Phantom Limb Pain Induced by Spinal Anesthesia

Schmidt, André; Takahashi, Márcia Emy; Posso, Irimar de Paula

doi:10.1590/s1807-59322005000300014

Cited by 18 publications

(4 citation statements)

References 12 publications

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“…Other treatments considered in the management of this patient included epidural analgesia and the use of tramadol, amantadine and gabapentin. Reports of inability of epidural or spinal analgesia administration to prevent the development of PLP 26 and the possible induction of PLP by the administration of spinal anaesthesia 27 indicate their may be little use for this modality in treating PLP. Expense and formulation of the other medications made these unattractive options.…”

Section: Discussionmentioning

confidence: 99%

Case Report

O'Hagan¹

2006

Aust Veterinary J

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Phantom limb pain is a form of neuropathic pain experienced by human patients who have had amputations. To date there are no reported cases of phantom limb pain in the veterinary literature. A cat presented with signs consistent with neuropathic or phantom limb pain 42 days after iatrogenic sciatic nerve injury and 38 days after subsequent hind limb amputation. Multimodal analgesic therapy resulted in resolution of signs of pain.

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Section: Discussionmentioning

confidence: 99%

Case Report

O'Hagan¹

2006

Aust Veterinary J

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“…Case reports have documented the development of phantom limb pain with spinal anesthesia, the disappearance and recurrence of phantom limb pain after the development and resection of a spinal tumor, respectively, and phantom limb pain attributed to both herniated discs and herpes zoster infections. 87,115,116 The latter two cases are examples of pain referred from a sensate body part near the spinal column to an insensate one, which is mechanistically different from pain that results from rendering a body part insensate but may be clinically indistinguishable. Spinal cord stimulation has also been reported in uncontrolled studies to relieve central poststroke pain, phantom limb pain, spinal cord injury–neuropathic pain, and brachial plexus avulsion.…”

Section: Epidemiology and Clinical Presentationmentioning

confidence: 99%

Pain in the Context of Sensory Deafferentation

Cohen,

Caterina,

Yang

et al. 2024

Anesthesiology

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Pain that accompanies deafferentation is one of the most mysterious and misunderstood medical conditions. Prevalence rates for the assorted conditions vary considerably but the most reliable estimates are greater than 50% for strokes involving the somatosensory system, brachial plexus avulsions, spinal cord injury, and limb amputation, with controversy surrounding the mechanistic contributions of deafferentation to ensuing neuropathic pain syndromes. Deafferentation pain has also been described for loss of other body parts (e.g., eyes and breasts) and may contribute to between 10% and upwards of 30% of neuropathic symptoms in peripheral neuropathies. There is no pathognomonic test or sign to identify deafferentation pain, and part of the controversy surrounding it stems from the prodigious challenges in differentiating cause and effect. For example, it is unknown whether cortical reorganization causes pain or is a byproduct of pathoanatomical changes accompanying injury, including pain. Similarly, ascertaining whether deafferentation contributes to neuropathic pain, or whether concomitant injury to nerve fibers transmitting pain and touch sensation leads to a deafferentation-like phenotype can be clinically difficult, although a detailed neurologic examination, functional imaging, and psychophysical tests may provide clues. Due in part to the concurrent morbidities, the physical, psychologic, and by extension socioeconomic costs of disorders associated with deafferentation are higher than for other chronic pain conditions. Treatment is symptom-based, with evidence supporting first-line antineuropathic medications such as gabapentinoids and antidepressants. Studies examining noninvasive neuromodulation and virtual reality have yielded mixed results.

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“…Clinical observations support the role of the spinal cord in the development and maintenance of PLP. As just one example, cases of PLP elicited by or recurring with spinal anesthesia have been reported [33][34][35].…”

Section: Spinal Changes (Dysfunctions In Transduction)mentioning

confidence: 99%

Chronic post amputation pain: pathophysiology and prevention options for a heterogenous phenomenon

Stone

Hollmann

Terwindt

et al. 2023

Current Opinion in Anaesthesiology

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Purpose of review Chronic postamputation pain (cPAP) remains a clinical challenge, and current understanding places a high emphasis on prevention strategies. Unfortunately, there is still no evidence-based regimen to reliably prevent chronic pain after amputation. Recent findings Risk factors for the development of phantom limb pain have been proposed. Analgesic preventive interventions are numerous and no silver bullet has been found. Novel techniques such as neuromodulation and cryoablation have been proposed. Surgical techniques focusing on reimplantation of the injured nerve might reduce the incidence of phantom limb pain after surgery. Summary Phantom limb pain is a multifactorial process involving profound functional and structural changes in the peripheral and central nervous system. These changes interact with individual medical, psychosocial and genetic patient risk factors. The patient collective of amputees is very heterogeneous. Available evidence suggests that efforts should focus on prevention of phantom limb pain, since treatment is notoriously difficult. Questions as yet unanswered include the evidence-base of specific analgesic interventions, their optimal “window of opportunity” where they may be most effective, and whether patient stratification according to biopsychosocial risk factors can help guide preventive therapy.

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Phantom Limb Pain Induced by Spinal Anesthesia

Cited by 18 publications

References 12 publications

Case Report

Case Report

Pain in the Context of Sensory Deafferentation

Chronic post amputation pain: pathophysiology and prevention options for a heterogenous phenomenon

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