Phantom Limb Pain- Mechanism and Evidence Based Management

Vol 3 | Issue 1 | January-June 2022 | Page 08-12 | Rajendra Sahoo

DOI: 10.13107/ijra.2022.v03i01.47


Authors: Rajendra Sahoo [1]

[1] Department of Pain & Palliative Medicine, Kalinga Institute of Medical Sciences, KIIT Deemed University, Bhubaneswar, Odisha, India.

Address of Correspondence:
Dr. Rajendra Sahoo,
Senior Consultant, Department of Pain & Palliative Medicine, Kalinga Institute of Medical Sciences, KIIT Deemed University, Bhubaneswar, Odisha, India.
E-mail: sss.raaj@gmail.com


Abstract


Phantom limb pain (PLP) is a complex condition resulting in manifestation of pain in the missing body part. PLP is very common in post-amputated individuals and the prevalence rate of as high as 80% has been reported in amputees. PLP leads to a poor quality of life and has a tremendous impact on socioeconomic status of individuals. The mechanism of pain in PLP is still poorly understood despite significant research involving the molecular and neurobiology of the pain. Similarly, various pharmacological and non-pharmacological therapies are described in the literature. This article aims at briefly reviewing the existing literature pertaining to the PLP mechanism and evidence based treatment.


References


1. Ephraim PL, Wegener ST, MacKenzie EJ, et al. Phantom pain, residual limb pain, and back pain in amputees: results of a national survey. Arch Phys Med Rehabil 2005;86(10): 1910–1919.
2. Nikolajsen L and Jensen TS. Phantom limb pain. Br J Anesth 2001; 87(1): 107–16.
3. Whyte AS and Carroll LJ. A preliminary examination of the relationship between employment, pain and disability in an amputee population. Disabil Rehabil 2002;24(9): 462–470.
4. Barbin J, Seetha V, Casillas J-M, Paysant J, Perennou D. The effects of mirror therapy on pain and motor control of phantom limb in amputees: A systematic review. Ann Phys Rehabil Med. 2016;59(4):270–275.
5. Privitera R, Birch R, Sinisi M, Mihaylov IR, Leech R, Anand P. Capsaicin 8% patch treatment for amputation stump and phantom limb pain: a clinical and functional MRI study. J Pain Res. 2017;10:1623.
6. Bosmans JC, Geertzen JHB, Post WJ, et al. Factors associated with phantom limb pain: a 31/2-year prospective study. Clinical Rehabilitation 2010; 24(5): 444–453.
7. Davidson JH, Khor KE and Jones LE. A cross-sectional study of post-amputation pain in upper and lower limb amputees, experience of a tertiary referral amputee clinic. Disabil Rehabil 2010; 32(22): 1855–1862.
8. Dickinson BD, Head CA, Gitlow S, et al. Maldynia: pathophysiology and management of neuropathic and maladaptive pain – a report of the AMA council on science and public health. Pain Med 2010; 11(11): 1635–1653.
9. Baron R. Mechanisms of disease: neuropathic pain – a clinical perspective. Nat Clin Pract Neurol 2006; 2(2):95–106.
10. Ramachandran VS, Brang D and McGeoch PD. Dynamic reorganization of referred sensations by movements of phantom limbs. NeuroReport 2010; 21(10):727–730.
11. Chapman C. Neuromatrix theory. J Pain 1996; 5(2):139–142.
12. Robinson L, Czerniecki J, Ehde D, et al. Trial of amitriptyline for relief of pain in amputees: results of a randomized controlled study. Arch Phys Med Rehabil 2004;85(1): 1–6.
13. Spiegel DR, Lappinen E, Gottlieb M. A presumed case of phantom limb pain treated successfully with duloxetine and pregabalin. Gen Hosp Psychiatry. 2010;32(2):228.e5-7.
14. Bone M, Critchley P, Buggy DJ. Gabapentin in postamputation phantom limb pain: a randomized, double-blind, placebo-controlled, cross-over study. Reg Anesth Pain Med. 2002;27(5):481–486.
15. Smith DG, Ehde DM, Hanley MA, et al. Efficacy of gabapentin in treating chronic phantom limb and residual limb pain. J Rehabil Res Dev. 2005;42(5):645–654.
16. Nikolajsen L, Finnerup NB, Kramp S, et al. A randomized study of the effects of gabapentin on postamputation pain. Anesthesiology 2006; 105(5): 1008–1015
17. Abbass K. Efficacy of gabapentin for treatment of adults with phantom limb pain. Ann Pharmacother. 2012;46(12):1707–1711.
18. Harden RN, Houle TT, Remble TA, et al. Topiramate for phantom limb pain: a time-series analysis. Pain Med 2005; 6(5): 375–378.
19. Jaeger H and Maier C. Calcitonin in phantom limb pain: a double-blind study. Pain 1992; 48: 21–27.
20. Eichenberger U, Neff F, Sveticic G, et al. Chronic phantom limb pain: the effects of calcitonin, ketamine, and their combination on pain and sensory thresholds. Anesth Analg 2008; 106(4): 1265–1273.
21. Nikolajsen L, Hansen CL, Nielsen J, et al. The effect of ketamine on phantom pain: a central neuropathic disorder maintained by peripheral input. Pain 1996; 67(1): 69–77.
22. Ben Abraham R, Marouani N, Kollender Y, et al. Dextromethorphan for phantom pain attenuation in cancer amputees: a double-blind crossover trial involving three patients. Clin J Pain 2002; 18(5): 282–285.
23. Wiech K, Kiefer RT, Töpfner S, et al. A placebo-controlled randomized crossover trial
of the N-methyl-D-aspartic acid receptor antagonist, memantine, in patients with
chronic phantom limb pain. Anesth Analg 2004; 98(2): 408–413.
24. Schley M, Topfner S, Wiech K, et al. Continuous brachial plexus blockade in combination with the NMDA receptor antagonist memantine prevents phantom pain in acute traumatic upper limb amputees. Eur J Pain 2007; 11(3): 299–308.
25. Huse E, Larbig W, Flor H, et al. The effect of opioids on phantom limb pain and cortical reorganization. Pain 2001; 90(1–2): 47–55.
26. Wu C, Tella P, Staats P, et al. Analgesic effects of intravenous lidocaine and morphine on postamputation pain: a randomized double-blind, active placebocontrolled, crossover trial. Anesthesiology 2002; 96(2):841–848.
27. Wu C, Agarwal S, Tella P, et al. Morphine versus mexiletine for treatment of postamputation pain: a randomized, placebo-controlled, crossover trial. Anesthesiology 2008; 109(2): 289–296.
28. Barbin J, Seetha V, Casillas JM, Paysant J, Pérennou D. The effects of mirror therapy on pain and motor control of phantom limb in amputees: A systematic review. Ann Phys Rehabil Med. 2016 Sep;59(4):270-5.
29. Richardson C, Kulkarni J. A review of the management of phantom limb pain: challenges and solutions. J Pain Res. 2017;10:1861-1870.
30. Alviar MJ, Hale T, Dungca M. Pharmacologic interventions for treating phantom limb pain. Cochrane Database Syst Rev. 2016;10(10):CD006380.


How to Cite this Article: Sahoo R | Phantom Limb Pain- Mechanism and Evidence Based Management | International Journal of Regional Anaesthesia | January-June 2022; 3(1): 08-12.

 


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