Faculty Opinions recommendation of Efficacy of eye movement desensitization and reprocessing on the phantom limb pain of patients with amputations within a 24-month follow-up.

ObjectiveTo determine whether training with a brain–computer interface (BCI) to control an image of a phantom hand, which moves based on cortical currents estimated from magnetoencephalographic signals, reduces phantom limb pain.MethodsTwelve patients with chronic phantom limb pain of the upper limb due to amputation or brachial plexus root avulsion participated in a randomized single-blinded crossover trial. Patients were trained to move the virtual hand image controlled by the BCI with a real decoder, which was constructed to classify intact hand movements from motor cortical currents, by moving their phantom hands for 3 days (“real training”). Pain was evaluated using a visual analogue scale (VAS) before and after training, and at follow-up for an additional 16 days. As a control, patients engaged in the training with the same hand image controlled by randomly changing values (“random training”). The 2 trainings were randomly assigned to the patients. This trial is registered at UMIN-CTR (UMIN000013608).ResultsVAS at day 4 was significantly reduced from the baseline after real training (mean [SD], 45.3 [24.2]–30.9 [20.6], 1/100 mm; p = 0.009 < 0.025), but not after random training (p = 0.047 > 0.025). Compared to VAS at day 1, VAS at days 4 and 8 was significantly reduced by 32% and 36%, respectively, after real training and was significantly lower than VAS after random training (p < 0.01).ConclusionThree-day training to move the hand images controlled by BCI significantly reduced pain for 1 week.Classification of evidenceThis study provides Class III evidence that BCI reduces phantom limb pain.

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Treatment of Chronic Phantom Limb Pain Using a Trauma-Focused Psychological Approach

Pain Research and Management ◽

10.1155/2010/981634 ◽

2010 ◽

Vol 15 (2) ◽

pp. 65-71 ◽

Cited By ~ 53

Author(s):

C de Roos ◽

AC Veenstra ◽

A de Jongh ◽

ME den Hollander-Gijsman ◽

NJA van der Wee ◽

...

Keyword(s):

Pain Intensity ◽

Repeated Measures ◽

Psychological Intervention ◽

Psychological Treatment ◽

Phantom Limb Pain ◽

Phantom Limb ◽

Limb Pain ◽

Before And After

BACKGROUND: Chronic phantom limb pain (PLP) is a disabling chronic pain syndrome for which regular pain treatment is seldom effective. Pain memories resulting from long-lasting preamputation pain or pain flashbacks, which are part of a traumatic memory, are reported to be powerful elicitors of PLP.OBJECTIVE: To investigate whether a psychological treatment directed at processing the emotional and somatosensory memories associated with amputation reduces PLP.METHODS: Ten consecutive participants (six men and four women) with chronic PLP after leg amputation were treated with eye movement desensitization and reprocessing (EMDR). Pain intensity was assessed during a two-week period before and after treatment (mean number of sessions = 5.9), and at short- (three months) and long-term (mean 2.8 years) follow-up.RESULTS: Multivariate ANOVA for repeated measures revealed an overall time effect (F[2, 8]=6.7; P<0.02) for pain intensity. Pairwise comparison showed a significant decrease in mean pain score before and after treatment (P=0.00), which was maintained three months later. All but two participants improved and four were considered to be completely pain free at three months follow-up. Of the six participants available at long-term follow-up (mean 2.8 years), three were pain free and two had reduced pain intensity.CONCLUSIONS: These preliminary results suggest that, following a psychological intervention focused on trauma or pain-related memories, substantial long-term reduction of chronic PLP can be achieved. However, larger outcome studies are required.

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Phantom limb pain

Journal of Neurosurgery ◽

10.3171/jns.1975.42.3.0301 ◽

1975 ◽

Vol 42 (3) ◽

pp. 301-307 ◽

Cited By ~ 49

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.

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

Pain Medicine ◽

10.1093/pm/pnaa039 ◽

2020 ◽

Vol 21 (10) ◽

pp. 2310-2322 ◽

Cited By ~ 1

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.

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Chronic pain in lower limb amputees: Is there a correlation with the use of perioperative epidural or perineural analgesia?

Neurorehabilitation ◽

10.3233/nre-210077 ◽

2021 ◽

pp. 1-10

Author(s):

Benedetti Maria Grazia ◽

De Santis Letizia ◽

Mariani Giorgio ◽

Donati Danilo ◽

Bardelli Roberta ◽

...

Keyword(s):

Chronic Pain ◽

Lower Limb ◽

Phantom Limb Pain ◽

Postal Survey ◽

Phantom Limb ◽

Limb Amputation ◽

Limb Pain ◽

Simultaneous Use

BACKGROUND: Chronic pain is common in patients who undergo lower limb amputation. The use of epidural or perineural catheters seems to reduce acute pain after surgery but their effects in a longer follow up are unknown. OBJECTIVE: To evaluate the long-term prevalence of phantom limb sensation (PLS), phantom limb pain (PLP), and residual limb pain (RLP) and their correlation with perioperative use of epidural or perineural catheters. METHODS: Postal survey. Patients with trans-femoral, trans-tibial or hemi-pelvectomy amputation were asked to partake in the study. The Prosthetic Evaluation Questionnaire was used for the presence of chronic post-surgical pain. Presence of catheters was retrieved from medical notes. RESULTS: 57 patients at a mean of 4.4 years follow up were included. PLS was reported in 68.4%, PLP in 63.2 % and RLP in 54.4% of amputees. No correlation was identified between pain syndromes and the presence of individual catheters and the duration of their permanence. The simultaneous use of 2 catheters was related to a lesser presence of PLP. CONCLUSIONS: Data on prevalence of PLP, PLS and RLP are consistent with the literature. Favourable effects in PLP reduction in the long term follow up was related to the simultaneous use of two catheters.

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EMDR and Phantom Limb Pain: Theoretical Implications, Case Study, and Treatment Guidelines

Journal of EMDR Practice and Research ◽

10.1891/1933-3196.1.1.31 ◽

2007 ◽

Vol 1 (1) ◽

pp. 31-45 ◽

Cited By ~ 13

Author(s):

Jens Schneider ◽

Arne Hofmann ◽

Christine Rost ◽

Francine Shapiro

Keyword(s):

Treatment Guidelines ◽

Phantom Limb Pain ◽

Somatic Complaints ◽

Phantom Limb ◽

Clinical Implications ◽

Limb Pain ◽

Medication Effects ◽

Adaptive Information Processing

This article reviews the literature on EMDR treatment of somatic complaints and describes the application of Shapiro’s Adaptive Information Processing (AIP) model in the treatment of phantom limb pain. The case study explores the use of EMDR with a 38-year-old man experiencing severe phantom limb pain 3 years after the loss of his leg and part of his pelvis in an accident. Despite treatment at several rehabilitation and pain centers during the 3 years, and the use of opiate medication, he continued to experience persistent pain. After 9 EMDR treatment sessions, the patient’s phantom limb pain was completely ablated, and he was taken off medication. Effects were maintained at 18-month follow-up. The clinical implications of this application of EMDR are explored.

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