Effect of Myofascial Trigger Points Electric Stimulation on Phantom Limb Pain after Lower Limb Amputation / 中国康复理论与实践

Objective:To explore the clinical efficacy of myofascial trigger point electric stimulation based on mirror therapy on phantom limb pain after lower limb amputation. Methods:From May to November, 2020, 50 patients with phantom limb pain after lower limb amputation were randomly divided into control group (n = 25) and experiment group (n = 25). Both groups accepted mirror therapy, while the experiment group received myofascial trigger point electric stimulation before mirror therapy, for four weeks. They were assessed with short-form of McGill Pain Questionnaire (SF-MPQ), Pittsburgh Sleep Quality Index (PSQI), Hamilton Anxiety Scale (HAMA), Timed 'Up & Go' Test (TUGT) and 6-minute walk test (6MWT) before and after treatment. Results:All the indexes improved in both groups after treatment (|t| > 8.210, P < 0.001), and improved more in the experiment group than in the control group (|t| > 5.103, P < 0.001), except the present pain intensity of SF-MPQ. Conclusion:Mirror therapy is effective on phantom limb pain after lower limb amputation in terms of pain, sleep, anxiety and walking, and the effect could be stronger after myofascial trigger point electric stimulation.

Phantom limb pain: A literature review / 中华创伤杂志(英文版)

Since the phantom limb sensation was first described by the French military surgeon Ambroise Pare in the 16th century, the number of studies surrounding phantom limb pain has increased every year. Especially in recent decades, scientists have achieved a better understanding of the mechanism and treatment of phantom limb pain. Although many hypotheses have been agreed and many treatments have been proven effective, scientists still do not have a very systematic understanding of the phantom limbs. The purpose of this review article is to summarize recent researches focusing on phantom limb in order to discuss its definition, mechanisms, and treatments.

Pharmaceutical Care for One Patient with Phantom Limb Pain / 中国药师

The clinical pharmacist involved in the treatment of one case of phantom limb pain from the aspects of doctor's order reorganization,dose adjustment of analgesic drugs,pain score monitoring,ADR monitoring and medication education. And significant effects were shown in the drug use safety and the pain improvement in the patient. Therefore,the participation of clinical pharmacist in pain treatment can optimize analgesic effects,detect adverse drug reactions timely and thus obtain more benefits for patients.

Psychotherapies for the treatment of phantom limb pain / Uso de psicoterapias como tratamiento del dolor de miembro fantasma

Abstract Introduction: The phantom limb pain has been described as a condition in which patients experience a feeling of itching, spasm or pain in a limb or body part that has been previously amputated. Such pain can be induced by a conflict between the representation of the visual and proprioceptive feedback of the previously healthy limb. The phantom limb pain occurs in at least 42-90% of amputees. Regular drug treatment of phantom limb pain is almost never effective. Methods: A systematic review of the literature was conducted in Medline and Cochrane using the MESH terms "phantom limb pain" and "psychotherapy", published in the last 10 years, in English and Spanish, finding 49 items. After reviewing the abstracts, 25 articles were excluded for not being related to the objective of the research. Additionally cross references of included articles and literature were reviewed. Objectives: To describe the psychotherapies used in the management of phantom limb pain, their effectiveness and clinical application reported in the literature. Aims: The mechanisms underlying phantom limb pain were initially explained, as were the published studies on the usefulness of some psychotherapies such as mirror visual feedback and immersive virtual reality, visual imagery, desensitisation and reprocessing eye movements and hypnosis. Conclusions: The phantom limb pain is a complex syndrome that requires pharmacological and psychotherapeutic intervention. The psychotherapies that have been used the most as adjuvants in the treatment of phantom limb pain are mirror visual feedback, desensitisation and reprocessing eye movements, imagery and hypnosis. Studies with more representative samples, specifically randomised trials are required.

Resumen Introducción: El dolor de miembro fantasma ha sido descrito como una condición en la que los pacientes experimentan una sensación de prurito, espasmo o dolor en un miembro o parte del cuerpo previamente amputado. Dicho dolor puede ser inducido por un conflicto entre la representación de la retroalimentación visual y propioceptiva del miembro previamente sano. El dolor de miembro fantasma ocurre en al menos 42 al 90% de los amputados. El tratamiento farmacológico regular del dolor del miembro fantasma casi nunca es efectivo. Método: Se realizó una revisión sistemática en las bases de datos Medline y Cochrane usando palabras MESH "phantom limb pain" y "psychotherapy", publicados en los últimos 10 anos, en español e inglés, encontrando 49 artículos. Al revisar los resúmenes, se excluyeron 25 artículos por no ser afines con el objetivo de la investigación. Adicionalmente se revisaron referencias cruzadas de los artículos incluidos y literatura médica. Objetivos: Describir las psicoterapias usadas en el manejo del dolor de miembro fantasma, su efectividad y aplicación clínica reportada en la literatura. Desarrollo: Se explican inicialmente los mecanismos subyacentes al dolor de miembro fantasma y se describen los estudios publicados sobre la utilidad del uso de algunas psicoterapias como la retroalimentación visual con espejo y con realidad virtual inmersiva, imaginería visual, reprocesamiento y desensibilización por movimientos oculares e hipnoterapia. Conclusiones: El dolor de miembro fantasma es un síndrome complejo que requiere intervención farmacológica y psicoterapéutica. Las psicoterapias que más se han usado como coadyuvantes en el tratamiento del dolor de miembro fantasma son la retroalimentación visual con espejo, la desensibilización y reprocesamiento por movimientos oculares, la imaginería y la hipnosis. Se requieren estudios con muestras más significativas, específicamente estudios clínicos aleatorizados.

Hypnosis with medication on resistant phantom limb pain: A case report / 中国心理卫生杂志

The aim of this study was to evaluate the effect and relative factors of hypnosis combing medication on resistant phantom limb pain (PLP).This study presented one case report involving of the use of visualization,hypnotic imagery,suggestions procedures combing venlafaxine in the alleviation of PLP and depression.Visual analogue score (VAS) and Hamilton Rating Scale for Depression-17 items (HAMD17) were used to assess the severity of PLP and depression,which were evaluated at baseline and the end.Existing literature were reviewed.After hypnosis combing medication,PLP and depression were consistently alleviated.Hypnosis may be a useful adjunct to established strategies for the treatment of PLP.

Effect of Protective Analgesia on Incidence of Phantom Limb Pain after Amputation:A Meta-analysis / 中国康复理论与实践

Objective To systemically evaluate the effect of protective analgesia on preventing phantom limb pain(PLP)after amputa-tion.Methods Published articles from the earliest date available to June,2017 were recalled from Cochrane Library,PubMed,Embase,Web of Science,OVID,and Science Direct to collect prospective studies using protective analgesia in perioperative period to prevent PLP after amputation.Two reviewers screened literatures referring to studies according to the inclusion and exclusion criteria,and assessed the quality of them.Data of general information and incidence of PLP in the follow-up period were extracted and analyzed with RevMan 5.3 software. Results Six studies were included with a total of 256 patients in the one-month follow-up period including 127 cases in the protective anal-gesia group(group P)and 129 cases in the control group(group C),a total of 232 patients in the six-month follow-up period including 114 cases in group P and 118 cases in group C,and a total of 118 patients in the twelve-month follow-up period including 58 cases in group P and 60 cases in group C.The incidence of PLP were lower in group P than those in group C in the one-month follow-up period(RD=-0.21, 95%CI[-0.38,-0.04],Z=2.47,P=0.01)and in the six-month follow-up period(RD=-0.28,95%CI[-0.52,-0.05],Z=2.37,P=0.02),and it was not significant in the twelve-month follow-up period(RD=-0.20,95%CI[-0.48,0.09],Z=1.35,P=0.18).Conclusion Protective analge-sia in perioperative period can prevent against PLP after amputation in the recent time,however,it needs further observation in long-term.

Role of NK-1 Receptor in Fos Protein Expression of Anterior Cingulate Cortex Neurons of Mice Induced by Amputation of the Tail Extremity / 中国医科大学学报

Objective To study whether amputation of the tail extremity could induce change of Fos protein expression in mice ACC neurons , and explore the role of NK?1 receptor in the change. Methods Immunohistochemistry technique was adopted to study Fos protein expression change in mice ACC neurons at 0.25 h,0.5 h,1 h,2 h after amputation of the tail extremity 2.5 cm,and also the effect of NK?1 receptor antagonist GR82334(iv)or GR82334(ith)in the change. Results Fos protein expression in mice ACC neurons was significantly increased at 0.25 h,0.5 h after the amputation,and reached its peak at 1 h after the amputation,then started to decrease at 2 h after the amputation. GR82334(iv)com?pletely antagonized the significant augment in Fos protein expression in mice ACC neurons after the amputation ,but the antagonism of GR82334 (ith)was incomplete. Conclusion Amputation of the tail extremity could significantly increase the Fos protein expression of mice ACC neurons in a time?dependent manner. Both peripheral and central NK?1 receptors were involved in the process. However ,there are also central conduction pathways of other receptors and neurotransmitters involved in the significant augment in Fos protein expression in mice ACC neurons after amputa?tion.

Tratamento da dor Fantasma em Pacientes Submetidos à Amputação: Revisão de Abordagens Clínicas e de Reabilitação / Phantom Pain Treatment in Pacients Submitted to Amputation: A Review of Clinical and Rehabilitation Approaches

A dor do membro fantasma é uma sequela comumapós uma amputação, sendo de difícil tratamento. Comprometea aquisição de habilidades e a qualidade de vida dosamputados, o que justifica a definição de uma terapêuticaeficaz. Objetivo: Identificar e descrever intervenções clínicase/ou de reabilitação para o tratamento da dor fantasma empessoas submetidas à amputação. Material e Métodos:Revisão estruturada da literatura de artigos publicados nasbases de dados eletrônicas Pubmed e Bireme de 2003 a2014 (salvo literaturas clássicas), foram aceitos artigoscompletos, disponíveis na íntegra e nos idiomas português,inglês ou espanhol. Resultados: Identificou-se setemodalidades distintas de tratamento para dor fantasma, sendoque, dos oito artigos inclusos, dois abordavam a mesmaterapia física. Portanto, as modalidades terapêuticas foramclassificadas em medidas invasivas associadas ou não àterapia farmacológica (quatro artigos) e terapia física (quatroartigos). Todas as modalidades terapêuticas identificadasna revisão: infusão venosa de lidocaína seguida de bloqueioda cadeia simpática torácica, substituição de terapiafarmacológica pelo uso de bomba intratecal de zicotinotide,uso bloqueio ciático contínuo, uso da gabapentina no préoperatório,terapia da caixa espelho, prática de exercíciosorientados e aplicação da corrente Transcutaneous electricalnerve stimulation demonstraram ser benéficas paradiminuição da dor fantasma. Conclusão: Foram identificadasas medidas terapêuticas mais relatas e utilizadas na práticaterapêutica, sendo: terapia medicamentosa, terapia invasivae terapia física, entretanto, não houve consenso na literaturaconsultada sobre a melhor opção terapêutica no tratamentoda dor fantasma...

Phantom limb pain is a common sequel ofamputation and difficult-to-treat condition. It compromises theamputees’ acquisition of skills and quality of life, whichjustifies the establishment of an effective treatment.Objective: To identify and describe the clinical and/orrehabilitation interventions to treat phantom limb pain in patientswho underwent amputations. Material and Methods: Thiswas a literature review of articles published in the electronicdatabases Pubmed and Bireme between 2003 and 2014(except classical literature). We selected complete scientificpapers available in full in Portuguese, English or Spanish.Results: Seven different types of treatment for phantom limbpain were identified. Two out of the eight papers includedaddressed the same physical therapy approach. Therefore,the therapeutic modalities were classified as invasivemeasures associated or not to pharmacological (four articles)and physical therapies (four articles). All therapeuticmodalities identified in the review were proved to be beneficialin ameliorating phantom pain, as follows: intravenous infusionof lidocaine followed by thoracic sympathetic chain blockage;replacement of the pharmacological therapy by a ziconotideintrathecal injection pump; continuous sciatic blockage; useof gabapentin preoperatively; mirror box therapy; practiceorientedexercises; and application of transcutaneouselectrical nerve stimulation. Conclusion: The most frequentlyreported and used therapeutic measures were drug therapy,invasive therapy and physical therapy. However, there wasno consensus in the literature about the best therapeuticoption to treat phantom limb pain...

Spinal Cauda Equina Stimulation for Alternative Location of Spinal Cord Stimulation in Intractable Phantom Limb Pain Syndrome: A Case Report

Phantom limb pain is a phenomenon in which patients experience pain in a part of the body that no longer exists. In several treatment modalities, spinal cord stimulation (SCS) has been introduced for the management of intractable post-amputation pain. A 46-year-old male patient complained of severe ankle and foot pain, following above-the-knee amputation surgery on the right side amputation surgery three years earlier. Despite undergoing treatment with multiple modalities for pain management involving numerous oral and intravenous medications, nerve blocks, and pulsed radiofrequency (RF) treatment, the effect duration was temporary and the decreases in the patient's pain score were not acceptable. Even the use of SCS did not provide completely satisfactory pain management. However, the trial lead positioning in the cauda equina was able to stimulate the site of the severe pain, and the patient's pain score was dramatically decreased. We report a case of successful pain management with spinal cauda equina stimulation following the failure of SCS in the treatment of intractable phantom limb pain.

Vivir con dolor de miembro fantasma: persona postamputada / Living with member phantom pain: person postamputada

Objetivo: Describir el vivir con dolor de miembro fantasma en la persona posamputada. Método: Estudio de abordaje cualitativo-descriptivo, exploratorio; y como técnica se empleó la entrevista semiestructurada, los sujetos participantes residen en el Estado de Durango, México; participaron 12 personas que al ser amputadas debutaron con Dolor de miembro fantasma, el soporte teórico estuvo apoyado con el dolor de Le Breton (1999)21. Resultados: En los discursos de la persona posamputada se evidencian expresiones de una vida sin objetivos, se de terminan a desempeñar el rol de enfermos al considerar su dolor como una tragedia personal o una desviación social que enluta su vida y la de su familia. Consideraciones Finales: La enfermera debe aprender a escuchar el cuerpo enfermo, seguir con atención sus señales y sus expresiones ya sean de alegría, llanto, tristeza, dolor, desagrado, silencio, etc., interpretando lo que trata de comunicar y solicita. Deberá estar atenta y vigilante procurando que el cuerpo-sujeto alivie el dolor físico y el dolor del alma, que se pueda revertir permanente por el resto de su vida, pues vivir con dolor desde el punto de vista fisiopatológico constituye una crisis circunstancial, eventual y controlable que no sucede igual con la enfermedad del alma.

Objective: To describe the live with phantom limb pain in posamputada person. Method: Qualitative Study-descriptive, exploratory approach; and as a semi-structured interview technique was employed, participating subjects residing in the State of Durango, Mexico; involving 12 people to be amputated debuted with painphantom limb the theoretical support was supported with the pain of Le Breton (1999)21 Results: In the discourses of posamputada individual expressions of life without goals is evident, are determined to play the role of patients to consider their pain as a personal tragedy or social deviance that his life and mourns for his family. Final Thoughts: The nurse must learn to listen to the sick body, carefully follow their signals and whether their expressions of joy, sorrow, sadness, pain, disgust, silence, etc; interpreting what is communicating and requests. You must be alert and vigilant care that the body-subject relieve physical pain and the pain of the soul, which can be reversed permanently for the rest of your life, because living with pain from the physiological point of view is a circumstantial eventual crisis and controllable which does not happen with the disease of the soul.

Successful Treatment of Phantom Limb Pain by 1 Hz Repetitive Transcranial Magnetic Stimulation Over Affected Supplementary Motor Complex: A Case Report

A 37-year-old man with a right transfemoral amputation suffered from severe phantom limb pain (PLP). After targeting the affected supplementary motor complex (SMC) or primary motor cortex (PMC) using a neuro-navigation system with 800 stimuli of 1 Hz repetitive transcranial magnetic stimulation (rTMS) at 85% of resting motor threshold, the 1 Hz rTMS over SMC dramatically reduced his visual analog scale (VAS) of PLP from 7 to 0. However, the 1 Hz rTMS over PMC failed to reduce pain. To our knowledge, this is the first case report of a successfully treated severe PLP with a low frequency rTMS over SMC in affected hemisphere.

Atypical Supernumerary Phantom Limb and Phantom Limb Pain in a Patient With Spinal Cord Injury: Case Report

Supernumerary phantom limb (SPL) resulting from spinal cord lesions are very rare, with only sporadic and brief descriptions in the literature. Furthermore, the reported cases of SPL typically occurred in neurologically incomplete spinal cord patients. Here, we report a rare case of SPL with phantom limb pain that occurred after traumatic spinal cord injury in a neurologically complete patient. After a traffic accident, a 43-year-old man suffered a complete spinal cord injury with a C6 neurologic level of injury. SPL and associated phantom limb pain occurred 6 days after trauma onset. The patient felt the presence of an additional pair of legs that originated at the hip joints and extended medially, at equal lengths to the paralyzed legs. The intensity of SPL and associated phantom limb pain subsequently decreased after visual-tactile stimulation treatment, in which the patient visually identified the paralyzed limbs and then gently tapped them with a wooden stick. This improvement continued over the 2 months of inpatient treatment at our hospital and the presence of the SPLs was reduced to 20% of the real paralyzed legs. This is the first comprehensive report on SPLs of the lower extremities after neurologically complete spinal cord injury.

Mirror Therapy for Phantom Limb Pain

Phantom limb pain is a painful sensation that is perceived in a body part that no longer exists. To control this pain, many methods have been used such as medication, physical treatment, nerve block, neuromodulation, surgical treatment and mirror therapy. However, until now, there effects have been uncertain. We report the successful reduction of phantom limb pain using mirror therapy when other treatments initially failed to control the pain.

Atypical Supernumerary Phantom Limb and Phantom Limb Pain in Two Patients with Pontine Hemorrhage

Phantom limbs are usually observed after amputation of extremities. In patients after a stroke, a similar but rarely occurring phenomenon consisting of the patient experiencing the presence of an additional limb has been described. This phenomenon, generally called supernumerary phantom limb (SPL), may be caused by lesions in the right or left cerebral hemisphere, but has been predominantly reported in patients who have had a right hemispheric stroke. We report two cases of atypical SPL and phantom limb pain (PLP) after pontine hemorrhage. The patients were treated conservatively and their symptoms lasted more than 1 month. This is the first report of SPLs after left pontine hemorrhage, and phantom perception and pain lasted longer than those in previously observed cases. Our results indicate that SPL may be more common than reported; therefore, thorough examinations are essential for the care of stroke patients.

Advance in Treatment of Phantom Limb Pain(review) / 中国康复理论与实践

@# Phantom limb pain(PLP) is a common sequela of amputation. With the lucubration of the pathophysiological mechanisms underlying PLP, lots of progression for the treatment of PLP has been achieved. Combined modality therapy is very important especially in psychological, behavior and operative therapy.

Effect of Transcutaneous Electrical Nerve Stimulation with Different Electrode Placement on Phantom Limb Pain / 中国康复理论与实践

@#Objective To study the effect electrode placement of transcutaneous electrical nerve stimulation(TENS) on phantom limb pain in the postoperative phase of amputation.Methods 60 cases with phantom limb pain after amputation were equal divided into the treatment group and the control group.The electrodes were placed in the contralateral side similar as phantom limb in the treatment group,but were placed at the stumps in the control group.Results After two course of treatment,93.3% of the treatment group improved,and 76.7% very improved,which were better than those of the control group(P<0.05).Conclusion Electrode placement of TENS effects the different result of treating phantom limb pain.

The Trial of Continuous Intravenous Infusion of Ketamine in Patients with Phantom Limb Pain: A case report / 대한통증학회지

Phantom limb pain is a painful sensation from an absent limb. The onset of pain is generally early, with 75% of patients developing pain within the first few days after amputation. The frequency and duration of attacks tend to be reduced with time, although the prevalence and intensity remain constant. We report here a case of a 38-year-old man who exhibited the signs and symptoms of phantom limb pain due to the above-knee amputations of both legs. He was not responded to opioid therapy and a continuous intravenous infusion of ketamine, an N-methyl-D-aspatate receptor antagonist, reduced his severe pain.