Central nervous system stimulation therapies in phantom limb pain: a systematic review of clinical trials

Introduction. Neuropathic pain, or pain associated with disease or injury to the peripheral or central nervous system, is a common symptom of a heterogeneous group of conditions, including diabetic neuropathy, trigeminal neuralgia, postherpetic neuralgia and spinal cord injury. Chronic neuropathic pain should not be thought of as a symptom. It should truly be thought of as a disease with a very complicated pathophysiology. Pathophysiology. The mechanisms involved in neuropathic pain are complex and involve both peripheral and central pathophysiologic phenomenon. The underlying dysfunction may involve deafferentation within the peripheral nervous system (e.g. neuropathy), deafferentation within the central nervous system (e.g. post-thalamic stroke) or an imbalance between the two (e.g. phantom limb pain). Clinical characteristics. Neuropathic pain is non-nociceptive, in contrast to acute nociceptive pain, and it can be described as ?burning?, ?electric?, ?tingling?, and ?shooting? in nature. Treatment. Rational polypharmacy is often necessary and actually it is almost always the rule. It would be an exception if a patient was completely satisfied with his treatment. Treatment goals should include understanding that our patients may need to be titrated and managed with more than one agent and one type of treatment. There should be the balance of safety, efficacy, and tolerability. Conclusion. There are many new agents and new applications of the existing agents being currently studied which will most certainly lead to even more improved ways of managing this very complicated set of disorders.

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Noninvasive neuromodulation for the management of phantom limb pain: A systematic review

Annals of Physical and Rehabilitation Medicine ◽

10.1016/j.rehab.2018.05.861 ◽

2018 ◽

Vol 61 ◽

pp. e371-e372

Author(s):

E. Giray ◽

G.D. Akyuz

Keyword(s):

Systematic Review ◽

Phantom Limb Pain ◽

Phantom Limb ◽

Limb Pain ◽

Noninvasive Neuromodulation

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Effectiveness of mirror therapy, motor imagery, and virtual feedback on phantom limb pain following amputation: A systematic review

Prosthetics and Orthotics International ◽

10.1177/0309364617740230 ◽

2017 ◽

Vol 42 (3) ◽

pp. 288-298 ◽

Cited By ~ 22

Author(s):

Laura Herrador Colmenero ◽

Jose Manuel Perez Marmol ◽

Celia Martí-García ◽

María de los Ángeles Querol Zaldivar ◽

Rosa María Tapia Haro ◽

...

Keyword(s):

Systematic Review ◽

Motor Imagery ◽

Visual Feedback ◽

Methodological Quality ◽

Internal Validity ◽

Phantom Limb Pain ◽

Research Quality ◽

Phantom Limb ◽

Mirror Therapy ◽

Limb Pain

Background: Phantom limb pain is reported in 50%–85% of people with amputation. Clinical interventions in treating central pain, such as mirror therapy, motor imagery, or virtual visual feedback, could redound in benefits to amputee patients with phantom limb pain. Objectives: To provide an overview of the effectiveness of different techniques for treating phantom limb pain in amputee patients. Study design: Systematic review. Methods: A computerized literature search up to April 2017 was performed using the following databases: PubMed, Scopus, CINAHL, MEDLINE, ProQuest, PEDro, EBSCOhost, and Cochrane Plus. Methodological quality and internal validity score of each study were assessed using PEDro scale. For data synthesis, qualitative methods from the Cochrane Back Review Group were applied. Results: In all, 12 studies met our inclusion criteria, where 9 were rated as low methodological quality and 3 rated moderate quality. All studies showed a significant reduction in pain, but there was heterogeneity among subjects and methodologies and any high-quality clinical trial (PEDro score ≤8; internal validity score ≤5) was not found. Conclusion: Mirror therapy, motor imaginary, and virtual visual feedback reduce phantom limb pain; however, there is limited scientific evidence supporting their effectiveness. Future studies should include designs with more solid research methods, exploring short- and long-term benefits of these therapies. Clinical relevance This systematic review investigates the effectiveness of mirror therapy, motor imagery, and virtual visual feedback on phantom limb pain, summarizing the currently published trials and evaluating the research quality. Although these interventions have positive benefits in phantom limb pain, there is still a lack of evidence for supporting their effectiveness.

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