Early Onset and Treatment of Phantom Limb Pain Following Surgical Amputation (original) (raw)
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Archives of Physical Medicine and Rehabilitation, 2000
Ehde DM, Czerniecki JM, Smith DG, Campbell KM, Edwards WT, Jensen MP, Robinson LR. Chronic phantom sensations, phantom pain, residual limb pain, and other regional pain after lower limb amputation. Arch Phys Med Rehabil 2000;81:1039-44.
Treating phantom limb pain following amputation
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Journal of the American College of Surgeons
BACKGROUND: A majority of the nearly 2 million Americans living with limb loss suffer from chronic pain in the form of neuroma-related residual limb and phantom limb pain (PLP). Targeted muscle reinnervation (TMR) surgically transfers amputated nerves to nearby motor nerves for prevention of neuroma. The objective of this study was to determine whether TMR at the time of major limb amputation decreases the incidence and severity of PLP and residual limb pain. STUDY DESIGN: A multi-institutional cohort study was conducted between 2012 and 2018. Fifty-one patients undergoing major limb amputation with immediate TMR were compared with 438 unselected major limb amputees. Primary outcomes included an 11-point Numerical Rating Scale (NRS) and Patient-Reported Outcomes Measurement Information System (PROMIS) pain intensity, behavior, and interference. RESULTS: Patients who underwent TMR had less PLP and residual limb pain compared with untreated amputee controls, across all subgroups and by all measures. Median "worst pain in the past 24 hours" for the TMR cohort was 1 out of 10 compared to 5 (PLP) and 4 (residual) out of 10 in the control population (p ¼ 0.003 and p < 0.001, respectively). Median PROMIS t-scores were lower in TMR patients for both PLP (pain intensity [36.3 vs 48.3], pain behavior [50.1 vs 56.6], and pain interference [40.7 vs 55.8]) and residual limb pain (pain intensity [30.7 vs 46.8], pain behavior [36.7 vs 57.3], and pain interference [40.7 vs 57.3]). Targeted muscle reinnervation was associated with 3.03 (PLP) and 3.92 (residual) times higher odds of decreasing pain severity compared with general amputee participants. CONCLUSIONS: Preemptive surgical intervention of amputated nerves with TMR at the time of limb loss should be strongly considered to reduce pathologic phantom limb pain and symptomatic neuroma-related residual limb pain.
Factors associated with phantom limb pain: a 31/2-year prospective study
Clinical Rehabilitation, 2010
Objective: To analyse the prevalence of phantom (limb) pain over time and to analyse factors associated with phantom (limb) pain in a prospective cohort of amputees. Design: A multicentre longitudinal study. Patients: One hundred and thirty-four patients scheduled for amputation were included. Methods: Patients filled in questionnaires before amputation, and postal questionnaires six months, 1½ years and 2½ years to a maximum of 3½ years after amputation. Preoperative assessment included patients' characteristics, date, side and level of, and reason for amputation. The follow-up questionnaires assessed the frequencies of the experienced phantom pain, prosthetic use and walking distance. The occurrence of phantom pain was defined as phantom pain a few times a day or more frequently. Results: Pre-and postoperative questionnaires were available filled in by 85 amputees (33 females and 52 males). The percentage of lower limb amputees with phantom pain was the highest at six months after amputation, and of upper limb amputees at 1½ years. In general, more women than men experienced phantom pain. One and a half years and 2½ years after amputation the highest percentages of the lower limb amputees used their prosthesis more than 4 hours a day (66%), after that time this percentage decreased to 60%. The results of the two-level logistic regression analysis to predict phantom pain show that phantom pain was less frequently present in men (odds ratio (OR) ¼ 0.12), in lower limb amputees (OR ¼ 0.14) and that it decreased in due course (OR ¼ 0.53 for 1 year). Conclusion: Protective factors for phantom pain are: being male, having a lower limb amputation and the time elapsed since amputation.
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].
The International Journal of Psychiatry in Medicine, 1988
Phantom limb pain, which affects a majority of amputees, must be distinguished from phantom limb sensation, a universal consequence of limb amputation. Although the characteristics and time course of phantom limb pain are well described in the literature, no single theoretical approach can fully account for the contradictory aspects of this condition, thus its underlying mechanisms remain unclear. Theories concerning the etiology of phantom limb pain categorized as peripheral, central and psychological have given rise to a myriad of treatment approaches.
Original article, 2022
Objective: To determine the prevalence of phantom limb pain and stump pain in amputees during first six months of amputation and to examine the intensity of phantom limb pain and stump pain with the passage of time. Methodology: It was cross sectional survey conducted from 16 th May to 30 th November 2019 at District Head Quarter hospital and Allied hospital Faisalabad during first six months of amputation. Total 80 patients including both gender and age ranging from 18-75 years were enrolled in the study. Data was collected using a questionnaire named "Phantom and stump pain questionnaire in amputees. And data was analyzed by using SPSS 20. Results: It was observed that 45 (56.25%) were males and 35 (43.75%) were females. In this study 22 (27.50%) patients were presented with upper limb amputation and 58 (72.50%) were with lower limb amputation. Findings of this study showed that the prevalence of phantom limb pain was 48 (60%) and stump pain was 52 (65%) and their intensity decreased with the passage of time because a negative correlation was found between two variables "duration since amputation and phantom pain" (r =-0.76, p = .000) and "duration since amputation and stump pain" (r =-0.49, p = .000). Stump pain was most common in traumatic cause of amputation and phantom limb pain was seen more in patient with amputation due to diabetes and peripheral vascular disease. Conclusion: It was concluded that phantom limb pain and stump pain appeared to be common in patients after upper and lower limb amputation during first six months of amputation and it was reported that the intensity of pain decreases gradually with the passage of time.
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.