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Ata AM, Borman P, Bilir EE, Alemdaroğlu E, Tezen Ö, Söyler O, Yaşar E. The effect of medium-tension bandage and stump stocking on residual limb maturation in earthquake survivors. Prosthet Orthot Int 2024:00006479-990000000-00252. [PMID: 38775756 DOI: 10.1097/pxr.0000000000000356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 03/14/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Residual limb maturation is a crucial stage in postamputation care. OBJECTIVE It was aimed to examine the effect of medium tension bandages and stump stockings on postamputation stump maturation in patients who underwent lower extremity amputations. STUDY DESIGN In this prospective observational study, patients who were earthquake survivors and had undergone emergency amputation of their lower extremities were included. METHODS Medium-tension elastic bandage or personalized stump stockings were used for stump maturation. Residual limb volume was measured once a week for 3 weeks. RESULTS The study included 23 patients and 29 amputated limbs. Because of the larger stump volume of transfemoral amputations and the higher number of these patients in the stocking group ( p < 0.001), the stump volume differed across groups before and during the follow-up ( p < 0.001). There was no difference in mean volumetric measurement between the bandage and stocking groups over time ( p = 0.272). Although the group interaction was significant (p < 0.001), the group × time interaction was not ( p = 0.306). CONCLUSION Medium-tension bandages and stump stockings had a similar effect on postamputation stump maturation in patients with lower extremity amputations. So, depending on the patient's and physician's preferences, both procedures can be used for stump maturation.
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Affiliation(s)
- Ayşe Merve Ata
- Ankara Bilkent City Hospital, Physical Therapy and Rehabilitation Hospital, Ankara, Turkey
| | - Pınar Borman
- Ankara Bilkent City Hospital, Physical Therapy and Rehabilitation Hospital, Ankara, Turkey
| | - Emine Esra Bilir
- Ankara Bilkent City Hospital, Physical Therapy and Rehabilitation Hospital, Ankara, Turkey
| | - Ebru Alemdaroğlu
- Ankara Bilkent City Hospital, Physical Therapy and Rehabilitation Hospital, Ankara, Turkey
| | - Özge Tezen
- Ankara Bilkent City Hospital, Physical Therapy and Rehabilitation Hospital, Ankara, Turkey
| | - Osman Söyler
- European University of Lefke, Northern Cyprus, Mersin, Turkey
| | - Evren Yaşar
- Ankara Bilkent City Hospital, Physical Therapy and Rehabilitation Hospital, Ankara, Turkey
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Shan X, Li J, Zeng L, Wang H, Yang T, Shao Y, Yu M. Motor Imagery-Related Changes of Neural Oscillation in Unilateral Lower Limb Amputation. Front Neurosci 2022; 16:799995. [PMID: 35663556 PMCID: PMC9160601 DOI: 10.3389/fnins.2022.799995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 05/02/2022] [Indexed: 12/02/2022] Open
Abstract
An amputation is known to seriously affect patient quality of life. This study aimed to investigate changes in neural activity in amputees during the postoperative period using neural electrophysiological techniques. In total, 14 patients with left lower limb amputation and 18 healthy participants were included in our study. All participants were required to perform motor imagery paradigm tasks while electroencephalogram (EEG) data were recorded. Data analysis results indicated that the beta frequency band showed significantly decreased oscillatory activity in motor imaging-related brain regions such as the frontal lobe and the precentral and postcentral gyri in amputees. Furthermore, the functional independent component analysis (fICA) value of neural oscillation negatively correlated with the C4 electrode power value of the motor imagery task in amputees (p < 0.05). Therefore, changes in neural oscillations and beta frequency band in motor imagery regions may be related to brain remodeling in amputees.
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Affiliation(s)
- Xinying Shan
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing, China
| | - Jialu Li
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Lingjing Zeng
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Haiteng Wang
- School of Psychology, Beijing Sport University, Beijing, China
| | - Tianyi Yang
- School of Psychology, Beijing Sport University, Beijing, China
| | - Yongcong Shao
- School of Psychology, Beijing Sport University, Beijing, China
- *Correspondence: Yongcong Shao,
| | - Mengsun Yu
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- Mengsun Yu,
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Prophylactic Regenerative Peripheral Nerve Interfaces in Elective Lower Limb Amputations. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2022; 43:41-48. [PMID: 35451289 DOI: 10.2478/prilozi-2022-0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Regenerative peripheral nerve interface (RPNI) is a relatively new surgical technique to manage neuromas and phantom pain after limb amputation. This study evaluates prophylactic RPNI efficacy in managing post-amputation pain and neuroma formation in amputees compared with patients in which lower limb amputation was performed without this procedure. We included 28 patients who underwent above the knee amputation (AKA) or below the knee amputation (BKA) for severe soft tissue infection from July 2019 till December 2020. All patients had insulin-dependent diabetes. The patients were divided into two groups, 14 patients with primary RPNI and 14 patients without. We analyzed the demographic data, level of amputation, number of RPNIs, operative time, postoperative complications and functional outcome on the defined follow up period. The mean patient age was 68.6 years (range 49-85), 19 (67.9 %) male and 9 (32.1 %) female patients. In this study 11 (39.3 %) AKA and 17 (60.7 %) BKA were performed. Overall, 37 RPNIs were made. The mean follow-up period was 49 weeks. PROMIS T-score decreased by 15.9 points in favor for the patients with RPNI. The VAS score showed that, in the RPNI group, all 14 patients were without pain compared to the group of patients without RPNI, where the 11 (78.6 %) patients described their pain as severe. Patients with RPNI used prosthesis significantly more (p < 0.005). Data showed significant reduction in pain and high patient satisfaction after amputation with RPNIs. This technique is oriented as to prevent neuroma formation with RPNI surgery, performed at the time of amputation. RPNI surgery did not provoke complications or significant lengthening of operative time and it should be furthermore exploited as a surgical technique.
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List EB, Krijgh DD, Martin E, Coert JH. Prevalence of residual limb pain and symptomatic neuromas after lower extremity amputation: a systematic review and meta-analysis. Pain 2021; 162:1906-1913. [PMID: 33470746 DOI: 10.1097/j.pain.0000000000002202] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/11/2021] [Indexed: 01/11/2023]
Abstract
ABSTRACT Residual limb pain (RLP) is associated with (partial) extremity amputations and is defined as pain felt in the remaining part of the amputated limb. A common cause of RLP is neuroma formation after nerve transections. Neuromas can be very painful and severely debilitating pathologies, preventing prosthetic use, reducing quality of life, and requiring medication. Residual limb pain and symptomatic neuromas are often not properly recognized by physicians explaining the varying prevalence in the literature. This systematic review and meta-analysis aim to provide a comprehensive overview of published literature on the prevalence of RLP and symptomatic neuroma after lower extremity amputation. Studies reporting the prevalence of RLP and symptomatic neuroma pain in patients who have had a lower extremity amputation published between 2000 and 2020 were identified in PubMed and Embase. Random-effects meta-analyses of proportions were performed to quantify the prevalence of RLP and symptomatic neuroma. Subgroups were identified and analysed. For RLP, the pooled prevalence was 59% (95% CI: 51-67). For symptomatic neuromas, the pooled prevalence was 15% (95% CI: 7-28). Residual limb pain subgroup analysis showed statistically significant higher prevalence in patients aged >50 years, follow-up >2 years, and in studies using a self-administered questionnaire for data collection. The prevalence of RLP and symptomatic neuroma in patients who have had a lower extremity amputation is 59% and 15%, respectively. Knowledge of their high prevalence may result in better awareness among physicians, in turn providing timely and adequate management.
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Affiliation(s)
- Emile B List
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
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5
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Jiang S, Zheng K, Wang W, Pei Y, Qiu E, Zhu G. Phantom Limb Pain and Sensations in Chinese Malignant Tumor Amputees: A Retrospective Epidemiological Study. Neuropsychiatr Dis Treat 2021; 17:1579-1587. [PMID: 34045860 PMCID: PMC8149272 DOI: 10.2147/ndt.s299771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/06/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Phantom limb pain (PLP) was a common problem in malignant tumor amputees that can cause considerable suffering. The purposes of this study were to determine the incidence and factors associated with the occurrence of post-operation PLP, stump limb pain (SLP), and phantom limb sensations (PLS) in tumor amputees within the first month after surgery. Additionally, differences in phantom phenomena between upper and lower extremities were investigated. METHODS In total, 162 amputees participated in this retrospective study who underwent malignant limb amputation between 2012 and 2019. Clinical characteristics were collected from medical records and reconfirmed by telephone interviews. A numerical rating scale (NRS) was used to quantitate phantom phenomena. We used analysis of variance and non-parametric statistics for categorical variables and ordinal variables separately. RESULTS In the first month after malignant amputation, the incidence of PLP was 54.3%, that of PLS was 65.4%, and that of SLP was 32.7%. The duration of preoperative pain and amputation level was significantly different for the incidence of acute PLP. Further subgroup analysis of amputation level showed that patients whose amputation level was below the wrist and ankle joints had a significantly reduced incidence of PLP (p<0.0083 in Bonferroni test). Binary logistics regression analysis determined that amputation level was the primary risk factor for the incidence of PLP. Factors related to the severity of postoperative PLP also included amputation level, preoperative pain, and amputation times. By comparing the differences between upper and lower limbs after amputation, we found that the incidence of PLS was higher after lower limb amputation, but there was no significant difference in the incidence of PLP and SLP. Preoperative experience of chemotherapy was not a risk factor for PLP. CONCLUSION Proximal amputation and long-term preoperative pain seemed to count more for PLP incidence. Further research may be required to individually determine factors associated with the occurrence and chronicity of phantom phenomena.
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Affiliation(s)
- Shuang Jiang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, 110001, People's Republic of China.,Department of Pain Medicine (Psychology Clinic), Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, 110042, People's Republic of China
| | - Ke Zheng
- Department of Bone and Soft Tissue Tumor Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, 110042, People's Republic of China
| | - Wei Wang
- Department of Bone and Soft Tissue Tumor Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, 110042, People's Republic of China
| | - Yi Pei
- Department of Bone and Soft Tissue Tumor Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, 110042, People's Republic of China
| | - Enduo Qiu
- Department of Bone and Soft Tissue Tumor Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, 110042, People's Republic of China
| | - Gang Zhu
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, 110001, People's Republic of China.,Central Laboratory, The First Affiliated Hospital of China Medical University, Shenyang, 110001, People's Republic of China
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Limakatso K, Bedwell GJ, Madden VJ, Parker R. The prevalence and risk factors for phantom limb pain in people with amputations: A systematic review and meta-analysis. PLoS One 2020; 15:e0240431. [PMID: 33052924 PMCID: PMC7556495 DOI: 10.1371/journal.pone.0240431] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 09/23/2020] [Indexed: 12/31/2022] Open
Abstract
Background Phantom limb pain (PLP)—pain felt in the amputated limb–is often accompanied by significant suffering. Estimates of the burden of PLP have provided conflicting data. To obtain a robust estimate of the burden of PLP, we gathered and critically appraised the literature on the prevalence and risk factors associated with PLP in people with limb amputations. Methods Articles published between 1980 and July 2019 were identified through a systematic search of the following electronic databases: MEDLINE/PubMed, PsycINFO, PsycArticles, Cumulative Index to Nursing and Allied Health Literature, Africa-Wide Information, Health Source: Nursing/Academic Edition, SCOPUS, Web of Science and Academic Search Premier. Grey literature was searched on databases for preprints. Two reviewers independently conducted the screening of articles, data extraction and risk of bias assessment. The meta-analyses were conducted using the random effects model. A statistically significant level for the analyses was set at p<0.05. Results The pooling of all studies demonstrated a prevalence estimate of 64% [95% CI: 60.01–68.05] with high heterogeneity [I2 = 95.95% (95% CI: 95.10–96.60)]. The prevalence of PLP was significantly lower in developing countries compared to developed countries [53.98% vs 66.55%; p = 0.03]. Persistent pre-operative pain, proximal site of amputation, stump pain, lower limb amputation and phantom sensations were identified as risk factors for PLP. Conclusion This systematic review and meta-analysis estimates that six of every 10 people with an amputation report PLP–a high and important prevalence of PLP. Healthcare professionals ought to be aware of the high rates of PLP and implement strategies to reduce PLP by addressing known risk factors, specifically those identified by the current study.
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Affiliation(s)
- Katleho Limakatso
- Department of Anaesthesia and Perioperative Medicine, Pain Management Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Gillian J. Bedwell
- Department of Anaesthesia and Perioperative Medicine, Pain Management Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
| | - Victoria J. Madden
- Department of Anaesthesia and Perioperative Medicine, Pain Management Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Romy Parker
- Department of Anaesthesia and Perioperative Medicine, Pain Management Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
- * E-mail:
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Oosterhoff M, Geertzen JHB, Dijkstra PU. More than half of persons with lower limb amputation suffer from chronic back pain or residual limb pain: a systematic review with meta-analysis. Disabil Rehabil 2020; 44:835-855. [PMID: 32603198 DOI: 10.1080/09638288.2020.1783377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: The aim of this study is to systematically review and critically assess the methodological quality of literature regarding prevalence, characteristics and factors influencing pain, other than phantom limb pain (PLP) in persons with lower limb amputation (LLA).Materials and methods: A systematic review was performed (PROSPERO CRD42019138018). Literature was searched using PubMed, EMBASE, PsycINFO, and PEDro. Studies were included if describing pain other than PLP at least three months after amputation. For residual limb pain (RLP) and back pain, a meta-regression was performed.Results: Fifty-one studies were included in which predominantly young males with a unilateral traumatic amputation using a prosthesis were investigated. Pooled prevalence of RLP was 0.51 (95% CI 0.40-0.62) with a positive association with presence of back pain (p = 0.044) in the univariate meta-regression. Pooled prevalence of back pain was 0.55 (95% CI 0.45-0.64), with a positive association of time since amputation (p < 0.001) and co-occurrence of RLP (p = 0.050).Conclusions: Back pain and RLP are common after LLA. The prevalence of back pain was positively associated with the presence of RLP, and vice versa. Future studies should give more attention to other chronic pain types, to persons with a diabetic or vascular cause of amputation, and to pain-related interference.Implications for RehabilitationBoth back pain and residual limb pain occur in more than 50% of persons with lower limb amputation (LLA), and both pain types are positively associated.Clinicians should be aware that chronic pain is common after LLA and can have a significant impact on the functioning of persons with LLA.Future research on this topic should give more attention to other chronic pain types, to persons with a diabetic or vascular cause of amputation, and to pain-related interference.
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Affiliation(s)
- Matthijs Oosterhoff
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan H B Geertzen
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Pieter U Dijkstra
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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8
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Knezevic NN, Aijaz T, Candido KD, Kovaleva S, Lissounov A, Knezevic I. The Effect of Once-Daily Gabapentin Extended Release Formulation in Patients With Postamputation Pain. Front Pharmacol 2019; 10:504. [PMID: 31156433 PMCID: PMC6529536 DOI: 10.3389/fphar.2019.00504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 04/23/2019] [Indexed: 12/31/2022] Open
Abstract
Objectives To compare gabapentin extended-release, a gastro-retentive formulation, in relieving postamputation pain among gabapentin-experienced and gabapentin-naïve patients. Design Open-labeled pilot study. Subjects Sixteen patients with postamputation pain (8 patients in the gabapentin-experienced and 8 patients in the gabapentin-naïve groups). Methods Patients were started on gabapentin extended-release and were followed up for 8 weeks. Patients reported their pain severity during rest and movement using a numeric rating scale (NRS), interference of pain with daily activities using the modified brief pain inventory (MBPI) questionnaire, and treatment satisfaction using the treatment satisfaction questionnaire for medication (TSQM). Results Patients from both gabapentin-experienced and gabapentin-naïve groups achieved a significant and sustainable pain relief over the course of therapy. The pain scores at rest decreased in both gabapentin-experienced and gabapentin-naïve groups from 5.88 ± 1.36 and 4.88 ± 2.95 to 1.88 ± 0.99 and 1.38 ± 1.51, respectively. An average percent of pain relief with gabapentin extended-release was noted to be significant (p < 0.01) after 8 weeks of therapy among gabapentin-experienced (81.25 ± 16.42%) and gabapentin-naïve groups (85 ± 17.73%) when compared to baseline for gabapentin-experienced (31.25 ± 29%) and gabapentin-naïve groups (36.25 ± 34.2%), respectively. Gabapentin-experienced and gabapentin-naïve groups had no significant difference in global satisfaction from treatment (79.14 ± 10.47 and 83.3 ± 20.82), convenience of treatment (73.78 ± 19.04 and 90.44 ± 11.66), effectiveness of treatment (72.6 ± 10.1 and 79.73 ± 11.6). The only statistically significant difference among gabapentin-experienced and gabapentin-naïve groups was found in adverse event tolerability (65.78 ± 10.36 and 85.8 ± 10.14, p < 0.01). Conclusion Once-daily dosing of gabapentin-extended release showed significant improvement in pain severity and functional status, with no difference found between gabapentin-experienced versus gabapentin-naïve patients.
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Affiliation(s)
- Nebojsa Nick Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, United States.,Department of Anesthesiology, The University of Illinois at Chicago, Chicago, IL, United States.,Department of Surgery, The University of Illinois at Chicago, Chicago, IL, United States
| | - Tabish Aijaz
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, United States
| | - Kenneth D Candido
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, United States.,Department of Anesthesiology, The University of Illinois at Chicago, Chicago, IL, United States.,Department of Surgery, The University of Illinois at Chicago, Chicago, IL, United States
| | - Svetlana Kovaleva
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, United States
| | - Alexei Lissounov
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, United States
| | - Ivana Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, United States
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Corbett M, South E, Harden M, Eldabe S, Pereira E, Sedki I, Hall N, Woolacott N. Brain and spinal stimulation therapies for phantom limb pain: a systematic review. Health Technol Assess 2019; 22:1-94. [PMID: 30407905 DOI: 10.3310/hta22620] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although many treatments exist for phantom limb pain (PLP), the evidence supporting them is limited and there are no guidelines for PLP management. Brain and spinal cord neurostimulation therapies are targeted at patients with chronic PLP but have yet to be systematically reviewed. OBJECTIVE To determine which types of brain and spinal stimulation therapy appear to be the best for treating chronic PLP. DESIGN Systematic reviews of effectiveness and epidemiology studies, and a survey of NHS practice. POPULATION All patients with PLP. INTERVENTIONS Invasive interventions - deep brain stimulation (DBS), motor cortex stimulation (MCS), spinal cord stimulation (SCS) and dorsal root ganglion (DRG) stimulation. Non-invasive interventions - repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS). MAIN OUTCOME MEASURES Phantom limb pain and quality of life. DATA SOURCES Twelve databases (including MEDLINE and EMBASE) and clinical trial registries were searched in May 2017, with no date limits applied. REVIEW METHODS Two reviewers screened titles and abstracts and full texts. Data extraction and quality assessments were undertaken by one reviewer and checked by another. A questionnaire was distributed to clinicians via established e-mail lists of two relevant clinical societies. All results were presented narratively with accompanying tables. RESULTS Seven randomised controlled trials (RCTs), 30 non-comparative group studies, 18 case reports and 21 epidemiology studies were included. Results from a good-quality RCT suggested short-term benefits of rTMS in reducing PLP, but not in reducing anxiety or depression. Small randomised trials of tDCS suggested the possibility of modest, short-term reductions in PLP. No RCTs of invasive therapies were identified. Results from small, non-comparative group studies suggested that, although many patients benefited from short-term pain reduction, far fewer maintained their benefits. Most studies had important methodological or reporting limitations and few studies reported quality-of-life data. The evidence on prognostic factors for the development of chronic PLP from the longitudinal studies also had important limitations. The results from these studies suggested that pre-amputation pain and early PLP intensity are good predictors of chronic PLP. Results from the cross-sectional studies suggested that the proportion of patients with severe chronic PLP is between around 30% and 40% of the chronic PLP population, and that around one-quarter of chronic PLP patients find their PLP to be either moderately or severely limiting or bothersome. There were 37 responses to the questionnaire distributed to clinicians. SCS and DRG stimulation are frequently used in the NHS but the prevalence of use of DBS and MCS was low. Most responders considered SCS and DRG stimulation to be at least sometimes effective. Neurosurgeons had mixed views on DBS, but most considered MCS to rarely be effective. Most clinicians thought that a randomised trial design could be successfully used to study neurostimulation therapies. LIMITATION There was a lack of robust research studies. CONCLUSIONS Currently available studies of the efficacy, effectiveness and safety of neurostimulation treatments do not provide robust, reliable results. Therefore, it is uncertain which treatments are best for chronic PLP. FUTURE WORK Randomised crossover trials, randomised N-of-1 trials and prospective registry trials are viable study designs for future research. STUDY REGISTRATION The study is registered as PROSPERO CRD42017065387. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Mark Corbett
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
| | - Emily South
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
| | - Melissa Harden
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
| | - Sam Eldabe
- James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesborough, UK
| | - Erlick Pereira
- Academic Neurosurgery Unit, St George's, University of London, London, UK
| | - Imad Sedki
- Royal National Orthopaedic Hospital, Stanmore, UK
| | - Neil Hall
- James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesborough, UK
| | - Nerys Woolacott
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
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Noninvasive neuromodulation techniques for the management of phantom limb pain: a systematic review of randomized controlled trials. Int J Rehabil Res 2018; 42:1-10. [PMID: 30222617 DOI: 10.1097/mrr.0000000000000317] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Neuromodulation techniques work by modulating pain perception by inducing changes in polarity of the neuronal membrane and thereby cortical excitability. The aim of this review is to evaluate the efficiency and safety of noninvasive neuromodulation techniques for phantom limb pain (PLP). A systematic literature search in the PubMed, Scopus, Web of Science, and Cochrane Library databases was performed to identify studies investigating the effects of noninvasive neuromodulation for PLP. The included journal articles were assessed with Furlan et al.'s method for examining the risk of bias to assess methodologic quality, and evidence was graded using the GRADE approach. The literature search identified 239 studies. Of these 239, four studies fulfilled the inclusion criteria and were included for data extraction. Two of the studies focused on repetitive transcranial magnetic stimulation (rTMS) whereas two other concentrated on transcranial direct current stimulation (tDCS). The present review showed that there is conflicting evidence to support the use of tDCS in short term and moderate evidence to support the use of rTMS in immediate and short term. It is important to recognize that this evidence comes from a very small sample size. No serious adverse effects were reported. Further information from randomized controlled trials with larger sample size investigating immediate and short-term and long-term effects are needed to clarify the best effective stimulation parameters and number of sessions of tDCS and rTMS for PLP.
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