Incidence and Management of Phantom Limb Pain According to World Health Organization Analgesic Ladder in Amputees of Malignant Origin

Abstract

Antidepressants and anticonvulsants are currently considered to be the drug treatment of choice for neuropathic pain. Opioids are effective in relieving neuropathic pain, including phantom pain in the early postoperative course. The present study of 42 cancer patients with limb amputation was conducted to determine the incidence of phantom limb pain and phantom sensation and to test the utility of the World Health Organization 3-step analgesic ladder in phantom limb pain management. Patients were monitored monthly for the first 2 months postoperatively and every 2 months thereafter for 2 years. The World Health Organization analgesic ladder was followed for pain management. The patients complaining of phantom sensation, phantom pain, and stump pain decreased from 69%, 60%, and 31%, respectively, at 1 month to 32%, 32%, and 5%, at the end of 2 years with the addition of opioids. The World Health Organization analgesic ladder played significant role in phantom limb pain management.

Influence of Surgical Complications on the Level of Pain after Radical Inguinal/Iliacal Lymph Node Dissection

“…The therapy was according to level I and II of the World Health Organisation (WHO) analgesic ladder for pain therapy (16). We recognised that this therapy resulted in a sufficient level of pain through postoperative period at rest.…”

Mirror Therapy in the Rehabilitation of Lower-Limb Amputation

“…[3][4][5][6][7][8] The term PLRP encompasses all the positive and negative sensations felt by people with amputation in their missing limb, including phantom limb sensations and phantom limb pain. 9 The mirror box is a device that allows people with amputation to view a reflection of their anatomical limb in the visual space occupied by their phantom limb. The box has been reported to induce vivid sensations of movement originating from the missing limb, improving motor control over a paralyzed phantom limb, 6 and to reduce PLRP.…”

Management of Phantom Limb Pain

“…The WHO analgesic ladder was developed to provide a logical stepwise approach to cancer pain (WHO 1996), beginning with simple analgesics such as paracetamol and moving up to more potent analgesia such as morphine, as the need arose (Mishra et al 2008). The original 3-step ladder consists of the prescription of non-opiate analgesia (paracetamol, non-steroidal analgesics) for mild-moderate pain; weak opiates for mild-moderate pain and strong opiates for moderate-severe pain (Grond et al 1999).…”

“…It has been adapted to a 4-step ladder to incorporate the use of adjuvant medications (for example anti-depressants or anti-convulsants) and interventions (such as nerve blocks) which may be necessary for the management of the neuropathic element of cancer pain (Grond et al 1999). Mishra et al (2008) used this 4-step ladder in a small study of phantom pain related to limb amputation for cancer. They found no reduction in phantom pain when step 1 (non-opiate medication) was in use, and although the best results were obtained with the use of morphine (Step 3, strong opiate) there was no significant difference between Step 2 and Step 3.…”