scholarly journals 488 An Evaluation of Pain Related Outcomes Following Nerve Sheath Catheter Insertion after Major Lower Limb Amputations

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
C Vincenti ◽  
V Bhattacharya ◽  
N Kansal
Keyword(s):  
Pain Control ◽  
Phantom Limb Pain ◽  
Pain Scale ◽  
Phantom Limb ◽  
Limb Pain ◽  
Nerve Sheath ◽  
Stump Pain ◽  
Small Patient ◽  
Spurious Results

Abstract Aim Limb amputations have many post-op complications, including pain. The evidence supporting the use of nerve sheath catheters (NSC) to manage post-op pain is mixed. Current literature suggests NSC reduces post-op opioid requirements but does not reduce pain score, phantom limb pain or chronic stump pain. This study compared post-op pain in those with and without NSC after above knee amputations (AKA) and below knee amputations (BKA). Method Retrospective data from April 2014 – March 2017 was reviewed. Information regarding indication, anaesthetic, morphine requirement at 72 hours, phantom limb, chronic limb pain and a pain scale (1-10) at 24, 48 and 72 hours were collected. Results 32 patients were involved in the study. 11 had NSC for pain control. Of those patients without NSC, 43% experienced no pain. In comparison, 33% of those with NSC experienced no post-op pain. Phantom limb pain was experienced in a higher proportion of patients with NSC (18%) and in those with AKA (11%). 18% of patients with NSC experienced chronic limb pain, compared to 33% without NSC. 62% of patients with NSC required morphine at 72 hours and at higher dosages compared to those without. However, two patients used large amounts of morphine potentially giving spurious results. Conclusions Though limited by small patient group, patients with NSC were more likely to require morphine at 72 hours and at higher dosages but were less likely to experience chronic limb pain thus proving the role of NSC in post-op pain control.

scholarly journals EP.WE.501The Role of Nerve Sheath Catheters after Major Lower Limb Amputations in Post-operative Pain Control

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Cara Vincenti ◽  
Nisheeth Kansal ◽  
Vishwanath Bhattacharya
Keyword(s):  
Lower Limb ◽  
Pain Control ◽  
Phantom Limb Pain ◽  
Phantom Limb ◽  
Limb Amputation ◽  
Opioid Use ◽  
Limb Pain ◽  
Nerve Sheath ◽  
Post Operative Pain ◽  
Pain Outcomes

Abstract Aim Pain is a common post-operative complication after limb amputation. Though the evidence is mixed, current literature suggests nerve sheath catheters (NSC) have no effect on chronic stump pain, phantom limb pain or post-operative pain score but reduces opioid use. This study aims to compare pain outcomes in those with and without NSC after above knee amputations (AKA) and below knee amputations (BKA). Method This retrospective study collected information from 32 patients after lower-limb amputation from April 2014 - March 2017. Information regarding indication, anaesthetic and morphine requirement at 72 hours were collected from medical records and standardised questions used to assess phantom limb pain, chronic limb pain and pain intensity (1-10) at 24, 48 and 72 hours. Results Of the 11 patients who received a NSC catheter for pain control, 33% experienced no post-operative pain, 18% experienced phantom limb pain, 18% reported chronic limb pain and 62% required higher dosages of morphine at 72 hours. However, two patients used large amounts of morphine potentially giving spurious results. In comparison, of those patients without NCS, 43% experienced no pain, 9% experienced phantom limb pain, 33% reported chronic limb pain and only 47% required morphine at 72 hours and at lower doses compared to with NSC. The incidence of phantom limb pain was higher in those who had AKA regardless of the analgesic technique used. Conclusion Patients with NSC were less likely to experience chronic limb pain thus proving their role in post-operative pain control despite having higher morphine requirements.

Persistent Phantom Limb Pain

1981 ◽  
Vol 53 (1) ◽  
pp. 135-138 ◽  
Author(s):  
Linda Dawson ◽  
Paul Arnold
Keyword(s):  
Psychological Factors ◽  
Phantom Limb Pain ◽  
Phantom Limb ◽  
Limb Pain ◽  
Personal Problems ◽  
Phantom Limbs

The role of psychological factors in 10 patients with painful phantom limbs was investigated by means of a questionnaire and interviews. The hypotheses were that the severity of pain would be positively correlated with their present personal problems and attitudes and with experience of pain in the limb before amputation. The first hypothesis was confirmed but the second was not.

scholarly journals Psychological Factors Associated with Phantom Limb Pain: A Review of Recent Findings

2018 ◽  
Vol 2018 ◽  
pp. 1-12 ◽  
Author(s):  
Xaver Fuchs ◽  
Herta Flor ◽  
Robin Bekrater-Bodmann
Keyword(s):  
Chronic Pain ◽  
Psychological Factors ◽  
Phantom Limb Pain ◽  
Phantom Limb ◽  
Body Perception ◽  
Limb Pain ◽  
Psychological Variables ◽  
Emotional Factors ◽  
Pain Symptoms

Phantom limb pain (PLP) is a common phenomenon occurring after the amputation of a limb and can be accompanied by serious suffering. Psychological factors have been shown to play an important role in other types of chronic pain, where they are pivotal in the acquisition and maintenance of pain symptoms. For PLP, however, the interaction between pain and psychological variables is less well documented. In this review, we summarize research on the role of emotional, motivational, cognitive, and perceptual factors in PLP. The reported findings indicate that emotional factors modulate PLP but might be less important compared to other types of chronic pain. Additional factors such as the amount of disability and adjustment to the amputation appear to also play a role. Bidirectional relationships between stress and PLP have been shown quite consistently, and the potential of stress and tension reduction in PLP treatment could be further exploited. Little is known about the role of cognitive variables such as attention or expectation. Catastrophizing seems to aggravate PLP and could be targeted in treatment. Body perception is altered in PLP and poses a potential target for novel mechanistic treatments. More research on psychological factors and their interactions in PLP is needed.

Chronic Motor Cortex Stimulation for Phantom Limb Pain Control: Correlations between Analgesic Effects and Cortex Mapping

Neurosurgery ◽  
2005 ◽  
Vol 57 (2) ◽  
pp. 413-413
Author(s):  
Yves Lazorthes ◽  
Jean-Christophe Sol ◽  
Pascal Cintas ◽  
Jean-Albert Lotterie ◽  
Jean-Claude Verdie ◽  
...  
Keyword(s):  
Motor Cortex ◽  
Pain Control ◽  
Phantom Limb Pain ◽  
Phantom Limb ◽  
Motor Cortex Stimulation ◽  
Limb Pain ◽  
Analgesic Effects

scholarly journals Neuromodulation Techniques in Phantom Limb Pain: A Systematic Review and Meta-analysis

Pain Medicine ◽  
2020 ◽  
Vol 21 (10) ◽  
pp. 2310-2322 ◽  
Author(s):  
Kevin Pacheco-Barrios ◽  
Xianguo Meng ◽  
Felipe Fregni
Keyword(s):  
Primary Motor Cortex ◽  
Positive Impact ◽  
Meta Analysis ◽  
Phantom Limb Pain ◽  
Pain Scale ◽  
High Rate ◽  
Phantom Limb ◽  
Limb Pain ◽  
Stimulation Rate

Abstract Objective To evaluate the effects of neuromodulation techniques in adults with phantom limb pain (PLP). Methods A systematic search was performed, comprising randomized controlled trials (RCTs) and quasi-experimental (QE) studies that were published from database inception to February 2019 and that measured the effects of neuromodulation in adults with PLP. Hedge’s g effect size (ES) and 95% confidence intervals were calculated, and random-effects meta-analyses were performed. Results Fourteen studies (nine RCTs and five QE noncontrolled studies) were included. The meta-analysis of RCTs showed significant effects for i) excitatory primary motor cortex (M1) stimulation in reducing pain after stimulation (ES = −1.36, 95% confidence interval [CI] = −2.26 to −0.45); ii) anodal M1 transcranial direct current stimulation (tDCS) in lowering pain after stimulation (ES = −1.50, 95% CI = −2.05 to 0.95), and one-week follow-up (ES = −1.04, 95% CI = −1.64 to 0.45). The meta-analysis of noncontrolled QE studies demonstrated a high rate of pain reduction after stimulation with transcutaneous electrical nerve stimulation (rate = 67%, 95% CI = 60% to 73%) and at one-year follow-up with deep brain stimulation (rate = 73%, 95% CI = 63% to 82%). Conclusions The evidence from RCTs suggests that excitatory M1 stimulation—specifically, anodal M1 tDCS—has a significant short-term effect in reducing pain scale scores in PLP. Various neuromodulation techniques appear to have a significant and positive impact on PLP, but due to the limited amount of data, it is not possible to draw more definite conclusions.

Risk factors for post-amputation pain

2018 ◽  
Author(s):  
Tudor Phillips
Keyword(s):  
Older Patients ◽  
Clinical Characteristics ◽  
Phantom Limb Pain ◽  
Phantom Limb ◽  
Limb Amputation ◽  
Limb Pain ◽  
Experienced Pain ◽  
Stump Pain ◽  
Peripheral Pain

The landmark paper discussed in this chapter is ‘Immediate and long-term phantom limb pain in amputees: Incidence, clinical characteristics and relationship to pre-amputation limb pain’, published by Jensen et al. in 1985. This study examined a cohort of older patients undergoing limb amputation, and carefully related pre-amputation pain to the development and nature of phantom limb pain. The authors demonstrated that a third of patients experienced pain similar to the pre-amputated limb pain immediately after amputation; patients who had experienced pre-amputation pain were more likely to experience phantom limb pain in the first 6 months after the amputation; and persistent phantom limb pain was more likely in patients who experienced stump pain after amputation. The study had clear implications for pain management but, importantly, it also demonstrated that peripheral pain, in the form of pre-amputation and stump pain, was important in determining the development and maintenance of phantom limb pain.

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