Phantom limb pain is a chronic pain syndrome that is difficult to cope with.Despite neurostimulation treatment is indicated for refractory neuropathic pain,there is scant evidence from randomized controlled trials to ...Phantom limb pain is a chronic pain syndrome that is difficult to cope with.Despite neurostimulation treatment is indicated for refractory neuropathic pain,there is scant evidence from randomized controlled trials to recommend it as the treatment choice.Thus,a systematic review was performed to analyze the efficacy of central nervous system stimulation therapies as a strategy for pain management in patients with phantom limb pain.A literature search for studies conducted between 1970 and September 2020 was carried out using the MEDLINE and Embase databases.Principles of The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline were followed.There were a total of 10 full-text articles retrieved and included in this review.Deep brain stimulation,repetitive transcranial magnetic stimulation,transcranial direct current stimulation,and motor cortex stimulation were the treatment strategies used in the selected clinical trials.Repetitive transcranial magnetic stimulation and transcranial direct current stimulation were effective therapies to reduce pain perception,as well as to relieve anxiety and depression symptoms in phantom limb pain patients.Conversely,invasive approaches were considered the last treatment option as evidence in deep brain stimulation and motor cortex stimulation suggests that the value of phantom limb pain treatment remains controversial.However,the findings on use of these treatment strategies in other forms of neuropathic pain suggest that these invasive approaches could be a potential option for phantom limb pain patients.展开更多
Phantom limb pain(PLP) is not uncommon after amputation. PLP is described as a painful sensation perceived in the missing limb. Despite of its complicated pathophysiology, high prevalence of PLP has been associated wi...Phantom limb pain(PLP) is not uncommon after amputation. PLP is described as a painful sensation perceived in the missing limb. Despite of its complicated pathophysiology, high prevalence of PLP has been associated with poor health-related quality of life, low daily activity and short walking distances. A prompt and effective management of PLP is essential in caring for the amputee population. Current treatments including physical therapy, psychotherapy, medications, and interventions have been used with limited success. In this review,we provided an updated and evidence-based review of treatment options for PLP.展开更多
Phantom Limb Pain (PLP) is a phenomenon commonly observed in orthopedic rehabilitation units that can have detrimental effects on patients’ functioning. Psychological aspects of PLP have been widely investigated show...Phantom Limb Pain (PLP) is a phenomenon commonly observed in orthopedic rehabilitation units that can have detrimental effects on patients’ functioning. Psychological aspects of PLP have been widely investigated showing that some coping mechanisms are advantageous at certain points but not at others. However, the mechanisms related to positive adjustment to PLP during the course of rehabilitation have not been adequately examined. The aim of the study was to investigate the relationship between PLP and coping mechanism at two points during the rehabilitation process. Thirty one orthopedic inpatients, who had undergone lower-limb amputation following diabetic complications, rated their pain levels and mental coping strategies. The Ways of Coping Checklist, Life Orientation Test, and the McGill Pain Questionnaire, 1-15 days post-surgery and six months post-surgery were used for evaluation. Denial was found to be negatively correlated with PLP shortly after amputation. In contrast, optimism was found to be negatively correlated with PLP six months after the surgery. Emotion-focused coping mechanisms were found to be positively correlated with PLP. It is concluded that denial during the early stages of recuperation and optimism at later stages of rehabilitation is associated with reduced PLP. Awareness of these mental processes by both medical staff and family members may enable acceptance of these processes and thus facilitate patients’ rehabilitation.展开更多
When working at K(?)tzting Hospital of Traditional Chinese Medicine near Munich, Germany from March 1991 to May 1993, the author had treated 9 cases of phantom limb pain by means of acupuncture with satisfactory thera...When working at K(?)tzting Hospital of Traditional Chinese Medicine near Munich, Germany from March 1991 to May 1993, the author had treated 9 cases of phantom limb pain by means of acupuncture with satisfactory therapeutic effect as reported in the following. Clinical Data In this series, all the 9 cases were male, aged 60-79 years, with the course of disease ranging from 3-49 years. Five cases were amputated because of wound in war, 1 case embolism of femoral artery, 1 case tumor in the knee joint, 1 case comminuted展开更多
BACKGROUND Supernumerary phantom limb(SPL)sensation is the experience of additional limbs,either single or a pair of limbs.Unique to traumatic spinal cord injuries,we report effect of transcranial direct current stimu...BACKGROUND Supernumerary phantom limb(SPL)sensation is the experience of additional limbs,either single or a pair of limbs.Unique to traumatic spinal cord injuries,we report effect of transcranial direct current stimulation(tDCS)on SPL pain in a patient with cervical cord injury.CASE SUMMARY The subject was a 57-year-old man who was diagnosed with complete spinal cord injury(C6/C5,motor level;C5/C5,sensory level;AIS-A)approximately three months ago.After a period of 2 wk,we administered anodal tDCS over the motor cortex for 15 minutes at an intensity of 1.5 mA.Following that treatment,the patient experienced a decrease of SPL pain intensity and frequency,which lasted for 1 week after the end of treatment.CONCLUSION Targeting the motor cortex through neuromodulation appears to be a promising option for the management of SPL pain.展开更多
Objective To review the mechanisms and current clinical application of pharmacological interventions for phantom limb pain. Data sources Both Chinese and English language literatures were searched using MEDLINE （1982...Objective To review the mechanisms and current clinical application of pharmacological interventions for phantom limb pain. Data sources Both Chinese and English language literatures were searched using MEDLINE （1982-2011）, Pubmed （1982-2011） and the Index of Chinese Language Literature （1982-2011 ）. Study selection Data from published articles about pharmacological management of phantom limb pain in recent domestic and foreign literature were selected. Data extraction Data were mainly extracted from 96 articles which are listed in the reference section of this review. Results By reviewing the mechanisms and current clinical application of pharmacological interventions for phantom limb pain, including anticonvulsants, antidepressants, local anaesthetics, N-methyI-D-aspartate receptor antagonists, non-steroidal anti-inflammatory drugs, tramadol, opioids, calcitonin, capsaicin, beta-adrenergic blockers, clonidine, muscle relaxants, and emerging drugs, we examined the efficacy and safety of these medications, outlined the limitations and future directions. Conclusions Although there is lack of evidence-based consensus guidelines for the pharmacological management of phantom limb pain, we recommend tricyclic antidepressants, gabapentin, tramadol, opioids, local anaesthetics and N-methyI-D-aspartate receptor antagonists as the rational options for the treatment of phantom limb pain.展开更多
People with diabetes are 30 times more likely to undergo amputation than the general population.A total of 3.2million people in the UK have been diagnosed with diabetes and by 2025 this number is estimated to be 5mill...People with diabetes are 30 times more likely to undergo amputation than the general population.A total of 3.2million people in the UK have been diagnosed with diabetes and by 2025 this number is estimated to be 5million.One potential complication post amputation is phantom limb pain(PLP),a prevalent and often chronic condition which is difficult to treat.To inform a展开更多
Phantom limb pain(PLP)is a complex medical condition that is often difficult to treat,and thus can become detrimental to patients’quality of life.No standardized clinical treatments exist and there is no conclusive u...Phantom limb pain(PLP)is a complex medical condition that is often difficult to treat,and thus can become detrimental to patients’quality of life.No standardized clinical treatments exist and there is no conclusive understanding of the underlying mechanisms causing it.Noninvasive brain stimulation(NIBS)has been used to find correlations between changes in brain activity and various brain conditions,including neurological disease,mental illnesses,and brain disorders.Studies have also shown that NIBS can be effective in alleviating pain.Here,we examined the literature on a particular type of NIBS,known as transcranial direct current stimulation(tDCS),and its application to the treatment of PLP.We first discuss the current hypotheses on the working mech-anism of tDCS and then we examine published evidence of its efficacy to treat PLP.We conclude this article by discussing how tDCS alone,and in combination with brain imaging techniques such as electroencephalography(EEG)and magnetic resonance imagining,could be applied to further investigate the mechanisms underlying PLP.展开更多
目的系统评价保护性镇痛对截肢后幻肢痛发生率的影响。方法检索建库至2017年6月Cochrane Library、PubMed、Embase、Web of Science、OVID、Science Direct数据库,收集围术期保护性镇痛防治截肢后幻肢痛的临床研究进行评价。由两位独立...目的系统评价保护性镇痛对截肢后幻肢痛发生率的影响。方法检索建库至2017年6月Cochrane Library、PubMed、Embase、Web of Science、OVID、Science Direct数据库,收集围术期保护性镇痛防治截肢后幻肢痛的临床研究进行评价。由两位独立研究人员根据纳入与排除标准筛选文献并进行质量评价后,提取文献中的相关资料,包括一般资料和幻肢痛发生率,利用RevMan 5.3软件进行Meta分析。结果最终筛选出6篇符合条件的文献。术后随访1个月期共纳入256例患者,其中对照组129例,实验组127例。术后随访6个月期共纳入232例患者,其中对照组118例,实验组114例。术后随访12个月期共纳入118例患者,其中对照组60例,实验组58例。采用围术期保护性镇痛方式进行干预后术后1个月[RD=-0.21,95%CI(-0.38,-0.04),Z=2.47,P=0.01]和术后6个月[RD=-0.28,95%CI(-0.52,-0.05),Z=2.37,P=0.02]的幻肢痛发生率低于对照组,而术后12个月的幻肢痛发病率两组之间无显著性差异[RD=-0.20,95%CI(-0.48,0.09),Z=1.35,P=0.18]。结论围术期保护性镇痛能够预防截肢后近期和中期幻肢痛的发生率,但远期效果需要做进一步观察。展开更多
文摘Phantom limb pain is a chronic pain syndrome that is difficult to cope with.Despite neurostimulation treatment is indicated for refractory neuropathic pain,there is scant evidence from randomized controlled trials to recommend it as the treatment choice.Thus,a systematic review was performed to analyze the efficacy of central nervous system stimulation therapies as a strategy for pain management in patients with phantom limb pain.A literature search for studies conducted between 1970 and September 2020 was carried out using the MEDLINE and Embase databases.Principles of The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline were followed.There were a total of 10 full-text articles retrieved and included in this review.Deep brain stimulation,repetitive transcranial magnetic stimulation,transcranial direct current stimulation,and motor cortex stimulation were the treatment strategies used in the selected clinical trials.Repetitive transcranial magnetic stimulation and transcranial direct current stimulation were effective therapies to reduce pain perception,as well as to relieve anxiety and depression symptoms in phantom limb pain patients.Conversely,invasive approaches were considered the last treatment option as evidence in deep brain stimulation and motor cortex stimulation suggests that the value of phantom limb pain treatment remains controversial.However,the findings on use of these treatment strategies in other forms of neuropathic pain suggest that these invasive approaches could be a potential option for phantom limb pain patients.
文摘Phantom limb pain(PLP) is not uncommon after amputation. PLP is described as a painful sensation perceived in the missing limb. Despite of its complicated pathophysiology, high prevalence of PLP has been associated with poor health-related quality of life, low daily activity and short walking distances. A prompt and effective management of PLP is essential in caring for the amputee population. Current treatments including physical therapy, psychotherapy, medications, and interventions have been used with limited success. In this review,we provided an updated and evidence-based review of treatment options for PLP.
文摘Phantom Limb Pain (PLP) is a phenomenon commonly observed in orthopedic rehabilitation units that can have detrimental effects on patients’ functioning. Psychological aspects of PLP have been widely investigated showing that some coping mechanisms are advantageous at certain points but not at others. However, the mechanisms related to positive adjustment to PLP during the course of rehabilitation have not been adequately examined. The aim of the study was to investigate the relationship between PLP and coping mechanism at two points during the rehabilitation process. Thirty one orthopedic inpatients, who had undergone lower-limb amputation following diabetic complications, rated their pain levels and mental coping strategies. The Ways of Coping Checklist, Life Orientation Test, and the McGill Pain Questionnaire, 1-15 days post-surgery and six months post-surgery were used for evaluation. Denial was found to be negatively correlated with PLP shortly after amputation. In contrast, optimism was found to be negatively correlated with PLP six months after the surgery. Emotion-focused coping mechanisms were found to be positively correlated with PLP. It is concluded that denial during the early stages of recuperation and optimism at later stages of rehabilitation is associated with reduced PLP. Awareness of these mental processes by both medical staff and family members may enable acceptance of these processes and thus facilitate patients’ rehabilitation.
文摘When working at K(?)tzting Hospital of Traditional Chinese Medicine near Munich, Germany from March 1991 to May 1993, the author had treated 9 cases of phantom limb pain by means of acupuncture with satisfactory therapeutic effect as reported in the following. Clinical Data In this series, all the 9 cases were male, aged 60-79 years, with the course of disease ranging from 3-49 years. Five cases were amputated because of wound in war, 1 case embolism of femoral artery, 1 case tumor in the knee joint, 1 case comminuted
文摘BACKGROUND Supernumerary phantom limb(SPL)sensation is the experience of additional limbs,either single or a pair of limbs.Unique to traumatic spinal cord injuries,we report effect of transcranial direct current stimulation(tDCS)on SPL pain in a patient with cervical cord injury.CASE SUMMARY The subject was a 57-year-old man who was diagnosed with complete spinal cord injury(C6/C5,motor level;C5/C5,sensory level;AIS-A)approximately three months ago.After a period of 2 wk,we administered anodal tDCS over the motor cortex for 15 minutes at an intensity of 1.5 mA.Following that treatment,the patient experienced a decrease of SPL pain intensity and frequency,which lasted for 1 week after the end of treatment.CONCLUSION Targeting the motor cortex through neuromodulation appears to be a promising option for the management of SPL pain.
文摘Objective To review the mechanisms and current clinical application of pharmacological interventions for phantom limb pain. Data sources Both Chinese and English language literatures were searched using MEDLINE （1982-2011）, Pubmed （1982-2011） and the Index of Chinese Language Literature （1982-2011 ）. Study selection Data from published articles about pharmacological management of phantom limb pain in recent domestic and foreign literature were selected. Data extraction Data were mainly extracted from 96 articles which are listed in the reference section of this review. Results By reviewing the mechanisms and current clinical application of pharmacological interventions for phantom limb pain, including anticonvulsants, antidepressants, local anaesthetics, N-methyI-D-aspartate receptor antagonists, non-steroidal anti-inflammatory drugs, tramadol, opioids, calcitonin, capsaicin, beta-adrenergic blockers, clonidine, muscle relaxants, and emerging drugs, we examined the efficacy and safety of these medications, outlined the limitations and future directions. Conclusions Although there is lack of evidence-based consensus guidelines for the pharmacological management of phantom limb pain, we recommend tricyclic antidepressants, gabapentin, tramadol, opioids, local anaesthetics and N-methyI-D-aspartate receptor antagonists as the rational options for the treatment of phantom limb pain.
文摘People with diabetes are 30 times more likely to undergo amputation than the general population.A total of 3.2million people in the UK have been diagnosed with diabetes and by 2025 this number is estimated to be 5million.One potential complication post amputation is phantom limb pain(PLP),a prevalent and often chronic condition which is difficult to treat.To inform a
文摘Phantom limb pain(PLP)is a complex medical condition that is often difficult to treat,and thus can become detrimental to patients’quality of life.No standardized clinical treatments exist and there is no conclusive understanding of the underlying mechanisms causing it.Noninvasive brain stimulation(NIBS)has been used to find correlations between changes in brain activity and various brain conditions,including neurological disease,mental illnesses,and brain disorders.Studies have also shown that NIBS can be effective in alleviating pain.Here,we examined the literature on a particular type of NIBS,known as transcranial direct current stimulation(tDCS),and its application to the treatment of PLP.We first discuss the current hypotheses on the working mech-anism of tDCS and then we examine published evidence of its efficacy to treat PLP.We conclude this article by discussing how tDCS alone,and in combination with brain imaging techniques such as electroencephalography(EEG)and magnetic resonance imagining,could be applied to further investigate the mechanisms underlying PLP.
