Pathophysiology and treatment of phantom limb pain☆

Angarita, Mayra Alejandra Malavera; Villa, Sandra Carrillo; Ribero, Omar Fernando Gomezese; García, Ronald G.; Sieger, Federico Arturo Silva

doi:10.1097/01819236-201442010-00009

Cited by 4 publications

(8 citation statements)

References 39 publications

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“…Patients found to be at risk for PLP are those who have pre-amputation pain, traumatic amputation, residual pain in remaining limb and upper extremity amputation. [ 1 2 ]…”

Section: Discussionmentioning

confidence: 99%

“…Suggested therapies include administration of pharmacological agents (e.g., anti-epileptic drugs, anti-depressant drugs, opioids and calcitonin), behavioural interventions, transcutaneous electrical nerve stimulation, various invasive techniques (e.g., epidural blockade, sympathectomy, dorsal root entry zone lesion, spinal cord stimulation, motor cortex stimulation) and even electroconvulsive therapy. [ 2 ]…”

Section: Discussionmentioning

confidence: 99%

“…It occurs in up to 80% of limb amputees and affects the patient's quality of life and rehabilitation. [ 1 2 ] The mechanisms of PLP remain unknown but involve both peripheral and central neural factors including activation of N-methyl-D-aspartate (NMDA) receptors. [ 2 ] Although ketamine, an NMDA receptor blocker, has been successfully used in many neuropathic pain conditions, its role in treating PLP is unclear.…”

Section: Introductionmentioning

confidence: 99%

“…[ 1 2 ] The mechanisms of PLP remain unknown but involve both peripheral and central neural factors including activation of N-methyl-D-aspartate (NMDA) receptors. [ 2 ] Although ketamine, an NMDA receptor blocker, has been successfully used in many neuropathic pain conditions, its role in treating PLP is unclear. [ 3 4 ] We describe a challenging case of PLP where treatment with oral ketamine provided adequate relief.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Oral ketamine for phantom limb pain: An option for challenging cases

Mitra

Kazal

2015

Indian J Anaesth

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“…Patients found to be at risk for PLP are those who have pre-amputation pain, traumatic amputation, residual pain in remaining limb and upper extremity amputation. [ 1 2 ]…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Oral ketamine for phantom limb pain: An option for challenging cases

Mitra

Kazal

2015

Indian J Anaesth

View full text Add to dashboard Cite

“…Proposed mechanisms of PLP within the peripheral nervous system suggest that nerve regeneration and sprouting may drive formation of a neuroma at the amputation site ( 20 ). These neuromas are responsible for abnormal afferent impulses to the CNS that then cause the experience of PLP ( 19 , 21 ).…”

Section: Theorized Mechanisms Of Plpmentioning

confidence: 99%

Phantom Limb Pain in Pediatric Oncology

2018

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Phantom limb pain (PLP) is a prevalent problem for children and adolescents undergoing amputation due to cancer treatment. The symptoms are wide ranging from sharp to tingling. PLP in children typically lasts for a few minutes but can be almost constant and can be highly distressing. This focused review describes the characteristics, epidemiology, mechanisms, and evidence-based treatment of PLP in pediatric populations, focusing on pediatric cancer. In pediatric oncology, the administration of chemotherapy is a risk factor that potentially sensitizes the nervous system and predisposes pediatric cancer patients to develop PLP after amputation. Gabapentin, tricyclic antidepressants, opiates, nerve blocks, and epidural catheters have shown mixed success in adults and case reports document potential utility in pediatric patients. Non-pharmacologic treatments, such as mirror therapy, psychotherapy, and acupuncture have also been used in pediatric PLP with success. Prospective controlled trials are necessary to advance care for pediatric patients with PLP.

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The effectiveness of graded motor imagery for reducing phantom limb pain in amputees: a randomised controlled trial

et al. 2020

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Objective To investigate whether graded motor imagery (GMI) is effective for reducing phantom limb pain (PLP) in people who have undergone limb amputations. Design A single-blinded randomised, controlled trial. Setting Physiotherapy out-patient departments in three secondary level hospitals in Cape Town, South Africa. Participants Twenty-one adults (≥18 years) who had undergone unilateral upper or lower limb amputations and had self-reported PLP persisting beyond three months. Interventions A 6-week GMI programme was compared to routine physiotherapy. The study outcomes were evaluated at baseline, 6 weeks, 3 months and 6 months. Outcome measures The pain severity scale of the Brief Pain Inventory (BPI) was used to assess the primary outcome -PLP. The pain interference scale of the BPI and the EuroQol EQ-5D-5L were used to assess the secondary outcomes -pain interference with function and health-related quality of life (HRQoL) respectively. Results The participants in the experimental group had significantly greater improvements in pain than the control group at 6 weeks and 6 months. Further, the participants in the experimental group had significantly greater improvements than the control group in pain interference at all follow-up points. There was no between-group difference in HRQoL. ConclusionThe results of the current study suggest that GMI is better than routine physiotherapy for reducing PLP. Based on the significant reduction in PLP and pain interference within the participants who received GMI, and the ease of application, GMI may be a viable treatment for treating PLP in people who have undergone limb amputations. Clinical trial registration number (PACTR201701001979279).

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Pathophysiology and treatment of phantom limb pain☆

Cited by 4 publications

References 39 publications

Oral ketamine for phantom limb pain: An option for challenging cases

Oral ketamine for phantom limb pain: An option for challenging cases

Phantom Limb Pain in Pediatric Oncology

The effectiveness of graded motor imagery for reducing phantom limb pain in amputees: a randomised controlled trial

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