Painful and Nonpainful Phantom and Stump Sensations in Acute Traumatic Amputees

Schley, Marcus; Wilms, Petra; Toepfner, Stephanie; Schaller, Hanns Peter; Schmelz, Martin; Konrad, Christoph; Birbaumer, Niels

doi:10.1097/ta.0b013e31812eed9e

Cited by 112 publications

(96 citation statements)

References 52 publications

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“…The most common type of pain problems reported in these studies is phantom limb pain and residual (or stump) pain, although it is also possible for people to develop musculoskeletal pain following amputation, for example in the back (Hammarlund, Carlström, Melchior, & Persson, 2011;Kooijman, Dijkstra, Geertzen, Elzinga, & van der Schans, 2000). Prevalence estimates suggest that phantom limb pain occurs in approximately 45 to 80% of people postamputation, depending partly upon whether those with upper or lower limb amputations are considered, with rates of residual pain similarly high but varying (Behr, et al, 2009;Desmond & Maclachlan, 2010;Dijkstra, et al, 2002;Ehde, et al, 2000;Kooijman, et al, 2000;Schley, et al, 2008).…”

Section: Amputationmentioning

confidence: 99%

Chronic Pain in People with Physically Disabling Conditions: A Review of the Application of Biopsychosocial Models

Perry¹

2012

Pain Management - Current Issues and Opinions

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Section: Amputationmentioning

confidence: 99%

Chronic Pain in People with Physically Disabling Conditions: A Review of the Application of Biopsychosocial Models

Perry¹

2012

Pain Management - Current Issues and Opinions

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“…A common complaint among amputees is phantom limb pain (PLP), a phenomenon in which unpleasant sensations, often painful and severe, are perceived to originate from an absent limb. PLP occurs in 50%-80% of amputees, and there is no consistent evidence to support any specific pain control modality or intervention in this setting (1,(3)(4)(5)(6)(7). The objectives of this study were to (a) evaluate the safety and feasibility of …”

Section: Materials and Methods-frommentioning

confidence: 99%

Percutaneous image-guided cryoablation for the treatment of phantom limb pain in amputees: a pilot study

Prologo

Gilliland

Yamada

et al. 2016

Journal of Vascular and Interventional Radiology

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Purpose-To prospectively evaluate percutaneous image-guided nerve cryoablation for treatment of refractory phantom limb pain (PLP) in a pilot cohort for purposes of deriving parameters to design a larger, randomized, parallel-armed, controlled trial. Materials and Methods-FromJanuary 2015 to January 2016, 21 patients with refractory PLP underwent image-guided percutaneous cryoneurolysis procedures. Visual analog scale scores were documented at baseline and 7, 45, and 180 days after the procedure. Responses to a modified Roland Morris Disability Questionnaire were documented at baseline and 7 and 45 days after the procedure.Results-Technical success rate of the procedures was 100%. There were 6 (29%) minor procedure-related complications. Disability scores decreased from a baseline mean of 11.3 to 3.3 at 45-day follow-up (95% confidence interval 5.8, 10.3; P < .0001). Pain intensity scores decreased from a baseline mean of 6.2 to 2.0 at long-term follow-up (95% confidence interval 2.8, 5.6; P < .0001).Conclusions-Image-guided percutaneous nerve cryoablation is feasible and safe and may represent a new efficacious therapeutic option for patients with phantom pains related to limb loss.Approximately 185,000 amputations are performed each year in the United States, and studies estimate that nearly 3.6 million people will be living with limb loss worldwide by 2050 (1,2). A common complaint among amputees is phantom limb pain (PLP), a phenomenon in which unpleasant sensations, often painful and severe, are perceived to originate from an absent limb. PLP occurs in 50%-80% of amputees, and there is no consistent evidence to support any specific pain control modality or intervention in this setting (1,(3)(4)(5)(6)(7). The objectives of this study were to (a) evaluate the safety and feasibility of HHS Public Access Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript a separated 2-step procedural methodology consisting of computed tomography (CT)-guided perineural diagnostic injection and cryoablation in the setting of refractory PLP; (b) confirm the reproducibility of treatment response in relation to the findings of previous studies; and (c) derive estimates for key study parameters, such as recruitment rates, potentially confounding variables, and the treatment effect and its variation to inform the planning and design of a larger, parallel-armed, randomized controlled clinical trial investigating the efficacy of cryoablation for the treatment of PLP. MATERIALS AND METHODSThis study was approved by the university institutional review board and complied with the Health Insurance Portability and Accountability Act. The trial was registered before patient enrollment on ClinicalTrials.gov (NCT02366832). SubjectsSubjects were recruited from January 2015 to January 2016 from local vascular surgery, orthopedic surgery, and physical medicine and rehabilitation practices. All patients reported phantom pains and/or unwanted sensations related to a previously amputated upper or lower limb that were refr...

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“…There are early and late peaks of onset of phantom limb pain at one month and one year after amputation respectively. 55 Fortunately, phantom pain develops in less than 2% of all amputees although some report an incidence as high as 10%. 20,51,55,56 The phenomenon is thought to develop from either a central problem (basically psychogenic) or a peripheral problem (basically organic) 56 which is the current thinking.…”

Section: Complicationsmentioning

confidence: 99%

“…55 Fortunately, phantom pain develops in less than 2% of all amputees although some report an incidence as high as 10%. 20,51,55,56 The phenomenon is thought to develop from either a central problem (basically psychogenic) or a peripheral problem (basically organic) 56 which is the current thinking. It has been described as a constant burning type of pain similar to that noted in causalgia.…”

Section: Complicationsmentioning

confidence: 99%