2014, Number 1
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Rev Esp Med Quir 2014; 19 (1)
Phantom limb pain: pathophysiology and treatment
Villaseñor MJC, Escobar RVH, Sánchez OÁO, Quintero GIJ
Language: Spanish
References: 54
Page: 62-68
PDF size: 459.73 Kb.
ABSTRACT
Phantom limb pain is a common complication after amputation of a
limb, its pathophysiology is complex and includes changes in the peripheral
nerve, the dorsal root ganglia, spinal cord and cerebral cortex.
We consider that the multidisciplinary team that treats patients with
amputation should have the basic knowledge for the treatment of this
complication. Although there are several treatments, just a few have
good quality studies to support its use. We present a brief review of the
pathophysiology as well as some of the treatments used in their manage.
REFERENCES
Uustal H. Prosthetic rehabilitation issues in the diabetic and dysvascular amputee. Phys Med Rehabil Clin N Am 2009;20:689-703.
Real Academia Española. Diccionario de la lengua española 2001. Disponible en: http://www.rae.es/rae.html.
Dillingham TR, Pezzin LE, MacKenzie EJ. Limbamputation and limbdeficiency: epidemiology and recenttrends in the United States. South Med J 2002;95:875-83.
Guía de Práctica Clínica. Rehabilitación del paciente adulto amputado de extremidad inferior por Diabetes Mellitus, en el segundo y tercer nivel de atención. 2002.
Sherman RA, Arena JG. Phantom limb pain: mechanisms, incidence, and treatment. Crit Rev Phys Rehab 1992;4:26.
Andreas Kopf, Nilesh B. Patel. Appendix: Glossary. In: Pain IAFTSO, editor. Guide toPain Management in Low-Resource Settings. 1 ed. Seattle: International Association for the Study of Pain, 2010. p.368.
Hill. A. Phantom limb pain: a review of the literature on attributes and potential mechanisms. J Pain Symptom Manage 1999;17:125-42.
Clarke C, Lindsay DR, Pyati S, Buchheit T. Residual limb pain is not a diagnosis: a proposed algorithm to classify postamputation pain. Clin J Pain 2013;29:551-62.
Villaseñor-Moreno JC Escobar-Reyes VH, De la Lanza-Andrade LP, Guizar-Ramírez BI. Síndrome de dolor miofascial. Epidemiologia, fisiopatología, diagnóstico y tratamiento. Rev Esp Med Quir 2013;18:148-57.
Richardson C. Phantom Limb Pain; Prevalence, Mechanisms and AssociatedFactors. En: Murray C, editor. Amputation, Prosthesis Use, and Phantom Limb Pain An Interdisciplinary Perspective. 1 ed: Springer; 2010. p. 137 - 56.
Jensen TS, Krebs B, Nielsen J, Rasmussen P. Immediate and long-term phantom limb pain in amputees: incidence, clinical characteristics and relationship to pre-amputation limb pain. Pain 1985;21:267-78.
Whyte AS, Niven CA. Variation in phantom limb pain: results of a diary study. J Pain Symptom Manage 2001;22:947-53.
Giummarra MJ, Gibson SJ, Georgiou-Karistianis N, Bradshaw JL. Review Central mechanisms in phantom limb perception: the past, present and future. Brain Res Rev 2007;54:219-32.
Flor H, Nikolajsen L, Staehelin Jensen T. Phantom limb pain: a case of maladaptive CNS plasticity? Nat Rev Neurosci 2006;7:873-81.
Ramachandran VS. Theperception of phantom limbs. The D. O. Hebblecture. Brain Res Rev 1998;121:1603-30.
Subedi B, Grossberg GT. Phantom limb pain: mechanisms and treatment approaches. Pain Res Treat 2011.
Kooijman CM, Dijkstra PU, Geertzen JH, Elzinga A. Phantom pain and phantom sensations in upper limb amputees: an epidemiological study. Pain 2000;87:33-41.
Shankar H. Ultrasound-guided sciatic neuroma block for treatment of intractable stump pain. J Clin Anesth 2008;20:483-4.
Amir R, Devor M. Ongoing activity in neuroma afferents bearing retrograde sprouts. Brain Res Rev 1993;630:283- 8.
Novakovic SD, Tzoumaka E, McGivern JG, Haraguchi M, Sangameswaran L, Gogas KR, Eglen RM, Hunter JC. Distribution of the tetrodotoxin-resistant sodium channel PN3 in ratsensory neurons in normal and neuropathic conditions. J Neurosci 1998;18:2174-87.
Flor H, Elbert T, Knecht S, Wienbruch C, Pantev C, Birbaumer N, Larbig W, Taub E. Phantom-limb pain as a perceptual correlate of cortical reorganization following arm amputation. Nature 1995;8:482-4.
Karl A, Birbaumer N, Lutzenberger W, Cohen LG, Flor H. Reorganization of motor and somatosensory cortex in upper extremity amputees with phantom limb pain. J Neurosci 2001;15:3609-18.
Ramachandran VS, Rogers-Ramachandran D, Cobb S. Touching the phantom limb. Nature 1995;377:489-90.
Diers M, Christmann C, Koeppe C, Ruf M, Flor H. Mirrored, imagined and executed movements differentially activate sensori motor cortex in amputees with and without phantom limb pain. Pain 2010;149:296-304.
Nikolajsen L, Ilkjaer S, Krøner K, Christensen JH, Jensen TS. The influence of preamputation pain on postamputation stump and phantom pain. Pain 1997;72:393-405.
Borghi B, D’Addabbo M, White PF, Gallerani P, Toccaceli L, Raffaeli W, Tognù A, Fabbri N, Mercuri M. The use of prolonged peripheral neural blockade after lower extremity amputation: the effect on symptoms associated with phantom limb syndrome. Anesth Analg 2010;111:1308-15.
Katz J. Prevention of phantom limb pain by regional anaesthesia. Lancet 1997;349:519-20.
Madabhushi L, Reuben SS, Steinberg RB, Adesioye J. The efficacy of postoperative perineural infusion of bupivacaine and clonidine after lower extremity amputation in preventing phantom limb and stump pain. J Clin Anesth 2007;19:226-9.
Sevtap H S, Alkin C, Cavidan A, Ebru T, Necdet S, Barış Y, Murat B. A Retrospective Trial Comparing the Effects of Different Anesthetic Techniques on Phantom Pain After Lower Limb Amputation. Current Therapeutic Research 2011;72:127-37.
Hanley MA, Ehde DM, Campbell KM, Osborn B, Smith DG. Self-reported treatments used for lower-limb phantom pain: descriptive findings. Arch Phys Med Rehabi 2006;87:270-7.
Huse E, Larbig W, Flor H, Birbaumer N. Theeffect of opioids on phantom limb pain and cortical reorganization. Pain 2001;90:47-55.
Wilder-Smith CH HL, Laurent S. Post amputation pain and sensory changes in treatment-naïve patients: characteristics and responses to treatment with tramadol, amitriptyline, and placebo. Anesthesiology 2005;103:619-28.
Attal N, Cruccu G, Baron R, Haanpää M, Hansson P, Jensen TS, Nurmikko T. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol. 2010;17:1113-e88.
Robinson LR, Czerniecki JM, Ehde DM, Edwards WT, Judish DA, Goldberg ML, Campbell KM, Smith DG, Jensen MP. Trial of amitriptyline for relief of pain in amputees: results of a randomized controlled study. Arch Phys Med Rehabi 2004;85:1-6.
Finnerup NB, Otto M, Jensen TS, Sindrup SH. An evidencebased algorithm for the treatment of neuropathic pain. Med Gen Med 2007;9:36-41.
Spiegel DR, Lappinen E, Gottlieb M. A presumed case of phantom limb pain treated successfully with duloxetine and pregabalin. Gen Hosp Psychiatry 2010;33:228.e5-7.
Chalana H. A case report of Milnacipran in phantomlimbpain. Asian J Psychiatr 2010;3:155-6.
Bockbrader HN, Wesche D, Miller R, Chapel S, Janiczek N, Burger P. A comparison of the pharmacokinetics and pharmacodynamics of pregabalin and gabapentin. Clinical Pharmacokinetics 2010;49:661-9.
Bone M, Critchley P, Buggy DJ. Gabapentin in post amputation phantom limb pain: a randomized, double-blind, placebo-controlled, cross-overstudy. Regional Anesthesia and Pain Medicine 2002;27:481-6.
Abbass K. Efficacy of gabapentin for treatment of adults with phantom limb pain. The Annals of Pharmacotherapy 2012;46:1707-11.
Durkin B, Page C, Glass P. Pregabalin for the treatment of post surgical pain. Expert Opinionon Pharmacotherapy 2010;11:2751-8.
Clarke H, Bonin RP, Orser BA, Englesakis M, Wijeysundera DN, Katz J. The prevention of chronic postsurgical pain using gabapentin and pregabalin: a combined systematic review and meta-analysis. Anesthesia & Analgesia 2012;115:428-42.
Visser EJ. A review of calcitonin and its use in thetreatment of acutepain. AcutePain. 2005;7:185-9.
Yu LC, Hou JF, Fu FH, Zhang YX. Roles of calcitonin generelated peptide and its receptors in pain-related behavioral responses in the central nervous system. Neuroscience and Biobehavioral Reviews 2009;33:1185-91.
Jaeger H, Maier C. Calcitonin in phantom limb pain: a double-blind study. Pain 1992;48:21-7.
Eichenberger U, Neff F, Sveticic G, Björgo S, Petersen-Felix S, Arendt-Nielsen L, Curatolo M. Chronic phantom limb pain: the effects of calcitonin, ketamine, and their combination on pain and sensory thresholds. Anesthesia & Analgesia 2008;106:1265-73.
De Kock MF, Lavand’homme PM. The clinical role of NMDA receptor antagonists for the treatment of postoperative pain. Best Practice & Research Clinical Anaesthesiology 2007;21:85-98.
Maier C DR, Mansourian N, Hosbach I, Schwenkreis P, Senne I. Efficacy of the NMDA-receptor antagonist memantine in patients with chronic phantom limb pain-results of a randomizeddouble-blinded, placebo-controlled trial. Pain 2003;103:277-83.
Schwenkreis PMC, Pleger B, Mansourian N, Dertwinkel R, Malin J-P. NMDA-mediated mechanisms in cortical excitability changes after limb amputation. Acta Neurologica Scandinavica 2003;108:179-84.
Wiech KKR, Topfner S, Preissl H, Braun C, Unertl K. A placebo-controlled randomized crossover trial of the Nmethyl- D-aspartic acid receptor antagonist, memantine, in patients with chronic phantom limb pain. Anesthesia & Analgesia 2004;98:408-13.
Abraham RMN, Weinbroum A. Dextromethorphan mitigates phantom pain in cancer amputees. Annals of SurgicalOncology 2003;10:268-74.
Nikolajsen LHC, Nielsen J, Keller J, Arendt-Nielsen L, Jensen T. The effect of ketamine on phantom pain: a central neuropathic disorder maintained by peripheral input. Pain 1996;67:69-77.
Mulvey MR BA, Johnson MI, Marchant PR. Transcutaneous electrical nerve stimulation (TENS) for phantom pain and stump pain following amputation in adults. Cochrane Database Syst Rev 2010;12(5).
Mulvey MRRH, Fawkner HJ, Hirst L, Neumann V, Johnson MI. Transcutaneous electrical nerve stimulation for phantom pain and stump pain in adult amputees. Pain Pract 2013;13:289-96.