Pain Management after Lower Extremity Amputation

Abstract Phantom pain may occur in up to 85% of patients after limb amputation. Although the pathophysiology of postamputation phantom pain is not well understood, it seems to be produced by a complex multifactorial interaction between the peripheral, sympathetic, and central nervous systems. The theoretical aspects of this are reviewed. Management of phantom limb pain may be both medical and surgical. Among the pharmacological agents proved effective against phantom pain are B-blockers, tricyclic antidepressants, and anticonvulsants. Surgical management includes peripheral nerve stimulation, thermocontrolled coagulation of the spinal cord, spinal cord stimulation, transcutaneous nerve stimulation, and stereotactic deep brain stimulation.

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Role of Physical Medicine and Rehabilitation in Phantom Pain Management

Indonesian Journal of Physical Medicine & Rehabilitation ◽

10.36803/ijpmr.v5i01.199 ◽

1970 ◽

Vol 5 (01) ◽

pp. 39-54

Author(s):

Yudith Dian Prawitri ◽

Ratna Darjanti Haryadi

Keyword(s):

Phantom Limb Pain ◽

Rehabilitation Program ◽

Phantom Limb ◽

Limb Amputation ◽

Phantom Pain ◽

Mirror Therapy ◽

Physical Medicine ◽

Physical Medicine And Rehabilitation ◽

Sensory Experiences ◽

Stump Pain

Limb amputation often results in the alteration of painful (phantom and stump pain) and nonpainful sensoryexperiences (phantom sensation). It is important to know the characteristics of sensory experiences to avoidmistakes in identifying phantom pain. Phantom pain can cause disability for patient, disturbance in mobility,and deteriorate the quality of post-amputated patient. Management of phantom pain include pharmacologytreatment, surgery, anasthesia also psychotherapy. Physical medicine and rehabilitation program such asphysical therapy, biofeedback, desensitization, occupational therapy, mirror therapy, and applying prosthesisshould be performed not only to manage the pain, but also to improve functional level to increase patient’squality of life.Key Words: Amputation; Phantom limb pain; Stump pain; Sensation; Rehabilitation.

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Origin of phantom limb pain: A dynamic network perspective

e-Neuroforum ◽

10.1515/nf-2017-a018 ◽

2017 ◽

Vol 23 (3) ◽

Cited By ~ 2

Author(s):

Herta Flor ◽

Jamila Andoh

Keyword(s):

Chronic Pain ◽

Dynamic Network ◽

Phantom Limb Pain ◽

Phantom Limb ◽

Limb Amputation ◽

Phantom Pain ◽

Limb Pain ◽

Functional Changes ◽

Frequency Of Use ◽

Pain Symptoms

AbstractFunctional and structural plasticity in neural circuits may actively contribute to chronic pain. Changes in the central nervous system following limb amputation are one of the most remarkable evidences of brain plasticity.Such plastic changes result from combined sensorimotor deprivation with intense behavioral changes, including both acquisition of compensatory motor skills and coping with a chronic pain condition (phantom limb pain), which is a common consequence after amputation. This review aims to discuss the latest insights on functional changes and reorganization in nociceptive pathways, integrating analyses in human patients across several scales. Importantly, we address how functional changes interrelate with pain symptoms, not only locally within the primary somatosensory cortex but at a network-level including both spinal and cerebral areas of the nociceptive and pain networks. In addition, changes in the function of neurons and neural networks related to altered peripheral input are dynamic and influenced by psychological factors such as learning, prosthesis usage or frequency of use of the intact limb as well as comorbidity with anxiety and depression. We propose that both central and peripheral factors interact in a dynamic manner and create the phantom pain experience.

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Effectiveness of Perineural Dexmedetomidine and Ropivacaine on Preventing Phantom Limb Pain in Patients Undergoing Femoral Supracondylar Amputation

Global Journal of Medical Research ◽

10.34257/gjmrhvol20is1pg11 ◽

2020 ◽

pp. 11-17

Author(s):

MD. Ramírez Jaime ◽

MD. Estrada Sara ◽

MD. Martínez Raquel

Keyword(s):

Spinal Cord ◽

Peripheral Nerve ◽

Dorsal Root ◽

Peripheral Nerve Block ◽

Phantom Limb Pain ◽

Phantom Limb ◽

Limb Amputation ◽

Limb Pain ◽

Treatment And Prevention ◽

Local Anesthetic Infiltration

Background: Phantom limb pain is a frequent complication after limb amputation, its pathophysiology is complex and includes changes in the peripheral nerve, dorsal root ganglia, spinal cord, cerebral cortex, and thalamus. At this time, there is not an effective drug for treatment and prevention of phantom limb pain. Perineural local anesthetic infiltration has obtained different results in the prevention of phantom limb pain, so we propose to combine an α2 agonist in peripheral nerve block to assess its effectiveness in preventing postoperative pain.

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Addressing Phantom Pain Through Occupational Participation: A Qualitative Study of Support Group Participants

OTJR Occupation Participation and Health ◽

10.1177/1539449220973950 ◽

2021 ◽

Vol 41 (2) ◽

pp. 116-123

Author(s):

Victor M. Camacho ◽

Anna N. Carlson ◽

Salvador Bondoc

Keyword(s):

Lived Experience ◽

Support Group ◽

Phenomenological Study ◽

Phantom Limb Pain ◽

Phantom Limb ◽

Limb Amputation ◽

Phantom Pain ◽

Structured Interviews ◽

Qualitative Descriptive ◽

Occupational Participation

The purpose of this qualitative phenomenological study was to explore the adaptation process of support group participants who are survivors of lower limb amputation (LLA) experiencing phantom limb pain (PLP). The study followed a qualitative, descriptive phenomenological design. Ten adult participants with LLA met inclusion criteria and through semi-structured interviews shared their lived experience. A qualitative descriptive methodology was used to analyze the data collected from interview transcriptions. Analysis involved coding and theme development. Three themes emerged: PLP interrupted but does not prevent participation, adapting to PLP allowed for continued participation in meaningful occupations, and education to promote self-management of PLP. Themes identified highlight the importance of social support and early education on PLP to facilitate the adaption process and promote occupational participation. The finding underscores the value of empowering survivors to self-manage pain through their own personal and unique ways.

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The value of revision surgery after initial amputation of an upper or lower limb

Prosthetics and Orthotics International ◽

10.3109/03093648709079374 ◽

1987 ◽

Vol 11 (1) ◽

pp. 17-20 ◽

Cited By ~ 10

Author(s):

M. R. Wood ◽

G. A. Hunter ◽

S. G. Millstein

Keyword(s):

Surgical Procedures ◽

Nerve Stimulation ◽

Revision Surgery ◽

Lower Limb ◽

Phantom Limb Pain ◽

Surgical Revision ◽

Phantom Limb ◽

Limb Pain ◽

Transcutaneous Nerve Stimulation ◽

Amputation Surgery

The value of revision surgery when carried out more than six weeks after initial amputation of the upper or lower limb was assessed. When performed for stump and/or phantom limb pain alone, only 33/95 (35%) obtained satisfactory results after one revision; 25/95 (26%) of the patients required four or more surgical procedures without relief of pain. However, when carried out for local specific pathology, the results of surgical revision were 100% successful, even if the procedure had to be repeated once in 15% (28/189) of this group of patients. Transcutaneous nerve stimulation appeared to offer no long lasting relief of pain following amputation surgery.

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Phantom limb phenomenon as an example of body image distortion

Current Problems of Psychiatry ◽

10.1515/cpp-2017-0013 ◽

2017 ◽

Vol 18 (2) ◽

pp. 153-159 ◽

Cited By ~ 2

Author(s):

Magdalena Razmus ◽

Beata Daniluk ◽

Piotr Markiewicz

Keyword(s):

Body Image ◽

Phantom Limb Pain ◽

Image Distortion ◽

Limb Loss ◽

Phantom Limb ◽

Limb Amputation ◽

Mcgill Pain Questionnaire ◽

Phantom Pain ◽

Body Image Distortion ◽

Pain Questionnaire

AbstractIntroduction: The perception of one’s own body, its mental representation, and emotional attitude to it are the components of so-called “body image” [1]. The aim of the research was to analyse phantom pain and non-painful phantom sensations as results of limb loss and to explain them in terms of body image distortion.Material and method: Three methods were used in the study of 22 amputees (7 women and 15 men, between 43 and 76 years old, M = 61, SD = 11.3): (1) a clinical interview; (2) The Questionnaire of Body Experiencing after Limb Amputation; (3) modified version of The Pain Questionnaire based on The McGill Pain Questionnaire.Results: The prevalence of phantom limb pain was 59%. Some various non-painful phantom sensations after amputation were experienced by 77% of respondents. There was a statistically significant relationship between phantom pain and non-painful phantom sensations in a group of participants experiencing phantom limb phenomenon at the moment of the research.Conclusions: Deformation of body image in the form of phantom pain and non-painful phantom sensations is a frequent experience after limb loss. We suggest that phantom limb is a form of out-of-date or inadequate body image as an effect of the brain activity trying to keep a kind of status quo. A co-occurrence of non-painful phantom sensations and phantom pain suggests that these both forms of post-amputation sensations may share neural mechanisms. Results indicate, that there exists somatosensory memory which may be manifested in similarities between pre- and post-amputation sensations.

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Clinical Feasibility and Preliminary Outcomes of a Novel Mixed Reality Based System to Manage Phantom Pain for Patients with Lower Limb Amputation.: A Pilot Study

10.1101/2020.08.29.20133009 ◽

2020 ◽

Author(s):

Thiru M Annaswamy ◽

Kanchan Bahirat ◽

Gargi Raval ◽

Yu-Yen Chung ◽

Balakrishnan Prabhakaran

Keyword(s):

Lower Limb ◽

Mixed Reality ◽

Phantom Limb Pain ◽

Phantom Limb ◽

Limb Amputation ◽

Phantom Pain ◽

Mirror Therapy ◽

Limb Pain ◽

History Of ◽

Game Performance

Objective: This report describes the details of Mr. MAPP, a virtual mirror therapy system and the results of a clinical feasibility and evaluation study of a pilot sample of patients with history of lower limb amputation and phantom limb pain. Materials and Methods: Mr. MAPP system uses a Kinect V2 RGB-D camera to capture the patient, generates a live interactive 3D model, and incorporates it into a virtual exergame. Mr. MAPP mirrors their preserved limb and allows participants to visualize their amputated limb virtually and perform their prescribed exercise program. Mr. MAPP creates a digital diary of their therapy sessions by recording game performance and errors. Ten consecutive patients with history of limb loss and phantom pain were targeted for this pilot study. They received a Mr. MAPP system and a laptop for home use for 1-month. Outcome measures including pain intensity and pain interference measured on Numerical Rating Scale (NRS) and McGill Pain Questionnaire (MPQ) as well as functional outcomes measured on Patient Specific Functional Scale (PSFS) were obtained at baseline, and after 1-month. Results: Seven participants were enrolled, out of which four completed the study. The study was temporarily suspended due to restrictions imposed during the COVID-19 public health emergency. In-game performance data showed a trend towards improvement in most participants. Compared to baseline, NRS and MPQ scores at 1-month showed no clear trends. PSFS scores improved for 1 participant and remained unchanged for others. Conclusion: Gamified home exercises performed via a novel, mixed-reality system, Mr. MAPP, using which virtual mirror therapy was delivered, is feasible and has potential to improve pain and pain related function in patients with lower limb amputations and phantom limb pain.

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Lateral Spinal Cord Stimulation for Stump and Phantom Limb Pain Syndrome

10.26226/morressier.5ab3c881a874c600265593b4 ◽

2018 ◽

Author(s):

Ciro Visconti

Keyword(s):

Spinal Cord ◽

Spinal Cord Stimulation ◽

Phantom Limb Pain ◽

Pain Syndrome ◽

Phantom Limb ◽

Limb Pain

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An Experimental Study of Atypical Phantom Pain

The British Journal of Psychiatry ◽

10.1192/bjp.111.481.1185 ◽

1965 ◽

Vol 111 (481) ◽

pp. 1185-1187 ◽

Cited By ~ 23

Author(s):

I. Pilowsky ◽

A. Kaufman

Keyword(s):

Experimental Study ◽

Phantom Limb Pain ◽

Phantom Limb ◽

Phantom Pain ◽

Limb Pain ◽

Emotional Factors ◽

Psychological Mechanism

A number of writers have drawn attention to the importance of emotional factors in phantom limb pain (Kolb, 1950, 1952; Simmel, 1956; Russell, 1959; Von Hagen, 1963). Kolb (1950, 1952) reported an association between the discussion of certain emotionally loaded topics and accesses of pain in the phantom. Stengel (1965), in his Maudsley Lecture, discussed the role played in these experiences by the psychological mechanism of identification with others. He briefly referred to the patient whom we have studied.

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