Acute Neuropathic Pain
Pamela E. Macintyre, Stephan A. Schug in Acute Pain Management, 2021
Treatment options for phantom limb pain also include those mentioned previously for the management of acute neuropathic pain in general. Although based on limited evidence, there is some support for the use of ketamine, opioids, tramadol, gabapentinoids, and amitriptyline (Schug et al, 2020). Acute phantom limb pain can also be treated more specifically by the use of repeated daily IV infusions, subcutaneous injections or intranasal administration of salmon calcitonin (100–200 IU) after prophylactic use of an antiemetic (Schug et al, 2020). Nonpharmacological treatment options aiming at cortical reorganization such as mirror therapy, sensory discrimination training, and motor imagery may reduce chronic phantom limb pain. Institution of preventive analgesia prior to amputation is also worthwhile.
The management of chronic pain
Alison Twycross, Anthony Moriarty, Tracy Betts in Paediatric Pain Management a multi-disciplinary approach, 2018
Treatment methods are myriad for phantom limb pain, which suggests the poor efficacy of any of them. They can be classified as follows: pharmacological – standard analgesics both opiate and non-opiate, and other adjuvant drugs (anticonvulsants, antidepressants). Tricyclic antidepressants have been used in adults, as have antiepileptics such as carbamazepine. Children may be suffering a different kind of pain and only a few studies have used these drugs for neuropathic pain in children. The notable thing about neuropathic pain is that it may be resistant to opioids22regional blocks – diagnostic and therapeuticphysical therapies – TENS, heat, acupuncturepsychologicalsurgery – this should only be considered for a specific surgically treatable cause of the pain as it has no objective benefit over any of the other modalities.
Complications of Amputations
Stephen M. Cohn, Matthew O. Dolich in Complications in Surgery and Trauma, 2014
The most common postamputation pain syndrome is phantom pain. Almost all amputees experience phantom limb sensation, which is the feeling that the missing limb is still present. In some, however, this sensation presents as a poorly localized pain. Its incidence is at least 30%–50% [1]. Three major characteristics define this syndrome: (1) pain that lasts for some time after the wound has healed; (2) pain elicited by the activation of trigger zones; and (3) pain that resembles the pain experienced preoperatively [16]. A high level of pre-amputation pain in the limb may predis-pose to phantom limb pain [17]. Furthermore, the likelihood of phantom pain is correlated with the site of the amputation; the higher the level of amputation, the more likely the phantom pain. Phantom pain is more likely after upper-extremity amputations than after lower-extremity amputations. The etiology is very complex and treatment methods included narcotics, gabapentin, sensory discrimination training, and the use of more functional prosthesis and aggressive rehabilitation [18]. A recent prospective trial has suggested that optimized perioperative analgesia, in terms of maximal use of narcotics and gabapentin agonists, reduces chronic phantom limb pain [19].
Pain issues in the victims with lower-limb amputation: 10 years after the 2008 Sichuan earthquake
Published in Disability and Rehabilitation, 2022
Qian Wang, Caiyun Chen, Sheng Zhang, Yiming Tang, Hongxia Wang, Xue Zhou, Man-sang Wong
The Prostheses Evaluation Questionnaire (PEQ) is a comprehensive outcome measure specifically used for the individuals with lower-limb amputation [23–25]. The version of PEQ used in this study was translated and tested to be valid and reliable by a team of Chinese researchers in 2004 [17]. The simplified Chinese characters were converted from the traditional Chinese characters for local survey purpose. In the PEQ, 15 questions specifically cover the amputation-related pain including phantom limb sensation (PLS), PLP, RLP, NALP, and BP. Phantom limb sensation is described as the feelings like pressure, tickle, or a sense of position or location of the amputated limb. This abnormal sensation is a real issue for the amputees and is linked to the PLP. Phantom limb pain refers to painful sensation in the portion of the limb that has been amputated, whereas RLP refers to painful sensation in the residual portion of the limb which is still physically present following amputation. Non-amputated limb pain is defined as painful sensation on the contralateral side of amputation, while BP indicates the painful sensation at the back. These definitions were explained by the trained researchers prior to each survey to facilitate the understanding of the difference among the above-mentioned amputation-related pain.
Stepping forward following lower limb amputation
Published in Physical Therapy Reviews, 2018
Prasath Jayakaran, Natalie Vanicek
In this special issue we have compiled five expert reviews to inform individuals who are involved in the rehabilitation process following limb loss. One review explores how prosthetic prescription is an integral component of the rehabilitation phase and for user outcomes. Phantom limb pain is a common impairment, often debilitating for many individuals and impacts their physical function and quality of life. Therefore, one review explores the non-pharmacological management of this condition. Patient education about the prevention of limb loss through modifiable lifestyle risk factors is critical, especially in individuals with diabetes and/or peripheral vascular disease, and one review explores how physical therapy plays an important role for individuals at high risk of amputation. While regular physical activity is recommended for the prevention of other health comorbidities, individuals with a lower limb amputation may encounter a number of barriers preventing them from regular participation. One review discusses the importance of physical fitness, and factors that impact physical activity in those with a lower limb amputation. Finally, the last review summarises some of the available physical therapy interventions to improve balance and walking ability.
A Phantom Phallus?
Published in Studies in Gender and Sexuality, 2020
It is a proven scientific fact that phantom limb sensations are extremely common—about 70% to 90% of amputees experience them (Kaur and Guan, 2018; Subedi and Grossberg, 2011; Ramachandran and Hirstein, 1998; Sherman, Sherman, and Parker, 1984). Despite the vast amount of research and the many advances made in recent decades, neuroscience still does not offer a systematic understanding of the perception that the missing limb is still present and often causing pain. Shrouded by layers of mystery, this phenomenon continues to remain poorly understood and difficult to treat. Straayer links the phenomenon of phantom limbs to the experience of trans men. Straayer’s essay is inspiring, original, and thought-provoking. It begins by stating a paradox: On the one hand, the trans people quoted talk about “phantom penises”; on the other hand, they describe physical genital sensations as very intense and vivid. If they called their organs a “penis,” it was never associated with the word “phantom.” My first question would be to wonder why one would want to attribute a spectral value to penises whose main characteristic is aliveness and an enhancement of liveliness, as stated in the opening paragraph. The author goes on a limb (irony intended) when then delving at some length into the abundant medical literature on phantom limbs. Can we really say that a penis is a limb, a detachable part of the body (violently, of course, according to psychoanalytic castration phantasmagoria), which might have the same status, say, as a foot?