Traumatic amputations remain one of the most frequent and disturbing wounds of armed conflict.In this scenario,most amputees develop residual and phantom limb pain,impacting their quality of life.There are several ele...Traumatic amputations remain one of the most frequent and disturbing wounds of armed conflict.In this scenario,most amputees develop residual and phantom limb pain,impacting their quality of life.There are several elective surgical procedures available for both conditions,such as neuroma excision followed by nerve reconstruction,nerve relocation,e.g.,surgically implanting a transected nerve into a muscle,nerve transfers in cases of associated paralysis,and most recently,regenerative peripheral nerve interface surgery.Whenever possible in the post-conflict phase,a coordinated effort between traveling humanitarian surgeons specializing in reconstructive microsurgery and local healthcare providers is essential for successfully treating phantom and chronic residual limb pain in post-conflict amputees.While providing a detailed logistical framework for global humanitarian missions is beyond the scope of this article,we provide a brief perspective on a topic of utmost importance for reconstructive surgeons worldwide:the high-quality care and treatment of refugees and those whose lives have been impacted by conflict,disaster,or displacement.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
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
BACKGROUND Supernumerary phantom limb(SPL)caused by spinal cord injury(SCI)has previously been reported in several studies.However,the mechanisms and management of SPL in SCI patients are still not fully understood.He...BACKGROUND Supernumerary phantom limb(SPL)caused by spinal cord injury(SCI)has previously been reported in several studies.However,the mechanisms and management of SPL in SCI patients are still not fully understood.Herein,we report a rare case of SPL in a patient with incomplete SCI.CASE SUMMARY A 46-year-old man complained of four hands 7 d after SCI.He was diagnosed with SPL complicated with actual limb neuropathic pain.Following a period of treatment with neurotrophic agents and Chinese traditional and analgesic medications,SPL symptoms and actual limb pain did not improve.However,his symptoms gradually lessened after combined treatment with high-frequency repetitive transcranial magnetic stimulation(rTMS),a promising neuromodulation technique,over the M1 cortex and visual feedback.After 7 wk of this treatment,SPL disappeared completely and actual limb pain was significantly relieved.CONCLUSION Cerebral plasticity changes may be a mechanism underlying the occurrence of non-painful SPL in SCI patients,and high-frequency rTMS applied to the M1 cortex could be a promising treatment method for SPL.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: Limb amputation is considered the last resort when the limb is no longer salvageable or when the limb is dead or dying, viable but nonfunctional or endangering the patient’s life. It is associated with pr...Background: Limb amputation is considered the last resort when the limb is no longer salvageable or when the limb is dead or dying, viable but nonfunctional or endangering the patient’s life. It is associated with profound economic, social, and psychological effects on the patients. The aim of this study is to evaluate the quality of life of major limb amputees in a rural setting in western Cameroon. Methods: This was a cross-sectional descriptive and analytical study carried out at the BATSENGLA-DSCHANG community in the West Region of Cameroon. Participants were interviewed and data collected using a pre-defined accredited questionnaire of the WHOQOL-BREF to assess the quality of life. Results: There were 63 participants, and a majority (60.32%) reported trauma as the cause of amputation. Participants with prostheses had a better quality of life. Conclusion: The age range of the study participants was 18 to 85 years with a mean of 46.73 ± 18.31 years. The majority were males (74.6%). Most of them (41.27%) had attained at least a secondary level of education, a majority (80.95%) were unemployed and more than half (55.56%) have less than the guaranteed inter-professional minimum wage. Major limb amputations were mostly due to traumatic causes (72%) and involved the lower limbs. Only a few (12.70%) used prostheses. Almost all of them (90.48%) had symptoms consistent with a phantom limb. The quality of life after major limb amputation in this study was generally fair according to the WHO quality of life tool.展开更多
目的:探讨产科剖宫产患者腰硬联合麻醉后发生的肢体幻像现象对患者焦虑情绪的影响。方法:选取腰硬联合麻醉下行剖宫产的患者100例,入室前5 min对患者进行医院焦虑抑郁量表(HADS)评分,HADS评分≥11分者剔除。患者入室后自确定麻醉体位开...目的:探讨产科剖宫产患者腰硬联合麻醉后发生的肢体幻像现象对患者焦虑情绪的影响。方法:选取腰硬联合麻醉下行剖宫产的患者100例,入室前5 min对患者进行医院焦虑抑郁量表(HADS)评分,HADS评分≥11分者剔除。患者入室后自确定麻醉体位开始进行观察,对肢体幻像现象发生情况进行记录。对发生肢体幻像患者的焦虑发生情况进行HADS评分并记录、分析。探讨文化程度、初产妇或经产妇、首次和非首次剖宫产对发生肢体幻像现象患者焦虑情绪的影响。当肢体幻像现象消失后,再次对患者进行HADS评分。结果:100例剖宫产患者中,入室前5 min HADS评分≥11分者6例,予以剔除。HADS评分<11分者94例,其中72例发生肢体幻像现象,发生率高达76.60%。在72例发生肢体幻像现象患者中,焦虑情绪发生率高达68.06%。在22例未发生肢体幻像现象患者中,焦虑情绪发生率为4.55%。发生肢体幻像现象组与未发生肢体幻像现象组比较有统计学差异(P<0.05)。不同文化程度对发生肢体幻像现象患者的焦虑情绪有一定影响(P<0.05)。发生肢体幻像现象的患者中初产妇较经产妇更易产生焦虑情绪,首次剖宫产较非首次剖宫产患者更易产生焦虑情绪(P<0.05)。当肢体幻像现象消失后,发生肢体幻像现象患者与未发生肢体幻像患者焦虑情绪发生率比较无统计学差异(P>0.05)。结论:腰硬联合麻醉后发生肢体幻像现象患者较未发生肢体幻像现象患者更易产生焦虑情绪,文化程度、是否初产妇和首次剖宫产对发生肢体幻像现象患者焦虑情绪的产生有一定影响。展开更多
文摘Traumatic amputations remain one of the most frequent and disturbing wounds of armed conflict.In this scenario,most amputees develop residual and phantom limb pain,impacting their quality of life.There are several elective surgical procedures available for both conditions,such as neuroma excision followed by nerve reconstruction,nerve relocation,e.g.,surgically implanting a transected nerve into a muscle,nerve transfers in cases of associated paralysis,and most recently,regenerative peripheral nerve interface surgery.Whenever possible in the post-conflict phase,a coordinated effort between traveling humanitarian surgeons specializing in reconstructive microsurgery and local healthcare providers is essential for successfully treating phantom and chronic residual limb pain in post-conflict amputees.While providing a detailed logistical framework for global humanitarian missions is beyond the scope of this article,we provide a brief perspective on a topic of utmost importance for reconstructive surgeons worldwide:the high-quality care and treatment of refugees and those whose lives have been impacted by conflict,disaster,or displacement.
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BACKGROUND Supernumerary phantom limb(SPL)caused by spinal cord injury(SCI)has previously been reported in several studies.However,the mechanisms and management of SPL in SCI patients are still not fully understood.Herein,we report a rare case of SPL in a patient with incomplete SCI.CASE SUMMARY A 46-year-old man complained of four hands 7 d after SCI.He was diagnosed with SPL complicated with actual limb neuropathic pain.Following a period of treatment with neurotrophic agents and Chinese traditional and analgesic medications,SPL symptoms and actual limb pain did not improve.However,his symptoms gradually lessened after combined treatment with high-frequency repetitive transcranial magnetic stimulation(rTMS),a promising neuromodulation technique,over the M1 cortex and visual feedback.After 7 wk of this treatment,SPL disappeared completely and actual limb pain was significantly relieved.CONCLUSION Cerebral plasticity changes may be a mechanism underlying the occurrence of non-painful SPL in SCI patients,and high-frequency rTMS applied to the M1 cortex could be a promising treatment method for SPL.
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: Limb amputation is considered the last resort when the limb is no longer salvageable or when the limb is dead or dying, viable but nonfunctional or endangering the patient’s life. It is associated with profound economic, social, and psychological effects on the patients. The aim of this study is to evaluate the quality of life of major limb amputees in a rural setting in western Cameroon. Methods: This was a cross-sectional descriptive and analytical study carried out at the BATSENGLA-DSCHANG community in the West Region of Cameroon. Participants were interviewed and data collected using a pre-defined accredited questionnaire of the WHOQOL-BREF to assess the quality of life. Results: There were 63 participants, and a majority (60.32%) reported trauma as the cause of amputation. Participants with prostheses had a better quality of life. Conclusion: The age range of the study participants was 18 to 85 years with a mean of 46.73 ± 18.31 years. The majority were males (74.6%). Most of them (41.27%) had attained at least a secondary level of education, a majority (80.95%) were unemployed and more than half (55.56%) have less than the guaranteed inter-professional minimum wage. Major limb amputations were mostly due to traumatic causes (72%) and involved the lower limbs. Only a few (12.70%) used prostheses. Almost all of them (90.48%) had symptoms consistent with a phantom limb. The quality of life after major limb amputation in this study was generally fair according to the WHO quality of life tool.
文摘目的:探讨产科剖宫产患者腰硬联合麻醉后发生的肢体幻像现象对患者焦虑情绪的影响。方法:选取腰硬联合麻醉下行剖宫产的患者100例,入室前5 min对患者进行医院焦虑抑郁量表(HADS)评分,HADS评分≥11分者剔除。患者入室后自确定麻醉体位开始进行观察,对肢体幻像现象发生情况进行记录。对发生肢体幻像患者的焦虑发生情况进行HADS评分并记录、分析。探讨文化程度、初产妇或经产妇、首次和非首次剖宫产对发生肢体幻像现象患者焦虑情绪的影响。当肢体幻像现象消失后,再次对患者进行HADS评分。结果:100例剖宫产患者中,入室前5 min HADS评分≥11分者6例,予以剔除。HADS评分<11分者94例,其中72例发生肢体幻像现象,发生率高达76.60%。在72例发生肢体幻像现象患者中,焦虑情绪发生率高达68.06%。在22例未发生肢体幻像现象患者中,焦虑情绪发生率为4.55%。发生肢体幻像现象组与未发生肢体幻像现象组比较有统计学差异(P<0.05)。不同文化程度对发生肢体幻像现象患者的焦虑情绪有一定影响(P<0.05)。发生肢体幻像现象的患者中初产妇较经产妇更易产生焦虑情绪,首次剖宫产较非首次剖宫产患者更易产生焦虑情绪(P<0.05)。当肢体幻像现象消失后,发生肢体幻像现象患者与未发生肢体幻像患者焦虑情绪发生率比较无统计学差异(P>0.05)。结论:腰硬联合麻醉后发生肢体幻像现象患者较未发生肢体幻像现象患者更易产生焦虑情绪,文化程度、是否初产妇和首次剖宫产对发生肢体幻像现象患者焦虑情绪的产生有一定影响。
