本页推荐新近发表的英文文献摘要。如果您希望阅读全文，请与我们联系。 In this page we post selected abstracts of recent publications. If you wish to read the full text, please contact us. 七月份文摘主题 幻肢疼痛 The Topic of July Phantom Pain
Painful and Nonpainful Phantom and Stump Sensations in Acute Traumatic Amputees
Marcus T. Schley, MD, Petra Wilms, MD, Stephanie Toepfner, MD, Hanns-Peter Schaller, MD, PhD, Martin Schmelz, MD, PhD, Christoph J. Konrad, MD, PhD, and Niels Birbaumer, MD, PhD
Background: The formation, prevalence, intensity, course, and predisposing factors of phantom limb pain were investigated to determine possible mechanisms of the origin of phantom limb pain in traumatic upper limb amputees.
Methods: Ninety-six upper limb amputees participated in the study. A questionnaire assessed the following question:side, date, extension, and cause of amputation; preamputation pain; and presence or absence of phantom pain, phantom and stump sensations or stump pain or both.
Results: The response rate was 84%. Sixty-five (81%) participants returned the questionnaire. In 64 (98.5%) participants a traumatic injury led to amputation; the amputation was necessary because of infection in one patient (1.5%). The median follow-up time (from amputation to evaluation) was 3.2 years (range, 0.9 –3.8 years).
The prevalence of phantom pain was 44.6%, phantom sensation 53.8%, stump pain 61.5%, and stump sensation 78.5%. After its first appearance, phantom pain had a decreasing course in 14(48.2%) of 29 amputees, was stable in 11(37.9%) amputees, and worsened in 2(6.9%) of 29 amputees. Stump pain had a decreasing course in 19 (47.5%) of 40 amputees but was stable in 12 (30%) amputees.Phantom pain occurred immediately after amputation in 8 (28%) of 29 amputees between 1 month and 12 months in 3 (10%) amputees and after 12 or more months in 12 (41%) amputees.
Conclusion: Stump pain and stump sensation predominate traumatic amputees’ somatosensory experience immediately after amputation; phantom pain and phantom sensations are often long-term consequences of amputation. Amputees experience phantom sensations and phantom pain within 1 month after amputation, a second peak occurs 12 months after amputation. Revised diagnostic criteria for phantom pain are proposed on the basis of these data.
Key Words: Phantom pain, Phantom sensations, Stump pain, Stump sensation, Acute amputees, Incidence, Prevalence,Dynamic of pain.
J Trauma. 2008;65:858–864.
Self-Delivered Home-Based Mirror Therapy for Lower Limb Phantom Pain
Beth D. Darnall, PhD
Home-based patient-delivered mirror therapy is a promising approach in the treatment of phantom limb pain. Previous studies and case reports of mirror therapy have used a therapist-guided, structured protocol of exercises. No case report has described treatment for either upper or lower limb phantom pain by using home-based patient-delivered mirror therapy. The success of this case demonstrates that home-based patient-delivered mirror therapy may be an efficacious, low-cost treatment option that would eliminate many traditional barriers to care.
Key Words: Mirror Therapy, Amputation, Phantom Limb Pain, Lower Limb
Am J Phys Med Rehabil 2009;88:78–81.
Chronic Phantom Limb Pain: The Effects of Calcitonin, Ketamine, and Their Combination on Pain and Sensory Thresholds
Urs Eichenberger, MD, Frank Neff, MD, Gorazd Sveticic, MD, Steinar Bjo¨rgo, MD, Steen Petersen-Felix, MD, PhD, Lars Arendt-Nielsen, PhD, Michele Curatolo, MD, PhD
BACKGROUND: Calcitonin was effective in a study of acute phantom limb pain, but it was not studied in the chronic phase. The overall literature on N-methyl-daspartate antagonists is equivocal. We tested the hypothesis that calcitonin, ketamine, and their combination are effective in treating chronic phantom limb pain. Our secondary aim was to improve our understanding of the mechanisms of action of the investigated drugs using quantitative sensory testing.
METHODS: Twenty patients received, in a randomized, double-blind, crossover manner, 4 IV infusions of: 200 IE calcitonin; ketamine 0.4 mg/kg (only 10 patients); 200 IE of calcitonin combined with ketamine 0.4 mg/kg; placebo, 0.9% saline.
Intensity of phantom pain (visual analog scale) was recorded before, during, at the end, and the 48 h after each infusion. Pain thresholds after electrical, thermal, and pressure stimulation were recorded before and during each infusion.
RESULTS: Ketamine, but not calcitonin, reduced phantom limb pain. The combination was not superior to ketamine alone. There was no difference in basal pain thresholds between the amputated and contralateral side except for pressure pain. Pain thresholds were unaffected by calcitonin. The analgesic effect of the combination of calcitonin and ketamine was associated with a significant increase in electrical thresholds, but with no change in pressure and heat thresholds.
CONCLUSIONS: Our results question the usefulness of calcitonin in chronic phantom limb pain and stress the potential interest of N-methyl-d-aspartate antagonists. Sensory assessments indicated that peripheral mechanisms are unlikely important determinants of phantom limb pain. Ketamine, but not calcitonin, affects central sensitization processes that are probably involved in the pathophysiology of phantom limb pain.
(Anesth Analg 2008;106:1265–73)
A Randomized Study of the Effects of Gabapentin on Postamputation Pain
Lone Nikolajsen, M.D., Ph.D., Nanna B. Finnerup, M.D., Ph.D., Steffen Kramp, M.D., Anne-Sofie Vimtrup, Johnny Keller, M.D., Ph.D., Troels S. Jensen, M.D., Ph.D.
Background: Pain after amputation is common but difficult to treat. Therefore, the authors examined whether postoperative treatment with gabapentin could reduce postamputation stump and phantom pain.
Methods: Forty-six patients scheduled to undergo lower limb amputation were randomly assigned to receive oral gabapentin or placebo. Treatment was started on the first postoperative day and continued for 30 days. The daily dose of gabapentin or placebo was gradually increased to 2,400 mg/day. The intensity of stump and phantom pain was recorded every day on a numeric rating scale (0–10) during the 30-day treatment period. Five interviews were performed after 7, 14, and 30 days and after 3 and 6 months.
Results: Results from 41 patients were included in the data analysis. The risk of phantom pain (gabapentin vs. placebo) was 55.0% versus 52.6% (risk difference, 2.4%; 95% confidence interval, _28.9 to 33.7%; P _ 0.88; 30 days) and 58.8% versus 50.0% (risk difference, 8.8%; 95% confidence interval, 23.3 to 40.9%; P _ 0.59; 6 months). The median intensity of phantom pain (gabapentin vs. placebo) was 1.5 (range, 0–9.0) versus 1.2 (range, 0– 6.6) (P _ 0.60; 30 days) and 1.0 (range, 0– 6.0) versus 0.5 (range, 0–5.0) (P _ 0.77; 6 months).The median intensity of stump pain was 0.85 (range, 0– 8.2) versus 1.0 (range, 0–5.4) (P _ 0.68; 30 days) and 0 (range, 0– 8.0) versus 0 (range, 0–5.0) (P _ 0.58; 6 months).
Conclusion: Gabapentin administered in the first 30 postoperative days after amputation does not reduce the incidence or intensity of postamputation pain.
Anesthesiology 2006; 105:1008–15
Reconstructive
Surgical Treatment of Chronic Phantom Limb Sensation and Limb Pain after Lower Limb Amputation
Lukas Prantl, M.D., Stephan Schreml, M.D., Norbert Heine, M.D., Marita Eisenmann-Klein, M.D. And Peter Angele, M.D. Regensburg, Germany
Background: Therapy for phantom sensation and phantom limb pain following amputation is still difficult, because pathophysiologic mechanisms have not been clarified. This report illustrates a simple and useful surgical intervention. The authors propose that changes at the peripheral nerve site can influence the central feeling of phantom sensation and pain.
Methods: Fifteen patients (mean age, 56 years) with lower limb amputation were included in the study. In all patients, the sciatic nerve was split at a point approximately 3 cm proximal to the popliteal fossa, and the two parts were reconnected in a sling fashion using an epiperineurial technique under microscopic vision. The nerves were covered with a fibrin patch and anesthetics were applied by means of a local pain catheter. Frequency, duration, intensity, and quality of phantom pain were compared preoperatively and 1 week, 3 months, 6 months, and 1 year postoperatively.
Results: Fourteen of 15 patients defined the procedure as very helpful. Average, maximum, and minimum pain intensity were significantly reduced 1 week, 3 months, 6 months, and 1 year postoperatively (p _ 0.001). Pain intensity scores decreased significantly over the long term after surgical intervention (median visual analogue scale score: preoperatively, 7; 1 year postoperatively, 4) (p _ 0.001). The duration of pain attack shortened from approximately 120 minutes to 5 to 10 minutes.
Conclusions: This study shows that accurate treatment of the peripheral nerve can help to successfully reduce phantom limb pain. The authors feel encouraged to perform future investigations to test their operative method in a prospective, randomized, matched control study including electrophysiologic tests for more objective pain assessment.
Plast. Reconstr. Surg. 118: 1562, 2006
