Phantom limb pain in cancer‐related pediatric amputees: recent experience at St. Jude Children's Research Hospital

Abstract

Preliminary results show that homocysteine levels are not consistently correlated with N 2 O exposure. No clinical or biochemical adverse effects related to the gas have been detected. Conclusion: This interim analysis suggests that repeated N 2 O has a marginal effect on vitamin B12 metabolic indices in predisposed children. The study is on-going. This study is supported by a grant from SPANZA.

Prospective study of neuropathic pain after definitive surgery for extremity osteosarcoma in a pediatric population

“…20 In a study of children and young adults (ages 6-27 years, of which 64% were younger than 18 years) with cancer-related surgical amputations, 64% suffered pre-amputation pain, 76% experienced PLP within the first year after amputation, and 10% experienced PLP at 1 year postamputation. 22 Furthermore, in a subsequent study from is implicated in development of chronic postsurgical pain. 13 The duration of NP in our study group, of mean (SD) 6.5 weeks (7.2) (median 4.4, range 0.3-29.9), is significant and for some patients it qualifies for the "true" definition of chronic pain as exceeding 3 months.…”

“…The incidence of PLP is thought to be lower in children, and PLP has not been reported in patients younger than 4 years . In a study of children and young adults (ages 6–27 years, of which 64% were younger than 18 years) with cancer‐related surgical amputations, 64% suffered pre‐amputation pain, 76% experienced PLP within the first year after amputation, and 10% experienced PLP at 1 year postamputation . Furthermore, in a subsequent study from the same group of 21 adolescents and young adults (ages 8–24 years) who underwent an amputation during the prior 6 years at our institution (2009–2015), 18 (85.7%) experienced PLP; of them, 38.9% still experienced PLP at 1 year postamputation.…”

Neuropathic pain in children

“…Factors that are thought to predispose to phantom limb pain are surgical amputation (pain prevalence 49%–76% in contrast to 3%–4% in congenitally deficient limbs), older age at time of amputation, preoperative pain and amputation for cancer 35 39 40. Chemotherapy may also increase the risk of phantom pain (see below).…”

“…There is a perception that phantom limb pain resolves more rapidly in children than in adults. However, phantom limb pain can persist for months or years, and again, older age at amputation seems to be a negative prognostic indicator for recovery 35 38 40…”

Inflammatory pain memory facilitates occlusal interference‐induced masticatory muscle hyperalgesia in rats

“…Pain memories resulting from long-lasting preamputation pain are powerful elicitors of phantom limb pain (de Roos et al, 2010). What people remember about previous painful events, such as paediatric pain (Noel et al, 2012a), visceral pain (Gramsch et al, 2014), injections (Noel et al, 2012b) and surgery (Costantini et al, 2011;Burgoyne et al, 2012), influences future pain perception. In animals, pain memory is presented and measured through changes in performance or behaviour after prior exposure rather than through recalling past pain in words.…”