Prevention of Painful Neuroma and Phantom Limb Pain After Transfemoral Amputations Through Concomitant Nerve Coaptation and Collagen Nerve Wrapping

Neurosurgery ◽  
2016 ◽  
Vol 79 (3) ◽  
pp. 508-513 ◽  
Author(s):  
James M. Economides ◽  
Michael V. DeFazio ◽  
Christopher E. Attinger ◽  
John R. Barbour
Keyword(s):  
Peroneal Nerve ◽  
Phantom Limb Pain ◽  
Common Peroneal Nerve ◽  
Phantom Limb ◽  
Phantom Pain ◽  
Nerve Reconstruction ◽  
Limb Pain ◽  
Vas Scores ◽  
Postamputation Pain ◽  
Neuroma Formation

Abstract BACKGROUND: Postamputation pain is a debilitating condition that affects almost 60% of transfemoral amputees. Recent appreciation for the contribution of peripheral nerve derangement to the development of postamputation pain has resulted in focus on the role of nerve reconstruction in preventing pain after amputation. OBJECTIVE: To propose a method involving tibial and common peroneal nerve coaptation at the time of amputation, as a means to prevent residual limb pain and phantom sequelae resulting from neuroma formation. METHODS: Between May 2014 and May 2015, 17 patients underwent transfemoral amputation and nerve management through either (1) common peroneal nerve-to-tibial nerve coaptation and collagen nerve wrapping or (2) traction neurectomy alone. Visual analog scores (VAS) for pain, analgesic requirements, neuroma formation, phantom pain/sensations, and ambulatory status were compared between cohorts. RESULTS: Six patients underwent nerve coaptation/collagen nerve wrapping, whereas 11 underwent traction neurectomy. At 2 months, VAS scores were similar between cohorts (3 vs 3.82; P =.88); however, neuroma (0% vs 36.3%; P =.24) and phantom pain (0% and 54.5%; P =.03) were significantly lower after coaptation. After 6 months, VAS scores (0.75 vs 5.6; P =.02) as well as neuroma (0% vs 54.5%; P =.03) and phantom pain (0% vs 63.6%; P =.01) remained lower among patients who underwent coaptation. At follow-up, 67% of coaptation patients were ambulating with a prosthesis vs 9% of neurectomy patients (P =.01). CONCLUSION: Preemptive coaptation and collagen nerve wrapping is associated with lower VAS pain scores, phantom symptoms, and neuroma formation, with higher ambulation rates after 6 months when compared with traction neurectomy alone.

An Experimental Study of Atypical Phantom Pain

1965 ◽  
Vol 111 (481) ◽  
pp. 1185-1187 ◽  
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.

Phantom Limb Pain

2018 ◽  
Author(s):  
Kenneth D. Candido ◽  
Teresa M. Kusper ◽  
Alexei Lissounov ◽  
Nebojsa Nick Knezevic
Keyword(s):  
Alternative Therapy ◽  
Phantom Limb Pain ◽  
Body Part ◽  
Phantom Limb ◽  
Treatment Modalities ◽  
Phantom Pain ◽  
Limb Pain ◽  
Surgical Interventions ◽  
Neurologic Sequelae ◽  
The 19Th Century

Post-amputation pain (PAP) has challenged clinicians for centuries. The first written record of this perplexing condition came from the 16th-century French military surgeon Ambrose Paré. The term phantom limb pain (PLP) was coined by Silas Weir Mitchell, who provided a comprehensive description of the condition during the 19th century. Since that time, the understanding of PLP has greatly expanded; however, our knowledge of the exact mechanisms underlying it is still very deficient. Amputation of a body part can result in one sequela or more than one neurologic sequelae occurring concurrently: phantom sensation, phantom pain, and stump pain. The incidence and prevalence vary across the spectrum of these syndromes. A myriad of treatment modalities are employed in an attempt to terminate PLP, including pharmacotherapy, injections, alternative therapy, surgical interventions, and neuromodulation. Despite an extensive search for effective therapeutic options, PLP remains a highly challenging and debilitating condition.

Phantom Limb Pain Responds to Distant Skin Magnets: Support for the Functional Existence of Acupuncture Meridians

1998 ◽  
Vol 16 (2) ◽  
pp. 106-111 ◽  
Author(s):  
Timö Töysä
Keyword(s):  
Phantom Limb Pain ◽  
Phantom Limb ◽  
Leg Pain ◽  
Phantom Pain ◽  
Limb Pain ◽  
Stopping Treatment

Phantom leg pain in 10 patients was treated with skin magnets to the ipsilateral superior ends, on the thorax, of the leg Yin-meridians (KI.27, LR.14 and SP.21). The majority of patients reported relief of phantom pain while skin magnets were in situ, but in general this benefit was lost soon after stopping treatment. In two cases the method appeared more effective than morphine, and in a few patients it seemed to have some prophylactic benefit.

The effect of electromagnetic shielding on phantom limb pain: A placebo-controlled double-blind crossover trial

2015 ◽  
Vol 40 (3) ◽  
pp. 350-356 ◽  
Author(s):  
Keren Fisher ◽  
Sarah Oliver ◽  
Imad Sedki ◽  
Rajiv Hanspal
Keyword(s):  
Electromagnetic Field ◽  
Electromagnetic Fields ◽  
Crossover Trial ◽  
Phantom Limb Pain ◽  
Well Being ◽  
Electromagnetic Shielding ◽  
Phantom Limb ◽  
Phantom Pain ◽  
Limb Pain ◽  
Double Blind

Background: Environmental electromagnetic fields influence biological systems. Evidence suggests these have a role in the experience of phantom limb pain in patients with amputations. Objectives: This article followed a previous study to investigate the effect of electromagnetic field shielding with a specially designed prosthetic liner. Study design: Randomised placebo-controlled double-blind crossover trial. Methods: Twenty suitable participants with transtibial amputations, phantom pain at least 1 year with no other treatable cause or pathology were requested to record daily pain, well-being, activity and hours of prosthetic use on pre-printed diary sheets. These were issued for three 2-week periods (baseline, electromagnetic shielding (verum) and visually identical placebo liners – randomly allocated). Results: Thirty-three per cent of the recruited participants were unable to complete the trial. The resulting N was therefore smaller than was necessary for adequate power. The remaining data showed that maximum pain and well-being were improved from baseline under verum but not placebo. More participants improved on all variables with verum than placebo. Conclusion: Electromagnetic field shielding produced beneficial effects in those participants who could tolerate the liner. It is suggested that this might be due to protection of vulnerable nerve endings from nociceptive effects of environmental electromagnetic fields. Clinical relevance Electromagnetic field shielding with a suitable limb/prosthesis interface can be considered a useful technique to improve pain and well-being in patients with phantom limb pain.

Phantom limb pain

1975 ◽  
Vol 42 (3) ◽  
pp. 301-307 ◽  
Author(s):  
Karl D. Nielson ◽  
John E. Adams ◽  
Yoshio Hosobuchi
Keyword(s):  
Phantom Limb Pain ◽  
Dorsal Column ◽  
Phantom Limb ◽  
Phantom Pain ◽  
Limb Pain ◽  
Content Type ◽  
Successful Series ◽  
Dorsal Column Stimulation ◽  
Fine Print

✓ Good to excellent relief of phantom pain is reported in 5 of 6 patients by the use of dorsal column stimulation. Follow-up periods are 7 to 25 months. One failure occurred despite excellent pain relief; this patient could not tolerate application of the DCS apparatus to his chest wall. The authors review the physiology involved and some less successful series reported by others.

scholarly journals Phantom Limb Pain: Mechanisms and Treatment Approaches

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
Bishnu Subedi ◽  
George T. Grossberg
Keyword(s):  
Neuropathic Pain ◽  
Specific Treatment ◽  
Phantom Limb Pain ◽  
Cortical Reorganization ◽  
Phantom Limb ◽  
Phantom Pain ◽  
Limb Pain ◽  
Pain Mechanisms ◽  
Treatment Approaches ◽  
The Past

The vast amount of research over the past decades has significantly added to our knowledge of phantom limb pain. Multiple factors including site of amputation or presence of preamputation pain have been found to have a positive correlation with the development of phantom limb pain. The paradigms of proposed mechanisms have shifted over the past years from the psychogenic theory to peripheral and central neural changes involving cortical reorganization. More recently, the role of mirror neurons in the brain has been proposed in the generation of phantom pain. A wide variety of treatment approaches have been employed, but mechanism-based specific treatment guidelines are yet to evolve. Phantom limb pain is considered a neuropathic pain, and most treatment recommendations are based on recommendations for neuropathic pain syndromes. Mirror therapy, a relatively recently proposed therapy for phantom limb pain, has mixed results in randomized controlled trials. Most successful treatment outcomes include multidisciplinary measures. This paper attempts to review and summarize recent research relative to the proposed mechanisms of and treatments for phantom limb pain.

Perioperative Management of the Child Following an Extremity Amputation

2018 ◽  
Author(s):  
Jamie W. Sinton
Keyword(s):  
Perioperative Management ◽  
Phantom Limb Pain ◽  
Multimodal Analgesia ◽  
Opioid Therapy ◽  
Phantom Limb ◽  
Pharmacologic Therapy ◽  
Postoperative Phase ◽  
Limb Pain ◽  
Postamputation Pain ◽  
Extremity Amputation

Postamputation pain is multifactorial in nature. Pain often begins prior to the surgical amputation and can be related to trauma or malignancy. Types of pain experienced include nociceptive, neuropathic, phantom, and stump. Control of pain preoperatively and acutely in the postoperative phase, may prevent the conversion from acute to chronic pain. Each patient undergoing amputation experiences nociceptive pain due to surgery, and the overwhelming majority experience neuropathic and phantom limb pain as well. Goal-targeted pain therapies can reduce pain burden perioperatively. Multimodal analgesia begins preoperatively with antineuropathic agents; continues intraoperatively with regional anesthetics, anti-inflammatories, and opioid therapy; and continues for approximately 6 weeks postoperatively with nonpharmacologic and continued pharmacologic therapy.

Origin of phantom limb pain: A dynamic network perspective

e-Neuroforum ◽  
2017 ◽  
Vol 23 (3) ◽  
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.

scholarly journals Surgical Treatment of Symptomatic Neuromas After Lower Limb Amputations

2020 ◽  
pp. 11-17
Author(s):  
A.P. Liabakh ◽  
H.M. Lazarenko ◽  
V.M. Piatkovskyi
Keyword(s):  
Surgical Treatment ◽  
Lower Limb ◽  
Phantom Limb Pain ◽  
Blast Injury ◽  
Modern Medicine ◽  
Phantom Limb ◽  
Analog Scale ◽  
Limb Pain ◽  
Residual Limb Pain ◽  
Postamputation Pain

Summary. The pain after amputations is a global problem of modern medicine. There are three distinct clinical entities that can form the postamputation pain: phantom limb pain (PLP), phantom sensations (PSs), and residual limb pain (RLP). PLP and PSs are pathophysiological phenomena, which need complex conservative treatment. RLP is a local condition that arises from neuroma, excessive scarring, osteophites, etc. and can be resolved by surgery. Objective: to analyze the results of surgical treatment of patients with symptomatic neuromas after lower limb amputations (LLA). Materials and Methods. The study included 43 patients with symptomatic neuromas 3–10 years after LLA. There were 40 male and 3 female patients (mean age 33.9±3 years). Amputations were caused by trauma (33 cases), mine-blast injury (7 cases), diabetes (1 case), and oncology (2 cases). The level of amputation was thigh (3 cases), knee (1 case), and ankle (39 cases). The pain intensity was measured by the VAS (Visually Analog Scale) and prosthesis using by the ALAC (Artificial Limb and Appliance Centre, USA) scale. Results. RLP had 43 patients (100%), PLP – 8 (8.6%), and PSs – 35 (81.4%) patients. The average level of pain was 7.4±0.9. Prosthesis was used in 74.4% (32 patients), but 11 of them used prosthesis for cosmetic or transportation reasons (levels I and II by the ALAC scale). Complications after surgery were presented by hematoma (3 cases), marginal skin necrosis (2 cases), and tearing of m. gastrocnemius from the tibia after the fall on the stump (1 case). The results were assessed in 35 patients in terms from 1 to 15 years. The pain severity decreased from 7.4±0.9 to 3.2±0.6 (p˂0.05; two-sample t-test). The number of RLP cases decreased to 11 (31.4%), but the number of PLP and PSs cases did not significantly change (PLP – 5 cases or 14.3%; PSs – 27 cases or 77.1%). The prosthesis using rised to 100% due to functionality (III–VI levels by the ALAC scale). Conclusions. Surgical method is the main treatment of symptomatic neuromas after LLA. The surgery must expect proximal neurotomy and, if need, reamputation and stump reconstruction. This approach helps to reduce pain and improves the functional ability of persons with LLA.

scholarly journals The use of mirror therapy in the treatment of phantom limb pain in amputees

2021 ◽  
Vol 10 (2) ◽  
pp. 214-219
Author(s):  
Omar Fadili ◽  
Basile Labouche ◽  
Fatiha Rhattat Achour
Keyword(s):  
Central Body ◽  
Brain Plasticity ◽  
Phantom Limb Pain ◽  
Descriptive Study ◽  
Phantom Limb ◽  
Phantom Pain ◽  
Therapeutic Procedure ◽  
Mirror Therapy ◽  
Limb Pain ◽  
Non Invasive

Mirror therapy is a non-invasive and inexpensive therapeutic procedure indicated for the treatment of post-amputation phantom limb pain. This technique has proven its effectiveness and consists of bringing into play brain plasticity in order to reshape the central body architecture after amputation. This is a quantitative and descriptive study, which aims to objectify the use of mirror therapy on phantom pain in amputees, by combining the results in order to evaluate its effects, its application and its limits in the management of post-amputation.

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