 patients whose follow-ups ranged in duration from 1 week to 2 years. Only three randomized, controlled studies with parallel groups and three randomized crossover trials were identified. Eight trials examined treatment of acute phantom pain, including epidural treatments (three trials), regional nerve blocks (three trials), treatment with calcitonin (one trial), and transcutaneous electrical nerve stimulation (one trial). Three trials demonstrated a positive impact of the intervention on phantom limb pain, but the remainder demonstrated no difference between the intervention and control groups. Four trials examined late postoperative interventions, including transcutaneous electrical nerve stimulation (two trials) and the use of Farabloc (a metal threaded sock) and ketamine (one trial each). With regard to late postoperative interventions, three of the four trials showed modest short-term reduction of phantom limb pain. There was no relation between the quality of the trial and a positive result of the intervention. Conclusions: Although up to 70% of patients have phantom limb pain after amputation, there is little evidence from randomized trials to guide clinicians with treatment. Evidence on preemptive epidurals, early regional nerve blocks, and mechanical vibratory stimulation provides inconsistent support for these treatments. There is currently a gap between research and practice in the area of phantom limb pain.
Relief of pain from a phantom limb by peripheral stimulation 1985.pdf
In the present study, 24 patients suffering pain from a phantom limb were given vibratory stimulation or placebo as a pain-relieving measure. During stimulation, a reduction in pain was reported by 75% of the patients as compared to 44% during placebo. Depending on the phantom sensation, the best pain-reducing site was found to be either the area of pain or the antagonistic muscle. In 90% of the patients the best pain-reducing effect was obtained when stimulation was applied with moderate pressure over a large area. The results of the present study suggest that vibratory stimulation may be a valuable symptomatic treatment measure in patients suffering pain from a phantom limb.
Advances in the Treatment of Phantom Limb Pain
Current Physical Medicine and Rehabilitation Reports, 2014
Phantom limb pain (PLP) continues to place a significant emotional and physical burden on amputees and remains a challenge for those treating amputees. Despite advances in psychological, pharmacologic, and interventional therapies, treatment modalities and research results show promise, but there is no evidence to highly recommend any particular treatment. This review concludes that the best treatment approach is a measured and diligent trial of multiple modes of treatment. As researchers forge forward toward definitively establishing etiologies, focused treatment options may become available. Until then, PLP is an area that calls for intense research and which will continue to challenge the clinician caring for the amputee population.
Relief of pain from a phantom limb by peripheral stimulation
Journal of Neurology, 1985
In the present study, 24 patients suffering pain from a phantom limb were given vibratory stimulation or placebo as a pain-relieving measure. During stimulation, a reduction in pain was reported by 75% of the patients as compared to 44% during placebo. Depending on the phantom sensation, the best pain-reducing site was found to be either the area of pain or the antagonistic muscle. In 90% of the patients the best pain-reducing effect was obtained when stimulation was applied with moderate pressure over a large area. The results of the present study suggest that vibratory stimulation may be a valuable symptomatic treatment measure in patients suffering pain from a phantom limb.
Management of chronic limb pain with spinal cord stimulation
Pain Practice, 2003
Background: Spinal Cord Stimulation (SCS) is a treatment option for chronic pain patients. The most common indication for SCS is the failed back syndrome with leg pain. In the last decade, advances in our understanding of appropriate stimulation programming, lead placement and the physiology of SCS, have led to changes in multi-site stimulation, and stimulation with differing programs. In the past, low back, axial neuropathic type pain was not responsive to SCS. With dual electrode arrays, and dual stimulation with alternating programs of stimulation, steering of stimulation paresthesia, and versatile programmable stimulation parameters, SCS has become a more versatile form of analgesia. Purpose: To describe the current treatment rational for SCS and the results of that treatment. Results: The SCS is most efficient in patients with neuropathic pain of the extremities and less efficacious in patients with axial pain. Conclusion: SCS is the most effective treatment for limb pain not amenable to surgical decompression. The success of SCS in this chronic pain group is 80% successful in treatment of leg pain, and much less effective in treatment of axial pain.
Managing acute phantom limb pain with transcutaneous electrical nerve stimulation: a case report
Journal of Medical Case Reports
Introduction Phantom limb pain is characterized by painful sensations in the amputated limb. The clinical presentation of acute phantom limb pain may differ from that of patients with chronic phantom limb pain. The variation observed implies that acute phantom limb pain may be driven by peripheral mechanisms, indicating that therapies focused on the peripheral nervous system might be successful in reducing pain. Case presentation A 36-year-old African male with acute phantom limb pain in the left lower limb, was treated with transcutaneous electrical nerve stimulation. Conclusion The assessment results of the presented case and the evidence on acute phantom limb pain mechanisms contribute to the current body of literature, indicating that acute phantom limb pain presents differently to chronic phantom limb pain. These findings emphasize the importance of testing treatments that target the peripheral mechanisms responsible for phantom limb pain in relevant individuals with acquired a...
Management of Phantom Limb Pain: A Review
International Journal of Medical Reviews and Case Reports, 2018
There are two types of pain after limb amputation, residual limb pain (RLP) that is pain localised on the stump, and pain perceived by the patient on the area of the missing limb which is called phantom limb pain (PLP). The prevalence of phantom limb pain remain high; several studies reported 50%-80% of amputated patients experienced PLP. Phantom limb pain therapy is challenging because its mechanism is not precise yet. In recent years, many therapies are being studied; they are divided into pharmacologic and nonpharmacologic therapy. Pharmacologic treatment such as BoNT/A injection, antidepressants (amitriptyline), anticonvulsants (pregabalin and gabapentin), opioids, NMDA receptor antagonists (memantine and ketamine), and capsaicin 8% patch. Nonpharmacologic therapy such as mirror therapy, transcutaneous electrical stimulation (TENS), spinal cauda equina stimulation, cryoneurolysis, and acupuncture. However, from all those studies, they conclude that there is no first-line treatment. In this review, modalities for PLP treatment over the past few years will be discussed. KEYWORDS phantom limb pain, management of phantom limb pain, pharmacologic therapy, nonpharmacologic therapy 1.Introduction The sensation of pain, experienced in the area of the missing body part is called phantom limb pain (PLP) [1,2]. It has to be distinguished from residual limb pain (RLP), formerly known as "stump pain" [3]. PLP first describe by Ambroise Paré in 1552 [4] and named by Silas Weir Mitchell [2,5]. PLP is very frequent in post-amputated patients, and the prevalence may be as high as 50% to 80% [2,6-8]. In 92% of PLP patients, the pain occurs in the first-week post-amputation, and 65% occur in the first sixmonth post-amputation [3,9]. Phantom limb pain is classified as neuropathic pain and associated with differentiation and cortical reorganisation mechanism in the somatosensory system. From all those treatments that are being studied, no one shows significant effectiveness [7].
Siriraj Medical Journal, 2022
Objective: To observe the effects of TENS on the contralateral limb and PLP reduction.Materials and Methods: This was a single center retrospective study of 20 amputee participants with phantom limb pain. The inclusion criteria were participants aged above 18, average pain of at least 4/10 on the numerical rating scale (NRS), duration of pain longer than one week and treatment with TENS on the opposite side. We recorded pain intensity before and after TENS application, response time to treatment, satisfaction, and adverse effects.Results: Of the 20 amputee participants, all patients suffered from PLP and three also suffered from residual limb pain. The average pain score before use of TENS was 4.85/10 and after was 1.15/10. The mean pain intensity score was reduced by 3.7/10 (95% CI 2.95-4.45/10) or 76.28% (95% confidence interval 63.61-89.47%). The average overall satisfaction was 81.65%, and no adverse effects from application of TENS was reported.Conclusion: The study shows that ...