Phantom limb pain relief by contralateral myofascial injection with local anaesthetic in a placebo-controlled study: Preliminary results

Casale, Roberto; Ceccherelli, Francesco; Labeeb, Alaa; Biella, Gabriele

doi:10.2340/16501977-0353

Cited by 34 publications

(14 citation statements)

References 19 publications

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“…This contact produced what the subject defined as a "queer feeling." 11 Moreover, somatosensory manipulation of painful muscle areas in the contralateral limb also seem to be able to modify PLRP, 22 further supporting the importance of any sensory inputs and indicating that even subtle changes in sensory information from both body sides can affect phantom limb awareness. Our…”

Section: Discussionmentioning

confidence: 94%

Mirror Therapy in the Rehabilitation of Lower-Limb Amputation

Casale

Damiani

Rosati

2009

American Journal of Physical Medicine &Amp; Rehabilitation

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Possible reasons for this large number of side effects could be the lack of selection of patients and the fact that the mirror box therapy was paralleled by a conventional rehabilitation approach targeted to the use of a prosthesis. Warnings on the need to select patients, with regard to their psychologic as well as clinical profile (including time from amputation and clinical setting), and possible conflicting mechanisms between mirror box therapy and conventional therapies are presented.

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Section: Discussionmentioning

confidence: 94%

Mirror Therapy in the Rehabilitation of Lower-Limb Amputation

Casale

Damiani

Rosati

2009

American Journal of Physical Medicine &Amp; Rehabilitation

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“…Eleven trials including data from 324 participants assessed the effectiveness of local anaesthetics in providing pain relief after inguinal hernia repair, spinal surgery, amputation and breast cancer surgery. Risk of bias was evident in three studies, and concerned incomplete outcome data, random sequence generation and blinding, and early trial termination.…”

Section: Resultsmentioning

confidence: 99%

Systematic review of management of chronic pain after surgery

Wylde

Dennis

Beswick

et al. 2017

British Journal of Surgery

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BackgroundPain present for at least 3 months after a surgical procedure is considered chronic postsurgical pain (CPSP) and affects 10–50 per cent of patients. Interventions for CPSP may focus on the underlying condition that indicated surgery, the aetiology of new‐onset pain or be multifactorial in recognition of the diverse causes of this pain. The aim of this systematic review was to identify RCTs of interventions for the management of CPSP, and synthesize data across treatment type to estimate their effectiveness and safety.Methods MEDLINE, Embase, PsycINFO, CINAHL and the Cochrane Library were searched from inception to March 2016. Trials of pain interventions received by patients at 3 months or more after surgery were included. Risk of bias was assessed using the Cochrane risk‐of‐bias tool.ResultsSome 66 trials with data from 3149 participants were included. Most trials included patients with chronic pain after spinal surgery (25 trials) or phantom limb pain (21 trials). Interventions were predominantly pharmacological, including antiepileptics, capsaicin, epidural steroid injections, local anaesthetic, neurotoxins, N‐methyl‐d‐aspartate receptor antagonists and opioids. Other interventions included acupuncture, exercise, postamputation limb liner, spinal cord stimulation, further surgery, laser therapy, magnetic stimulation, mindfulness‐based stress reduction, mirror therapy and sensory discrimination training. Opportunities for meta‐analysis were limited by heterogeneity. For all interventions, there was insufficient evidence to draw conclusions on effectiveness.ConclusionThere is a need for more evidence about interventions for CPSP. High‐quality trials of multimodal interventions matched to pain characteristics are needed to provide robust evidence to guide management of CPSP.

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“…It is important to note that local injection therapy may have effects beyond providing local peripheral blockade of pain input. One small observational study found that contralateral myofascial injection with local anesthetic in unilateral amputees attenuated PLP and PSs in the affected limb, though follow-up was limited to 1 hour 63. Whereas the precise mechanism for this effect is unclear, animal studies have demonstrated that blocking afferent inputs on the contralateral side can decrease spontaneous hyperactivity of wide dynamic response neurons on the injured side, suggesting that a spinal mechanism may be at work 64…”

Section: Treatmentmentioning

confidence: 99%

Postamputation pain: epidemiology, mechanisms, and treatment

Hsu¹,

Cohen²

2013

JPR

155

151

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Postamputation pain (PAP) is highly prevalent after limb amputation but remains an extremely challenging pain condition to treat. A large part of its intractability stems from the myriad pathophysiological mechanisms. A state-of-art understanding of the pathophysiologic basis underlying postamputation phenomena can be broadly categorized in terms of supraspinal, spinal, and peripheral mechanisms. Supraspinal mechanisms involve somatosensory cortical reorganization of the area representing the deafferentated limb and are predominant in phantom limb pain and phantom sensations. Spinal reorganization in the dorsal horn occurs after deafferentataion from a peripheral nerve injury. Peripherally, axonal nerve damage initiates inflammation, regenerative sprouting, and increased “ectopic” afferent input which is thought by many to be the predominant mechanism involved in residual limb pain or neuroma pain, but may also contribute to phantom phenomena. To optimize treatment outcomes, therapy should be individually tailored and mechanism based. Treatment modalities include injection therapy, pharmacotherapy, complementary and alternative therapy, surgical therapy, and interventions aimed at prevention. Unfortunately, there is a lack of high quality clinical trials to support most of these treatments. Most of the randomized controlled trials in PAP have evaluated medications, with a trend for short-term Efficacy noted for ketamine and opioids. Evidence for peripheral injection therapy with botulinum toxin and pulsed radiofrequency for residual limb pain is limited to very small trials and case series. Mirror therapy is a safe and cost-effective alternative treatment modality for PAP. Neuromodulation using implanted motor cortex stimulation has shown a trend toward effectiveness for refractory phantom limb pain, though the evidence is largely anecdotal. Studies that aim to prevent PA P using epidural and perineural catheters have yielded inconsistent results, though there may be some benefit for epidural prevention when the infusions are started more than 24 hours preoperatively and compared with nonoptimized alternatives. Further investigation into the mechanisms responsible for and the factors associated with the development of PAP is needed to provide an evidence-based foundation to guide current and future treatment approaches.

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Phantom limb pain relief by contralateral myofascial injection with local anaesthetic in a placebo-controlled study: Preliminary results

Abstract: Contralateral injections of 1 ml 0.25% bupivacaine in myofascial hyperalgesic areas attenuated phantom limb pain and affected phantom limb sensation. The clinical importance of this treatment method requires further investigation.

Cited by 34 publications

References 19 publications

Mirror Therapy in the Rehabilitation of Lower-Limb Amputation

Mirror Therapy in the Rehabilitation of Lower-Limb Amputation

Systematic review of management of chronic pain after surgery

Postamputation pain: epidemiology, mechanisms, and treatment

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