Phantom pain in bilateral upper limb amputation

Modirian, Ehsan; Shojaei, Hadi; Soroush, Mohammad Reza; Masoumi, Maryam

doi:10.1080/09638280902810976

Cited by 5 publications

(12 citation statements)

References 15 publications

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“…Of the 21 epidemiology studies of amputees included in the review, eight had a longitudinal design [98][99][100][101][102][103][104][105] and 13 had a cross-sectional design. 9,10,[106][107][108][109][110][111][112][113][114][115][116] Longitudinal studies Table 21 shows the characteristics of the populations in the longitudinal studies. Six studies had a prospective design 98,100,102-105 and two were retrospective.…”

Section: Epidemiology Studiesmentioning

confidence: 99%

“…In most studies, questionnaires were mailed to participants or distributed by co-operating organisations. Data were collected through face-to-face interviews in three studies 106,109,110 and through telephone interviews in one study. 9 Of those studies that reported a method of selecting participants, two used random sampling 10,112 and one used census sampling.…”

Section: Cross-sectional Studiesmentioning

confidence: 99%

“…Almost half of the studies took place in the USA, 9,10,107,[111][112][113] with three in Iran, 106,109,110 one in the UK, 116 and two in the rest of Europe 114,115 (one study did not specify a location but appears likely to have been set in the USA 108 ). Amputation sites: bilateral.…”

Section: Cross-sectional Studiesmentioning

confidence: 99%

“…Four studies 106,109,110,115 only included participants with bilateral amputations. One study 106 included only upper-limb amputees and two studies 112,113 did not report on amputation site. The remaining studies included either only lower-limb amputees or cohorts in which most patients were lower-limb amputees.…”

Section: Cross-sectional Studiesmentioning

confidence: 99%

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Brain and spinal stimulation therapies for phantom limb pain: a systematic review

Corbett

South

Harden

et al. 2018

Health Technol Assess

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Background Although many treatments exist for phantom limb pain (PLP), the evidence supporting them is limited and there are no guidelines for PLP management. Brain and spinal cord neurostimulation therapies are targeted at patients with chronic PLP but have yet to be systematically reviewed. Objective To determine which types of brain and spinal stimulation therapy appear to be the best for treating chronic PLP. Design Systematic reviews of effectiveness and epidemiology studies, and a survey of NHS practice. Population All patients with PLP. Interventions Invasive interventions – deep brain stimulation (DBS), motor cortex stimulation (MCS), spinal cord stimulation (SCS) and dorsal root ganglion (DRG) stimulation. Non-invasive interventions – repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS). Main outcome measures Phantom limb pain and quality of life. Data sources Twelve databases (including MEDLINE and EMBASE) and clinical trial registries were searched in May 2017, with no date limits applied. Review methods Two reviewers screened titles and abstracts and full texts. Data extraction and quality assessments were undertaken by one reviewer and checked by another. A questionnaire was distributed to clinicians via established e-mail lists of two relevant clinical societies. All results were presented narratively with accompanying tables. Results Seven randomised controlled trials (RCTs), 30 non-comparative group studies, 18 case reports and 21 epidemiology studies were included. Results from a good-quality RCT suggested short-term benefits of rTMS in reducing PLP, but not in reducing anxiety or depression. Small randomised trials of tDCS suggested the possibility of modest, short-term reductions in PLP. No RCTs of invasive therapies were identified. Results from small, non-comparative group studies suggested that, although many patients benefited from short-term pain reduction, far fewer maintained their benefits. Most studies had important methodological or reporting limitations and few studies reported quality-of-life data. The evidence on prognostic factors for the development of chronic PLP from the longitudinal studies also had important limitations. The results from these studies suggested that pre-amputation pain and early PLP intensity are good predictors of chronic PLP. Results from the cross-sectional studies suggested that the proportion of patients with severe chronic PLP is between around 30% and 40% of the chronic PLP population, and that around one-quarter of chronic PLP patients find their PLP to be either moderately or severely limiting or bothersome. There were 37 responses to the questionnaire distributed to clinicians. SCS and DRG stimulation are frequently used in the NHS but the prevalence of use of DBS and MCS was low. Most responders considered SCS and DRG stimulation to be at least sometimes effective. Neurosurgeons had mixed views on DBS, but most considered MCS to rarely be effective. Most clinicians thought that a randomised trial design could be successfully used to study neurostimulation therapies. Limitation There was a lack of robust research studies. Conclusions Currently available studies of the efficacy, effectiveness and safety of neurostimulation treatments do not provide robust, reliable results. Therefore, it is uncertain which treatments are best for chronic PLP. Future work Randomised crossover trials, randomised N-of-1 trials and prospective registry trials are viable study designs for future research. Study registration The study is registered as PROSPERO CRD42017065387. Funding The National Institute for Health Research Health Technology Assessment programme.

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Section: Epidemiology Studiesmentioning

confidence: 99%

Section: Cross-sectional Studiesmentioning

confidence: 99%

Section: Cross-sectional Studiesmentioning

confidence: 99%

Section: Cross-sectional Studiesmentioning

confidence: 99%

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Brain and spinal stimulation therapies for phantom limb pain: a systematic review

Corbett

South

Harden

et al. 2018

Health Technol Assess

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“…3 A number of possible contributing mechanisms to PLP, including stump-related pathology, spinal and cortical changes, have been proposed, and it has proved notoriously difficult to treat, with the most promising methods complementing pharmacological approaches with physical, psychological and behavioural intervention. 4 PLP has variously been described as burning, tearing, electric shock in type.…”

Section: Treatmentmentioning

confidence: 99%

Acupuncture Treatment of Phantom Limb Pain and Phantom Limb Sensation in a Primary Care Setting

Davies¹

2013

Acupunct Med

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A 45-year-old man presented with phantom limb pain and phantom limb sensation 12 weeks after an above-elbow amputation of his right arm. He underwent seven sessions of acupuncture at weekly intervals carried out by his general practitioner on his intact left arm, with complete relief of the phantom limb pain and considerable improvement of the phantom limb sensation of his right arm. This case demonstrates the possible benefits from the use of short acupuncture sessions for a potentially chronic condition undertaken within the constraints of a busy general medical practice.

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Long-term symptoms and function after war-related lower limb amputation: A national cross-sectional study

Esfandiari¹,

Yavari²,

Karimi³

et al. 2018

Acta Orthopaedica et Traumatologica Turcica

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ObjectiveThe aim of this study was to document long-term symptoms and functional results following war-related knee disarticulation, trans-femoral amputation, and hip disarticulation.MethodsAn observational cross-sectional study was conducted in a 7-day recreational camp in Iran. One thousand patients with unilateral hip disarticulation, trans-femoral amputation and knee disarticulation due to war-related injuries were invited to undergo a thorough physical examination. Among the invited persons, 58.7% (587 subjects) responded to our invitations. A complete examination related to phantom pain, phantom sensation, stump pain, back pain, and sound limb joints pain with a self-constructed questionnaire was performed. In addition, Amputee Mobility Predictor (AMP) instrument with a prosthesis was completed to assess the function of patients.ResultsThe mean duration of time since amputation was 22 years. The most common symptoms reported by participants were phantom sensation (82%), back pain (69%), and phantom pain (63%). In addition, total scores of AMP with a prosthesis in persons with knee disarticulation and trans-femoral amputations were 20.8 and 28, respectively.The knee disarticulation was associated with higher scores of AMP with a prosthesis compared to transfemoral amputation (p < 0.01).ConclusionThe results of this study showed that patients with lower limb amputation suffer from significant clinical and functional problems. The findings may be useful to adopt new strategies in planning rehabilitation programs to improve quality of life and health status of patients with war-related lower limb amputation.Level of EvidenceLevel IV, Therapeutic study.

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Phantom pain in bilateral upper limb amputation

Abstract: At this time there is no healing for phantom pain; medical and surgical modalities only bring temporary relief, and less than 1% of the respondents achieve permanent relief through different treatment methods.

Cited by 5 publications

References 15 publications

Brain and spinal stimulation therapies for phantom limb pain: a systematic review

Brain and spinal stimulation therapies for phantom limb pain: a systematic review

Acupuncture Treatment of Phantom Limb Pain and Phantom Limb Sensation in a Primary Care Setting

Long-term symptoms and function after war-related lower limb amputation: A national cross-sectional study

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