No abstract

Since the last version of this review, we identified another study that added another form of medical therapy, BoNTs, specifically BoNT/A, to the list of pharmacologic interventions being reviewed for clinical efficacy in phantom limb pain. However, the results of this study did not substantially change the main conclusions. The short- and long-term effectiveness of BoNT/A, opioids, NMDA receptor antagonists, anticonvulsants, antidepressants, calcitonins, and local anaesthetics for clinically relevant outcomes including pain, function, mood, sleep, quality of life, treatment satisfaction, and adverse events remain unclear. Based on a small study, BoNT/A (versus lidocaine/methylprednisolone) does not decrease phantom limb pain. Morphine, gabapentin, and ketamine demonstrate favourable short-term analgesic efficacy compared with placebo. Memantine and amitriptyline may not be effective for PLP. However, results must be interpreted with caution, as they were based mostly on a small number of studies with limited sample sizes that varied considerably and also lacked long-term efficacy and safety outcomes. The direction of efficacy of calcitonin, local anaesthetics, and dextromethorphan needs further clarification. Overall, the efficacy evidence for the reviewed medications is thus far inconclusive. Larger and more rigorous randomised controlled trials are needed for us to reach more definitive conclusions about which medications would be useful for clinical practice.

The short- and long-term effectiveness of opioids, NMDA receptor antagonists, anticonvulsants, antidepressants, calcitonins, and anaesthetics for clinically relevant outcomes that include pain, function, mood, sleep, quality of life, satisfaction and adverse effects remains unclear. Morphine, gabapentin and ketamine demonstrate trends towards short-term analgesic efficacy. Memantine and amitriptyline were ineffective for PLP. Results, however, are to be interpreted with caution as these were based mostly on a small number of studies with limited sample sizes that varied considerably and also lacked long-term efficacy and safety outcomes. The direction of efficacy of calcitonin, anaesthetics and dextromethorphan need further clarification. Larger and more rigorous randomised controlled trials are needed to make stronger recommendations about which medications would be useful for clinical practice.

No abstract

Objectives: Data is necessary for a hospital-wide cerebral palsy (CP) profile, this being the leading pediatric diagnosis at the PGH Rehabilitation Medicine Out Patient clinic. This study aims to identify clinical features, severity of disability and common interventions in pediatric CP patients. Methods: CP profile data collection forms were accomplished from September 2014 to December 2015. Primary Results: Among 125 participants: 55% were < 5 years old, 47% were delivered vaginally, 42% had perinatal onset of condition, 34% had normal birth weight and 23% were moderately preterm. Most were quadriplegic (36%) and spastic (50%). Primary caregivers were mostly mothers (45%) and <20 years old (38%). Mobility-wise, 29% had Gross Motor Function Classification System score of 3. For hand function, 31% scored 2 in the Manual Ability Classification System and 26% were ‘below average’ in the Peabody Developmental Motor Skills-2. Common problems were: feeding (100%), communication (63%), seizure (58%), visual (56%) and auditory (54%). Majority (73%) had access to government medical facilities; 18% had no access. Physical (64%) and occupational (29%) therapy were common interventions; 29% received special education. Conclusion: A hospital-wide cerebral palsy profile should be established to monitor CP, given its multifactorial cause and complex functional impact. Trends should be correlated with maternal and patient factors, healthcare provision and socioeconomics.