Incidence of Phantom Phenomena Including Phantom Limb Pain 6 Months After Major Lower Limb Amputation in Patients With Peripheral Vascular Disease

Multimodal analgesia may include pharmacological components such as regional anesthesia, opioid and nonopioid systemic analgesics, nonsteroidal anti-inflammatories, and a variety of adjuvant agents. Multimodal analgesia has been reported for a variety of surgical procedures but not yet for lower limb amputation in vasculopathic patients. Perioperative pain management in these patients presents a particular challenge considering the multiple sources and pathways for acute and chronic pain that are involved, such as chronic ischemic limb pain, postoperative residual limb pain, coexisting musculoskeletal pain, phantom limb sensations, and chronic phantom limb pain. These pain mechanisms are explored and a proposed protocol for multimodal analgesia is outlined taking into account the common patient comorbidities found in this patient population.

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Phantom Pain in Major Lower Limb Amputation: Primary Ligation Cauterization vs Traction Neurectomy

IIUM Medical Journal Malaysia ◽

10.31436/imjm.v17i1.887 ◽

2018 ◽

Vol 17 (1) ◽

Author(s):

Ahmad Redzuan Arshad ◽

Nazri Mohd Yusoff

Keyword(s):

Vascular Disease ◽

Peripheral Vascular Disease ◽

Lower Limb ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Phantom Pain ◽

Peripheral Vascular ◽

Primary Amputation ◽

Group A ◽

Group B

Introduction: Phantom Limb Pain (PLP) is haunting amputees in silent. Neuroma hyperexcitability is one of the popular peripheral theories which can be addressed during primary amputation by orthopaedic surgeons. There was no study comparing type of neurectomy association with PLP. The objective was to compare the occurrence of PLP between conventional and alternative techniques of neurectomy in major lower limb amputations. Materials and Methods: A prospective, randomized, interventional study was conducted involving 98 patients in Hospital Kuala Lumpur requiring major lower limb amputation due to diabetic complication, tumor and trauma from October 2016 to June 2017. Patients were evenly randomized into two groups; Group A: conventional traction neurectomy (CTN) and Group B: ligation and cauterization neurectomy (LCN). End point of the study was the outcome of PLP which was assessed clinically at post-operative day 3, 14 and 6-month. Results were analyzed using univariate and multivariate simple logistic regression. Results: There were have 47 and 46 patients in Group A and B respectively. Of these, 70.2% in Group A (n=33) and 28.3% in Group B (n=13) end up with PLP (p<0.001). Sixty nine percent of patients who underwent amputation above knee level (n=20) suffered from PLP (p<0.05). Group B patients had higher mean PLP pain score (3.31 and 2.94) but it was not statistically significant. 69.6% of patients with pre-operative pain (n=32) and 43.5% with peripheral vascular disease (n=20) developed PLP (p<0.05). Conclusion: LCN has 0.1 chance to develop PLP compared to CTN. Other significant factors in those who developed PLP include levels of amputation, pre-operative pain and peripheral vascular disease. LCN should be considered in primary amputation.

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A randomised, placebo controlled trial of levobupivacaine or the combination of levobupivacaine and clonidine when administered as a sciatic perineural infusion for the prevention of phantom limb pain after lower limb amputation

http://isrctn.org/> ◽

10.1186/isrctn31319378 ◽

2012 ◽

Author(s):

Graeme McLeod

Keyword(s):

Lower Limb ◽

Controlled Trial ◽

Phantom Limb Pain ◽

Lower Limb Amputation ◽

Phantom Limb ◽

Limb Amputation ◽

Limb Pain

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Development of Core Outcome Sets for People Undergoing Major Lower Limb Amputation for Complications of Peripheral Vascular Disease

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2020.06.021 ◽

2020 ◽

Vol 60 (5) ◽

pp. 730-738 ◽

Cited By ~ 1

Author(s):

Graeme K. Ambler ◽

Lucy Brookes-Howell ◽

Jac A.R. Jones ◽

Naina Verma ◽

David C. Bosanquet ◽

...

Keyword(s):

Vascular Disease ◽

Peripheral Vascular Disease ◽

Lower Limb ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Core Outcome ◽

Peripheral Vascular ◽

Core Outcome Sets

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Tactile, thermal, and electrical thresholds in patients with and without phantom limb pain after traumatic lower limb amputation

Journal of Pain Research ◽

10.2147/jpr.s77412 ◽

2015 ◽

pp. 169 ◽

Cited By ~ 7

Author(s):

Sheng Li ◽

Shengai Li ◽

Danielle Melton

Keyword(s):

Lower Limb ◽

Phantom Limb Pain ◽

Lower Limb Amputation ◽

Phantom Limb ◽

Limb Amputation ◽

Limb Pain

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Virtual Reality Treatment Displaying the Missing Leg Improves Phantom Limb Pain: A Small Clinical Trial

Neurorehabilitation and Neural Repair ◽

10.1177/15459683211054164 ◽

2021 ◽

pp. 154596832110541

Author(s):

Elisabetta Ambron ◽

Laurel J. Buxbaum ◽

Alexander Miller ◽

Harrison Stoll ◽

Katherine J. Kuchenbecker ◽

...

Keyword(s):

Clinical Trial ◽

Virtual Reality ◽

Lower Limb ◽

Phantom Limb Pain ◽

Lower Limb Amputation ◽

Phantom Limb ◽

Limb Amputation ◽

Limb Pain ◽

Small Clinical Trial ◽

Leg Movements

Background Phantom limb pain (PLP) is a common and in some cases debilitating consequence of upper- or lower-limb amputation for which current treatments are inadequate. Objective This small clinical trial tested whether game-like interactions with immersive VR activities can reduce PLP in subjects with transtibial lower-limb amputation. Methods Seven participants attended 5–7 sessions in which they engaged in a visually immersive virtual reality experience that did not require leg movements (Cool! TM), followed by 10–12 sessions of targeted lower-limb VR treatment consisting of custom games requiring leg movement. In the latter condition, they controlled an avatar with 2 intact legs viewed in a head-mounted display (HTC Vive TM). A motion-tracking system mounted on the intact and residual limbs controlled the movements of both virtual extremities independently. Results All participants except one experienced a reduction of pain immediately after VR sessions, and their pre session pain levels also decreased over the course of the study. At a group level, PLP decreased by 28% after the treatment that did not include leg movements and 39.6% after the games requiring leg motions. Both treatments were successful in reducing PLP. Conclusions This VR intervention appears to be an efficacious treatment for PLP in subjects with lower-limb amputation.

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