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Rich T, Phelan H, Gravely A, Falbo K, Krebs E, Finn J, Matsumoto M, Muschler K, Kiecker J, Hansen A. Examining patient reported outcome measures for phantom limb pain: measurement use in a sample of Veterans with amputation. Disabil Rehabil 2024:1-9. [PMID: 38813752 DOI: 10.1080/09638288.2024.2356017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 05/12/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE Phantom limb pain (PLP) is treated with medications and non-drug treatments. Best clinical practices for measuring treatment outcomes have not been defined. The objective of this study was to evaluate the internal consistency of patient-reported outcomes measures (PROMs) in a sample of Veterans with lower limb amputation. MATERIALS AND METHODS The Veteran phone survey included administering PROMs [1) PLP numeric rating scale (NRS), 2) general pain NRS, 3) Pain, Enjoyment, and General Activity (PEG) scale, 4) Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference Short Form 6b Replacement, 5) PROMIS Short Form Depression 4a and 6) PROMIS Short Form Anxiety 4a]. RESULTS Fifty Veterans (48 male, 2 female; average age: 66 years) completed PROMs. In our sample, 40 Veterans (80%) experienced PLP with an average PLP NRS of 5 (±3.4). Internal consistency of each measure was good to excellent based on Cronbach's alpha co-efficient of >0.80. Correlations were moderate between PLP NRS and all other measures (≤0.32). Although many Veterans expressed bothersome PLP, the scores reflecting pain interference and impact on function were lower than pain intensity. Consistent use of outcome measures is needed to determine the effect of interventions for amputation-related pain.
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Affiliation(s)
- Tonya Rich
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- Department of Family Medicine and Community Health, University of MN, Minneapolis, MN, USA
| | - Hannah Phelan
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- Medical College of WI, Milwaukee, WI, USA
| | - Amy Gravely
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
| | - Kierra Falbo
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- Department of Family Medicine and Community Health, University of MN, Minneapolis, MN, USA
| | - Erin Krebs
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Jacob Finn
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MNUSA
| | - Mary Matsumoto
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | | | - Jessica Kiecker
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
| | - Andrew Hansen
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- Department of Family Medicine and Community Health, University of MN, Minneapolis, MN, USA
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
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Zernitz M, Rizzello C, Rigoni M, Van de Winckel A. Case Report: Phantom limb pain relief after cognitive multisensory rehabilitation. FRONTIERS IN PAIN RESEARCH 2024; 5:1374141. [PMID: 38726352 PMCID: PMC11079144 DOI: 10.3389/fpain.2024.1374141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 04/15/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction Relieving phantom limb pain (PLP) after amputation in patients resistant to conventional therapy remains a challenge. While the causes for PLP are unclear, one model suggests that maladaptive plasticity related to cortical remapping following amputation leads to altered mental body representations (MBR) and contributes to PLP. Cognitive Multisensory Rehabilitation (CMR) has led to reduced pain in other neurologic conditions by restoring MBR. This is the first study using CMR to relieve PLP. Methods A 26-year-old woman experienced excruciating PLP after amputation of the third proximal part of the leg, performed after several unsuccessful treatments (i.e., epidural stimulator, surgeries, analgesics) for debilitating neuropathic pain in the left foot for six years with foot deformities resulting from herniated discs. The PLP was resistant to pain medication and mirror therapy. PLP rendered donning a prosthesis impossible. The patient received 35 CMR sessions (2×/day during weekdays, October-December 2012). CMR provides multisensory discrimination exercises on the healthy side and multisensory motor imagery exercises of present and past actions in both limbs to restore MBR and reduce PLP. Results After CMR, PLP reduced from 6.5-9.5/10 to 0/10 for neuropathic pain with only 4-5.5/10 for muscular pain after exercising on the Numeric Pain Rating Scale. McGill Pain Questionnaire scores reduced from 39/78 to 5/78, and Identity (ID)-Pain scores reduced from 5/5 to 0/5. Her pain medication was reduced by at least 50% after discharge. At 10-month follow-up (9/2013), she no longer took Methadone or Fentanyl. After discharge, receiving CMR as outpatient, she learned to walk with a prosthesis, and gradually did not need crutches anymore to walk independently indoors and outdoors (9/2013). At present (3/2024), she no longer takes pain medication and walks independently with the prosthesis without assistive devices. PLP is under control. She addresses flare-ups with CMR exercises on her own, using multisensory motor imagery, bringing the pain down within 10-15 min. Conclusion The case study seems to support the hypothesis that CMR restores MBR which may lead to long-term (12-year) PLP reduction. MBR restoration may be linked to restoring accurate multisensory motor imagery of the remaining and amputated limb regarding present and past actions.
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Affiliation(s)
- Marina Zernitz
- Centro Studi di Riabilitazione Neurocognitiva, Villa Miari, Vicenza, Italy
| | - Carla Rizzello
- Centro Studi di Riabilitazione Neurocognitiva, Villa Miari, Vicenza, Italy
| | - Marco Rigoni
- Centro Studi di Riabilitazione Neurocognitiva, Villa Miari, Vicenza, Italy
| | - Ann Van de Winckel
- Division of Physical Therapy and Rehabilitation Science, Department of Family Medicine and Community Health, Medical School, University of Minnesota Twin Cities, Minneapolis, MN, United States
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Limakatso K, Tucker J, Banda L, Robertson C, Parker R. The profile of people undergoing lower limb amputations at Groote Schuur Hospital. Afr J Disabil 2024; 13:1152. [PMID: 38445074 PMCID: PMC10912944 DOI: 10.4102/ajod.v13i0.1152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 10/23/2023] [Indexed: 03/07/2024] Open
Abstract
Background The annual incidence of lower limb amputations (LLA) at Groote Schuur Hospital is rising gradually. However, little is known about the sociodemographic and clinical profiles of people undergoing these limb amputations. Objectives To collect and analyse data to describe the sociodemographic, health and amputation profiles of people who have undergone LLA at Groote Schuur Hospital. Method A descriptive retrospective chart review was conducted using a sample of 107 participants who had undergone LLA at Groote Schuur Hospital between January 2019 and July 2020. A customised assessment tool was used to extract data on the sociodemographic, health and amputation profiles of patients who had LLA. Data were analysed descriptively. Results Sixty per cent of the patients who had undergone LLA at Groote Schuur Hospital were women. Most of the patients were over the age of 60 years and had not completed school and were pensioners or unemployed, with very low income and multiple co-morbidities including poorly controlled diabetes. Conclusions Complications because of uncontrolled diabetes were the primary indication for LLAs at Groote Schuur Hospital. Therefore, health literacy projects are indicated to address chronic diseases of lifestyle, which, in turn, may reduce the overall burden of LLA, particularly on the South African under-resourced healthcare system. Contribution The results of this study may help us identify key factors that predispose patients to LLAs. Consequently, this may help us identify key areas for prevention and better management of diseases that can result in complications that indicate the need for amputation.
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Affiliation(s)
- Katleho Limakatso
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jenna Tucker
- Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Lennie Banda
- Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Cheyne Robertson
- Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Romy Parker
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Huo X, Huang P, Di H, Ma T, Jiang S, Yao J, Huang L. Risk Factors Analysis of Phantom Limb Pain in Amputees with Malignant Tumors. J Pain Res 2023; 16:3979-3992. [PMID: 38026454 PMCID: PMC10676115 DOI: 10.2147/jpr.s433996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 11/14/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Postamputation neuropathic pain is a common disease in patients with malignant tumor amputation, seriously affecting amputees' quality of life and mental health. The objective of this study was to identify independent risk factors for phantom limb pain in patients with tumor amputation and to construct a risk prediction model. Methods Patients who underwent amputation due to malignant tumors from 2013 to 2023 were retrospectively analyzed and divided into phantom limb pain group and non-phantom limb pain group. To determine which preoperative factors would affect the occurrence of phantom limb pain, we searched for candidate factors by univariate analysis and used multivariate logistic regression analysis to identify independent factors and construct a predictive model. The receiver operating characteristic curve (ROC) was drawn to further evaluate the accuracy of the prediction model in evaluating the phantom limb pain after amputation of bone and soft tissue tumors. Results Multivariate analysis showed that age (OR, 1.054; 95% CI, 1.027 to 1.080), preoperative pain (OR, 5.773; 95% CI, 2.362 to 14.104), number of surgeries (OR, 3.425; 95% CI, 1.505 to 7.795), amputation site (OR, 5.848; 95% CI, 1.837 to 18.620), amputation level (OR, 8.031; 95% CI, 2.491 to 25.888) were independent risk factors for phantom limb pain for bone and soft tissue tumors. The the area under the curve (AUC) of this model was 0.834. Conclusion Risk factors for postoperative phantom limb pain were the site of amputation, proximal amputation, preoperative pain, multiple amputations, and older age. These factors will help surgeons to individualize and stratify phantom limb pain and help patients with risk counseling. In particular, an informed clinical decision targeting those modifiable factors can be considered when needed.
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Affiliation(s)
- Xiulin Huo
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
| | - Peiying Huang
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
| | - Hexuan Di
- Department of Orthopaedic Surgery, The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
| | - Tianxiao Ma
- Department of Orthopaedic Surgery, The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
| | - Sufang Jiang
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
| | - Jie Yao
- Department of Anesthesiology, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, People’s Republic of China
| | - Lining Huang
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
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Zwierzchowska A, Gawel E, Karpinski J, Maszczyk A, Zebrowska A. The effect of swimming on the body posture, range of motion and musculoskeletal pain in elite para and able-bodied swimmers. BMC Sports Sci Med Rehabil 2023; 15:122. [PMID: 37749633 PMCID: PMC10521398 DOI: 10.1186/s13102-023-00734-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 09/14/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Elite swimmers may be predisposed to disturbances in the range of motion (ROM) of hip joints and spinal curvatures, which are a factor that induces body's compensatory mechanisms that may have an impact on sports training, athletic performance and health. This study aimed to identify compensatory mechanisms in body posture of elite Para and able-bodied swimmers (spinal curvatures, ROM), to indicate the dominant locations of the compensatory mechanisms in the groups of Para and able-bodied athletes, and to identify and compare the prevalence and location of musculoskeletal pain from the last week and the last six months in the context of compensatory mechanisms. METHODS Thirty-five (nF = 8; nM = 27; age = 20.51 ± 4.24) elite Para and able-bodied swimmers from the Polish national team took part in the study and were divided into: study group (SG) of Para swimmers and control group (CG) of able-bodied swimmers. Depth of the anteroposterior spinal curvatures and sagittal spinal mobility testing were evaluated with a Medi Mouse device. The prevalence and locations of musculoskeletal pain were assessed with a Nordic Musculoskeletal Questionnaire for the last seven days (NMQ-7) and the last six months (NMQ-6). RESULTS In both groups lumbar hypolordosis, anterior pelvic tilt and pain in the shoulders, lower back and hips/thighs (NMQ-7) were reported the most frequent. In SG several significant relationships were found between duration of sport-specific training experience (years) and depth of angle the lumbar lordosis, the depth of the angle of pelvic inclination the ROM in the lumbar spine and thoracic spine, what was not reported in CG. CONCLUSIONS Extrinsic compensatory mechanism was identified in both study groups, however only in SG it occurred as structural (depth of the angle of lumbar lordosis and pelvic inclination) and functional changes (ROM in the thoracic and lumbar spine) in the body posture. Internal compensatory mechanism was identified in SG, however external compensation showed only partially suppressive character regarding to internal compensation. The locations of the musculoskeletal complaints seems to result from both internal compensatory mechanism (SG) and continuous overload of the anatomy trains as a result of swimming training (SG, CG).
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Affiliation(s)
- Anna Zwierzchowska
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, Mikołowska 72A, Katowice, 40-065, Poland
| | - Eliza Gawel
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, Mikołowska 72A, Katowice, 40-065, Poland.
| | - Jakub Karpinski
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, Mikołowska 72A, Katowice, 40-065, Poland
| | - Adam Maszczyk
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, Mikołowska 72A, Katowice, 40-065, Poland
| | - Aleksandra Zebrowska
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, Mikołowska 72A, Katowice, 40-065, Poland
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Pilch M, van Rietschoten T, Ortiz-Catalan M, Lendaro E, van der Sluis CK, Hermansson L. Interplay Between Innovation and Intersubjectivity: Therapists Perceptions of Phantom Motor Execution Therapy and Its Effect on Phantom Limb Pain. J Pain Res 2023; 16:2747-2761. [PMID: 37577161 PMCID: PMC10422994 DOI: 10.2147/jpr.s412895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
Purpose Interpersonal processes, including therapeutic alliance, may modulate the impact of interventions on pain experience. However, the role of interpersonal context on the effects of technology-enhanced interventions remains underexplored. This study elicited therapists' perspectives on how a novel rehabilitative process, involving Phantom Motor Execution (PME), may impact phantom limb pain. The mediating role of therapeutic alliance, and the way PME influenced its formation, was investigated. Methods A qualitative descriptive design, using a framework method, was used to explore therapists' (n=11) experiences of delivering PME treatment. Semi-structured online-based interviews were conducted. Results A 3-way interaction between therapist, patient, and the PME device was an overarching construct tying four themes together. It formed the context for change in phantom limb experience. The perceived therapeutic effects (theme 1) extended beyond those initially hypothesised and highlighted the mediating role of the key actors and context (theme 2). The therapeutic relationship was perceived as a transformative journey (theme 3), creating an opportunity for communication, collaboration, and bonding. It was seen as a cause and a consequence of therapeutic effects. Future directions, including the role of expertise-informed adaptations and enabling aspects of customised solutions, were indicated (theme 4). Conclusion This study pointed to intrapersonal, interpersonal, and contextual factors that should be considered in clinical implementation of novel rehabilitative tools. The results demonstrated that therapists have unique insights and a crucial role in facilitating PME treatment. The study highlighted the need to consider the biopsychosocial model of pain in designing, evaluating, and implementing technology-supported interventions.
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Affiliation(s)
- Monika Pilch
- Centre for Health Policy & Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Tijn van Rietschoten
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
- University of Groningen, Faculty of Medical Sciences, Groningen, the Netherlands
| | - Max Ortiz-Catalan
- Center for Bionics and Pain Research, Mölndal, Sweden
- Bionics Institute, Melbourne, VC, Australia
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Eva Lendaro
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
- Department of Brain and Cognitive Sciences, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Corry K van der Sluis
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
| | - Liselotte Hermansson
- Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Deng C, Li Q. Case report: A combination of mirror therapy and magnetic stimulation to the sacral plexus relieved phantom limb pain in a patient. Front Neurosci 2023; 17:1187486. [PMID: 37304023 PMCID: PMC10251437 DOI: 10.3389/fnins.2023.1187486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/03/2023] [Indexed: 06/13/2023] Open
Abstract
Phantom limb pain (PLP) is a common sequela of amputation, experienced by 50-80% of amputees. Oral analgesics as the first-line therapy have limited effects. Since PLP usually affects activities of daily living and the psychological conditions of patients, effective treatments are imperatively needed. In this case study, a 49-year-old man was admitted to our hospital because of uncontrollable paroxysmal pain in his missing and residual leg. Due to severe injuries in a truck accident, the right lower limb of the patient was surgically amputated ~5 years ago. Around 1 month after amputation, he felt pain in his lost leg and PLP was diagnosed. Then, he started taking oral analgesics, but the pain still occurred. After admission on July 9, 2022, the patient received treatments of mirror therapy and magnetic stimulation to the sacral plexus. 1-month treatments reduced the frequency and intensity of pain in the phantom limb and the stump, without any adverse events. Analysis of high-resolution three-dimensional T1-weighted brain volume images at the end of 2-month treatments showed alterations in the thickness of cortex regions related to pain processing, compared to that before treatment. This case study gives us hints that one or both interventions of mirror therapy and sacral plexus magnetic stimulation effectively relieved PLP and stump limb pain. These non-invasive, low-cost and easily conducted treatments could be good options for PLP. But randomized controlled trials with a large number of cases are required to confirm their efficacy and safety.
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Limakatso K, Cashin AG, Williams S, Devonshire J, Parker R, McAuley JH. The Efficacy of Graded Motor Imagery and Its Components on Phantom Limb Pain and Disability: A Systematic Review and Meta-Analysis. Can J Pain 2023; 7:2188899. [PMID: 37214633 PMCID: PMC10193907 DOI: 10.1080/24740527.2023.2188899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/28/2023] [Accepted: 03/06/2023] [Indexed: 03/17/2023]
Abstract
Introduction Graded Motor Imagery (GMI) is a non-invasive and inexpensive therapy used to treat Phantom Limb Pain (PLP) by sequentially activating motor networks in such a way that movement and pain are unpaired. The objective of this systematic review was to critically appraise relevant data on the efficacy of GMI and its components for reducing PLP and disability in amputees. Methods We searched 11 electronic databases for controlled trials investigating GMI and its components in amputees with PLP from inception until February 2023. Two reviewers independently screened studies and extracted relevant data. Study-level data were entered using the inverse variance function of the Review Manager 5 and pooled with the random effects model. Results Eleven studies with varying risk of bias were eligible. No eligible study considered left/right judgement tasks in isolation. Studies showed no effect for imagined movements, but positive effects were seen for GMI [weighted mean difference: -21.29 (95%CI: -31.55, -11.02), I2= 0%] and mirror therapy [weighted mean difference: -8.55 (95%CI: -14.74, -2.35, I2= 61%]. A comparison of mirror therapy versus sham showed no difference [weighted mean difference: -4.43 (95%CI: -16.03, 7.16), I2= 51%]. Conclusion Our findings suggest that GMI and mirror therapy may be effective for reducing PLP. However, this conclusion was drawn from a limited body of evidence, and the certainty of the evidence was very low. Therefore, rigorous, high-quality trials are needed to address the gap in the literature and inform practice.
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Affiliation(s)
- Katleho Limakatso
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Sydney, Australia
| | - Aidan G. Cashin
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Sydney, Australia
| | - Sam Williams
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Sydney, Australia
| | - Jack Devonshire
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Sydney, Australia
| | - Romy Parker
- Pain Management Unit, Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - James H. McAuley
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Sydney, Australia
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Gunterstockman BM, Knight AD, Mahon CE, Childers WL, Cagle T, Hendershot BD, Farrokhi S. Relationship between phantom limb pain, function, and psychosocial health in individuals with lower-limb loss. Prosthet Orthot Int 2023; 47:181-188. [PMID: 36637908 DOI: 10.1097/pxr.0000000000000191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 08/17/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION The adverse influence of chronic pain on function and psychological health in the general population is well understood. However, the relationship between phantom limb pain (PLP) after limb loss with function and psychological health is less clear. The study purpose was to assess the influences of PLP presence and intensity on function and psychosocial health in individuals with lower-limb loss (LLL). METHODS One hundred two individuals with major LLL completed a study-specific questionnaire on the presence and intensity of their PLP. The Patient-Reported Outcomes Measurement Information System -29 questionnaire was also administered. RESULTS Of 102 participants, 64% reported PLP, with a mean intensity of 4.8 ± 2.3 out of 10. Individuals with vs. without PLP demonstrated significantly greater sleep disturbances ( p = 0.03), whereas the differences in function, fatigue, pain interference, depressive symptoms, anxiety, or ability to participate in social roles and activities were not statistically different between groups ( p > 0.05). Of note, mean scores for many of the Patient-Reported Outcomes Measurement Information System-29 short forms among the current sample were similar to the mean of the general population, minimizing the potential clinical impact of PLP on these domains. CONCLUSIONS Our findings indicate a lack of meaningful associations between PLP presence or intensity with function, and psychosocial health among individuals with LLL. These findings conflict with previous research suggesting an adverse relationship between PLP, function, and psychosocial health after limb loss.
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Affiliation(s)
- Brittney M Gunterstockman
- Doctor of Physical Therapy Program, Lincoln Memorial University, Knoxville, TN, USA
- Currently with Lincoln Memorial University, Harrogate, TN, USA
- Research & Surveillance Division, DoD-VA Extremity Trauma and Amputation Center of Excellence, San Diego, CA, USA
- Department of Physical & Occupational Therapy, Naval Medical Center San Diego, San Diego, CA, USA
| | - Ashley D Knight
- Research & Surveillance Division, DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, MD, USA
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Caitlin E Mahon
- Research & Surveillance Division, DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, MD, USA
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - W Lee Childers
- Research & Surveillance Division, DoD-VA Extremity Trauma and Amputation Center of Excellence, San Antonio, TX, USA
- Department of Rehabilitation Medicine, Center for the Intrepid, Brooke Army Medical Center, San Antonio, TX, USA
| | - Tyler Cagle
- Department of Rehabilitation Medicine, Center for the Intrepid, Brooke Army Medical Center, San Antonio, TX, USA
| | - Brad D Hendershot
- Research & Surveillance Division, DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, MD, USA
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Rehabilitation Medicine, Uniformed Services University, Bethesda, MD, USA
| | - Shawn Farrokhi
- Research & Surveillance Division, DoD-VA Extremity Trauma and Amputation Center of Excellence, San Diego, CA, USA
- Department of Physical & Occupational Therapy, Naval Medical Center San Diego, San Diego, CA, USA
- Department of Rehabilitation Medicine, Uniformed Services University, Bethesda, MD, USA
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Arizona P, Yulianti E, Fithriyah I. Psychiatric Approach in Phantom Erection Postpenectomy Patient. Case Rep Psychiatry 2023; 2023:4113455. [PMID: 37032998 PMCID: PMC10081895 DOI: 10.1155/2023/4113455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/17/2023] [Accepted: 03/17/2023] [Indexed: 04/03/2023] Open
Abstract
Introduction. Phantom limb pain is a pain sensation experienced in the area of the missing body part. The pain generally appears in the first few days after surgery. PLP could occur in teeth, tongue, breast, eyes, rectum, bladder, testicles, and penis. Phantom pain in the penis is not only felt as pain but sometimes as an erection or urination, even after the removal of the penis. Clinical Case. A 35-year-old man was referred to the psychiatrist due to phantom erection after undergoing reimplantation of the penis by the urologist. A few days before the referral, he was admitted to the emergency department after a penile amputation that his wife performed. During the recovery phase after the penile reimplantation procedure, the patient worried about his penis’ outcome and became depressed. The patient was in severe anxiety and moderate-to-severe depression status. Treatment. The patient was given nonpsychopharmacology such as supportive psychotherapy, family psychoeducation, relaxation and marital therapy, and psychopharmacology, such as amitriptyline 12.5 Mg PO two times a day and clobazam 10 Mg PO each day for 3 months. One and a half months later, his anxiety and depression were better. Conclusion. A psychiatric approach was needed in an amputated limb patient with psychopathologic symptoms. Nonpsychopharmacotherapy and psychopharmacotherapy were needed if the patient had symptoms. Further studies with a large number will be necessary to validate the psychiatric approach in amputated limb patients with psychopathologic symptoms cases.
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Affiliation(s)
- Popy Arizona
- Department of Psychiatry, Dr. Soetomo General Academic Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Erikavitri Yulianti
- Department of Psychiatry, Dr. Soetomo General Academic Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Izzatul Fithriyah
- Department of Psychiatry, Dr. Soetomo General Academic Hospital, Universitas Airlangga, Surabaya, Indonesia
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Valero EG, Acosta Acosta CDP, Vargas Useche W, Orozco Sandoval L, Seija-Butnaru D, Sánchez-Flórez JC, Linares Escobar R, Amaya S. Perioperative Management of Painful Phantom Limb Syndrome: A Narrative Review and Clinical Management Proposal. J Pain Palliat Care Pharmacother 2023:1-15. [PMID: 36929710 DOI: 10.1080/15360288.2023.2187005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Objective: Painful Phantom Limb Syndrome (PPLS) occurs in 50 to 80% of patients undergoing amputation, having a great impact on quality of life, productivity and psychosocial sphere. The objective of this review is to summarize the pharmacological and non-pharmacological strategies, surgical optimization, and provide a multidisciplinary approach aimed at reducing the incidence of chronic pain associated with PPLS in patients undergoing limb amputation.Methods: A narrative review was carried out using Medline, Pubmed, Proquest, LILACS and Cochrane, searching for articles between 2000 and 2021. Articles describing the epidemiology, pathophysiological considerations, and current treatments were selected after a screening process.Results: A multidisciplinary and multimodal approach is required in PPLS, and should include the use of regional techniques, and adjuvants such as NSAIDs, ketamine, lidocaine and gabapentinoids. In addition, an evaluation and continuous management of risk factors for chronic pain in conjunction with the surgical team is necessary.Conclusion: The current literature does not support that a single technique is effective in the prevention of PPLS. However, adequate acute pain control, rehabilitation and early restoration of the body scheme under a multidisciplinary and multimodal approach have shown benefit in the acute setting.
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Beisheim-Ryan EH, Hicks GE, Pohlig RT, Medina J, Sions JM. Body image and perception among adults with and without phantom limb pain. PM R 2023; 15:278-290. [PMID: 34914201 PMCID: PMC10211469 DOI: 10.1002/pmrj.12750] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/28/2021] [Accepted: 12/02/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Following lower-limb amputation, phantom limb pain (i.e., pain perceived as coming from the amputated portion of the limb) is common. Phantom limb pain may be associated with impaired body image and perception, which may be targets for rehabilitative intervention. OBJECTIVE To compare measures of body image and perception between adults with and without phantom limb pain post amputation and evaluate associations between measures of body image and perception and phantom limb pain. DESIGN Survey. SETTING Online, remote assessment. PARTICIPANTS Seventy-two adults ≥1 year post unilateral lower-limb loss (n = 42 with phantom limb pain, n = 30 without phantom limb pain or pain in the remaining portion of the limb). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Self-reported outcome measures assessing body image (i.e., Amputee Body Image Scale-Revised), perceptual disturbances associated with the phantom limb (i.e., a modified Bath Complex Regional Pain Syndrome Body Perception Disturbance Scale), and prosthesis satisfaction (i.e., Trinity Amputation and Prosthesis Experience Scale) were administered; participants with phantom limb pain reported pain interference via the Brief Pain Inventory-Short Form. Between-group comparisons of self-reported outcome measure scores were conducted using Mann Whitney U or chi-square tests, as appropriate (a = .05). RESULTS Compared to peers without phantom limb pain, adults with phantom limb pain reported more negative body image; increased phantom limb ownership, attention, and awareness; and reduced prosthesis satisfaction and embodiment (U = 175.50-364.00, p < .001 to .034). Disturbances in phantom limb perception (i.e., size, weight, pressure, temperature) were similar between groups (p = .086 to >.999). More negative body image was associated with increased phantom limb pain interference (τb = .25, p = .026). CONCLUSIONS Adults with phantom limb pain demonstrate more negative body image and hypervigilance of the phantom limb as compared to peers with nonpainful phantom sensations. Mind-body treatments that target impaired body image and perception may be critical interventions for adults with phantom limb pain.
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Affiliation(s)
- Emma Haldane Beisheim-Ryan
- University of Delaware Department of Physical Therapy, 540 South College Avenue, Newark, DE, 19713, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, CO, USA
| | - Gregory Evan Hicks
- University of Delaware Department of Physical Therapy, 540 South College Avenue, Newark, DE, 19713, USA
| | - Ryan Todd Pohlig
- University of Delaware Biostatistics Core, 102B STAR Tower, Newark, DE, 19713, USA
| | - Jared Medina
- University of Delaware Department of Psychological and Brain Sciences, 105 The Green, Room 108, Newark, DE, 19716, USA
| | - Jaclyn Megan Sions
- University of Delaware Department of Physical Therapy, 540 South College Avenue, Newark, DE, 19713, USA
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13
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Yanagisawa T, Fukuma R, Seymour B, Tanaka M, Yamashita O, Hosomi K, Kishima H, Kamitani Y, Saitoh Y. Neurofeedback Training without Explicit Phantom Hand Movements and Hand-Like Visual Feedback to Modulate Pain: A Randomized Crossover Feasibility Trial. THE JOURNAL OF PAIN 2022; 23:2080-2091. [PMID: 35932992 DOI: 10.1016/j.jpain.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 06/25/2022] [Accepted: 07/20/2022] [Indexed: 01/04/2023]
Abstract
Phantom limb pain is attributed to abnormal sensorimotor cortical representations, although the causal relationship between phantom limb pain and sensorimotor cortical representations suffers from the potentially confounding effects of phantom hand movements. We developed neurofeedback training to change sensorimotor cortical representations without explicit phantom hand movements or hand-like visual feedback. We tested the feasibility of neurofeedback training in fourteen patients with phantom limb pain. Neurofeedback training was performed in a single-blind, randomized, crossover trial using two decoders constructed using motor cortical currents measured during phantom hand movements; the motor cortical currents contralateral or ipsilateral to the phantom hand (contralateral and ipsilateral training) were estimated from magnetoencephalograms. Patients were instructed to control the size of a disk, which was proportional to the decoding results, but to not move their phantom hands or other body parts. The pain assessed by the visual analogue scale was significantly greater after contralateral training than after ipsilateral training. Classification accuracy of phantom hand movements significantly increased only after contralateral training. These results suggested that the proposed neurofeedback training changed phantom hand representation and modulated pain without explicit phantom hand movements or hand-like visual feedback, thus showing the relation between the phantom hand representations and pain. PERSPECTIVE: Our work demonstrates the feasibility of using neurofeedback training to change phantom hand representation and modulate pain perception without explicit phantom hand movements and hand-like visual feedback. The results enhance the mechanistic understanding of certain treatments, such as mirror therapy, that change the sensorimotor cortical representation.
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Affiliation(s)
- Takufumi Yanagisawa
- Osaka University, Institute for Advanced Co-Creation Studies, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; Osaka University Graduate School of Medicine, Department of Neurosurgery, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; ATR Computational Neuroscience Laboratories, Department of Neuroinformatics, 2-2-2 Hikaridai, Seika-cho, Kyoto 619-0288, Japan.
| | - Ryohei Fukuma
- Osaka University, Institute for Advanced Co-Creation Studies, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; Osaka University Graduate School of Medicine, Department of Neurosurgery, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; ATR Computational Neuroscience Laboratories, Department of Neuroinformatics, 2-2-2 Hikaridai, Seika-cho, Kyoto 619-0288, Japan
| | - Ben Seymour
- University of Oxford, Institute of Biomedical Engineering, Department of Engineering Science, Old Road Campus Research Building, Oxford OX3 7DQ, UK; National Institute for Information and Communications Technology, Center for Information and Neural Networks, 1-3 Suita, Osaka 565-0871, Japan
| | - Masataka Tanaka
- Osaka University Graduate School of Medicine, Department of Neurosurgery, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Okito Yamashita
- RIKEN Center for Advanced Intelligence Project, Nihonbashi 1-chome Mitsui Building, 15th floor, 1-4-1 Nihonbashi, Chuo-ku, Tokyo 103-0027, Japan; ATR Neural Information Analysis Laboratories, Department of Computational Brain Imaging, 2-2-2 Hikaridai, Seika-cho, Kyoto 619-0288, Japan
| | - Koichi Hosomi
- Osaka University Graduate School of Medicine, Department of Neurosurgery, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; Osaka University Graduate School of Medicine, Department of Neuromodulation and Neurosurgery, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Haruhiko Kishima
- Osaka University Graduate School of Medicine, Department of Neurosurgery, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Yukiyasu Kamitani
- ATR Computational Neuroscience Laboratories, Department of Neuroinformatics, 2-2-2 Hikaridai, Seika-cho, Kyoto 619-0288, Japan; Kyoto University, Graduate School of Informatics, Yoshidahonmachi, Sakyoku, Kyoto, Kyoto 606-8501, Japan
| | - Youichi Saitoh
- Osaka University Graduate School of Medicine, Department of Neurosurgery, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; Osaka University Graduate School of Medicine, Department of Neuromodulation and Neurosurgery, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
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14
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Wandrey JD, Schäfer M, Erlenwein J, Tafelski S. [Practice of perioperative phantom limb pain prevention in Germany: a nationwide survey]. DIE ANAESTHESIOLOGIE 2022; 71:834-845. [PMID: 36036261 PMCID: PMC9636281 DOI: 10.1007/s00101-022-01188-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 07/04/2022] [Accepted: 07/17/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The prevalence of phantom limb pain after major amputation remains high and affected patients suffer from relevant impairments in the quality of life. Perioperative treatment strategies may prevent phantom limb pain. This study aims to assess the state of the perioperative anesthesiological pain management for major amputations. Furthermore, it analyzes potentials for optimization and barriers towards a better treatment of patients with amputations. MATERIAL AND METHODS This online survey was distributed by the German Society of Anesthesiology and Intensive Care Medicine (DGAI) mailing list of anesthesiological consultants. It was approved by the Charité ethics board. RESULTS Overall, 402 persons participated in this survey. Mostly, general anesthesia (85%), regional anesthesia (63%) and neuraxial anesthesia (49%) were performed in different combinations. Furthermore, 72% of participants reported using i.v. opioids postoperatively, mostly applied via patient-controlled analgesia (PCA). In contrast, preoperative regional anesthesia (74%) and gabapentinoids (67%) were seen as potential methods to improve treatment; however, barrier analysis revealed that treatment options are limited especially by organizational aspects and intrinsic patient factors. CONCLUSION This survey describes the current practice of phantom limb pain prevention in Germany. It shows an unmet need for specialized perioperative pain treatment. As the evidence regarding treatment recommendations is limited, further research questions can be deduced from this study.
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Affiliation(s)
- Jan D Wandrey
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Campus Charité-Mitte und Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Gliedkörperschaft der Freien Universität Berlin, der Humboldt Universität zu Berlin und des Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Deutschland.
- Wissenschaftlicher Arbeitskreis Schmerzmedizin der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland.
| | - Michael Schäfer
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Campus Charité-Mitte und Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Gliedkörperschaft der Freien Universität Berlin, der Humboldt Universität zu Berlin und des Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Deutschland
- Wissenschaftlicher Arbeitskreis Schmerzmedizin der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland
| | - Joachim Erlenwein
- Wissenschaftlicher Arbeitskreis Schmerzmedizin der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland
- Universitätsmedizin Göttingen, Klinik für Anästhesiologie, Georg-August-Universität, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | - Sascha Tafelski
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Campus Charité-Mitte und Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Gliedkörperschaft der Freien Universität Berlin, der Humboldt Universität zu Berlin und des Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Deutschland
- Wissenschaftlicher Arbeitskreis Schmerzmedizin der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland
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15
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Akbulut A, Gungor F, Tarakci E, Aydin MA, Zaim AH, Catal C. Identification of phantom movements with an ensemble learning approach. Comput Biol Med 2022; 150:106132. [PMID: 36195047 DOI: 10.1016/j.compbiomed.2022.106132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 08/27/2022] [Accepted: 09/18/2022] [Indexed: 11/20/2022]
Abstract
Phantom limb pain after amputation is a debilitating condition that negatively affects activities of daily life and the quality of life of amputees. Most amputees are able to control the movement of the missing limb, which is called the phantom limb movement. Recognition of these movements is crucial for both technology-based amputee rehabilitation and prosthetic control. The aim of the current study is to classify and recognize the phantom movements in four different amputation levels of the upper and lower extremities. In the current study, we utilized ensemble learning algorithms for the recognition and classification of phantom movements of the different amputation levels of the upper and lower extremity. In this context, sEMG signals obtained from 38 amputees and 25 healthy individuals were collected and the dataset was created. Studies of processing sEMG signals in amputees are rather limited, and studies are generally on the classification of upper extremity and hand movements. Our study demonstrated that the ensemble learning-based models resulted in higher accuracy in the detection of phantom movements. The ensemble learning-based approaches outperformed the SVM, Decision tree, and kNN methods. The accuracy of the movement pattern recognition in healthy people was up to 96.33%, this was at most 79.16% in amputees.
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Affiliation(s)
- Akhan Akbulut
- Department of Computer Engineering, Istanbul Kültür University, 34536 Istanbul, Turkey.
| | - Feray Gungor
- Department of Physiotherapy and Rehabilitation, Istanbul University-Cerrahpasa, 34147, Istanbul, Turkey.
| | - Ela Tarakci
- Department of Physiotherapy and Rehabilitation, Istanbul University-Cerrahpasa, 34147, Istanbul, Turkey.
| | - Muhammed Ali Aydin
- Department of Computer Engineering, Istanbul University-Cerrahpasa, 34520 Istanbul, Turkey.
| | - Abdul Halim Zaim
- Department of Computer Engineering, Istanbul Commerce University, 34840 Istanbul, Turkey.
| | - Cagatay Catal
- Department of Computer Science and Engineering, Qatar University, Doha 2713, Qatar.
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16
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Boomgaardt J, Dastan K, Chan T, Shilling A, Abd-Elsayed A, Kohan L. An Algorithm Approach to Phantom Limb Pain. J Pain Res 2022; 15:3349-3367. [PMID: 36320223 PMCID: PMC9618240 DOI: 10.2147/jpr.s355278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
Abstract
Phantom limb pain (PLP) is a common condition that occurs following both upper and lower limb amputation. First recognized and described in 1551 by Ambroise Pare, research into its underlying pathology and effective treatments remains a very active and growing field. To date, however, there is little consensus regarding the optimal management of phantom limb pain. With few large well-designed clinical trials of which to make treatment recommendations, as well as significant heterogeneity in clinical response to available treatments, the management of PLP remains challenging. Below we summarize the current state of knowledge in the field, as well as propose an algorithm for the approach to the treatment of PLP.
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Affiliation(s)
- Jacob Boomgaardt
- Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, VA, USA
| | - Kovosh Dastan
- Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, VA, USA
| | - Tiffany Chan
- Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA
| | - Ashley Shilling
- Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Lynn Kohan
- Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA,Correspondence: Lynn Kohan, Department of Anesthesiology, University of Virginia, 545 Ray C Hunt Suite 3168, Charlottesville, VA, 22903, USA, Tel +1-434-243-5676, Fax +1-434-243-5689, Email
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17
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Zwierzchowska A, Gaweł E, Rosołek B. Determinants of the prevalence and location of musculoskeletal pain in elite Para athletes. Medicine (Baltimore) 2022; 101:e31268. [PMID: 36281199 PMCID: PMC9592444 DOI: 10.1097/md.0000000000031268] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The tendency for musculoskeletal complaints, injuries, and traumas remains significant among Para athletes. The aim of the study was to identify and verify the variables that impact the incidence and location of musculoskeletal pain in elite athletes with disabilities. It was assumed, that the type of disability and not the type of sport, or the type of injuries and traumas is the crucial determinant of the prevalence and location of musculoskeletal pain in Para athletes. A direct-participatory observation method was used in the study including both subjective (surveys questionnaires) and objective (anthropometric) methods of assessment. The study included 35 male and female elite Para athletes from the Polish national team (sitting volleyball [SG1: n = 21], para swimming [SG2 = 14]). Both groups of Para athletes mostly reported pain in the neck (37%), and the lower back (34%). The Spearman's rank-order correlation showed several large inversely proportional relationships between somatic parameters and the values in the Nordic Musculoskeletal Questionnaire from the last 7 days (NMQ-7) for SG2 and some moderate to large correlations between body adiposity index (BAI) and the prevalence of injuries, the total number of rehabilitation sessions, the number of humeral joint and fingers rehabilitation sessions, breaks from training over 4 weeks in SG1. In both groups relationships were found between the duration of Paralympic training and the number of injuries and rehabilitation sessions (R = -0.4; P < .02) and between the exclusion from training for less 4 and over 4 weeks (R = -0.4; P < .03). The age of the Para athletes correlated with the NMQ-7 (wrists) (R = 0.4; P < .01). Both duration of disability and the type and severity of the disability may be crucial determinants of the prevalence and location of pain in the musculoskeletal system in Para athletes. Sport-specific training seems to induce specific musculoskeletal complaints.
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Affiliation(s)
- Anna Zwierzchowska
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice 40-065, Poland
| | - Eliza Gaweł
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice 40-065, Poland
- *Correspondence: Eliza Gaweł, Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice 40-065, Poland (e-mail: )
| | - Barbara Rosołek
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice 40-065, Poland
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Runyan H, Herbert L, Knight J, Todd S, Washington L, Thompson MO. Lived Experiences of Combat-Related Amputees: A Phenomenological Study. JOURNAL OF LOSS & TRAUMA 2022. [DOI: 10.1080/15325024.2022.2129839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2022]
Affiliation(s)
- Helen Runyan
- Counseling Department, Regent University, Virginia Beach, Virginia, USA
| | - Linda Herbert
- Counseling Department, Regent University, Virginia Beach, Virginia, USA
| | - Jasmine Knight
- Counseling Department, Regent University, Virginia Beach, Virginia, USA
| | - Sherry Todd
- Clinical Counseling Department, University of the Cumberlands, Williamsburg, Kentucky, USA
| | - Lesley Washington
- Counseling Department, Regent University, Virginia Beach, Virginia, USA
| | - Megan O. Thompson
- Counseling Department, Regent University, Virginia Beach, Virginia, USA
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Rich TL, Marth LA, Brielmaier SM, Kiecker JE, Vogsland RJ, Macedo FJ, Ferguson JE, Hansen AH. Strategies for graded motor imagery for clients with phantom limb pain and cognitive impairment. Prosthet Orthot Int 2022; 46:496-499. [PMID: 35333828 DOI: 10.1097/pxr.0000000000000125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 02/15/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Individuals with amputations often experience phantom limb pain (PLP) that can limit their participation in rehabilitation, prosthesis training, desired activities, and roles. One nonpharmacological rehabilitation intervention for PLP is graded motor imagery (GMI). There are several components to GMI, including right/left discrimination or laterality, motor imagery, sensory retraining, and mirror therapy. Successful implementation of GMI requires a range of cognitive skills, such as attention span, working memory, abstract reasoning, and planning. For individuals with PLP who concurrently display cognitive impairments, GMI protocols can be adapted using strategies derived from clinical practice. OBJECTIVES The purpose of this technical clinical report was to discuss the application of clinically implemented cognitive compensation techniques to GMI instruction. STUDY DESIGN Not applicable. METHODS Clinical expert opinion to explore adaptations for GMI. TECHNIQUE Graded motor imagery can be an effective tool for pain treatment; however, some clients may need greater clinician support due to existing cognitive difficulties. RESULTS For clients to be successful, active engagement in learning about and implementing GMI techniques is necessary. CONCLUSIONS When serving the lifetime amputation care needs of patients with cognitive deficits, we find that targeted learning strategies and accommodations can be helpful when introducing GMI concepts and skill development. Enhanced patient education techniques support client learning.
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Affiliation(s)
- Tonya L Rich
- Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | | | | | | | | | - Franz J Macedo
- Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - John E Ferguson
- Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Andrew H Hansen
- Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
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Navarro-López V, Del-Valle-Gratacós M, Fernández-Vázquez D, Fernández-González P, Carratalá-Tejada M, Molina-Rueda F. Transcranial direct current stimulation in the management of phantom limb pain: a systematic review of randomized controlled trials. Eur J Phys Rehabil Med 2022; 58:738-748. [PMID: 35758072 PMCID: PMC10019480 DOI: 10.23736/s1973-9087.22.07439-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 06/13/2022] [Accepted: 06/20/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Phantom limb pain (PLP) after amputation is a frequent entity that conditions the life of those who suffer it. Current treatment methods are not sufficiently effective for PLP management. We aim to analyze the clinical application of transcranial direct current (tDCS) in people with amputation suffering from PLP. EVIDENCE ACQUISITION The following databases were consulted in September 2021: MEDLINE, EMBASE, The Web of Science, PEDro, SCOPUS and SciELO. Randomized controlled trials investigating the use of tDCS in people with amputation undergoing PLP were selected. Demographic data, type and cause of amputation, time since amputation, stimulation parameters, and outcomes were extracted. EVIDENCE SYNTHESIS Six articles were included in this review (seven studies were considered because one study performed two individual protocols). All included studies evaluated PLP; six evaluated the phantom limb sensations (PLS) and two evaluated the psychiatric disorders. In all included studies the intensity and frequency of PLP was reduced, in three PLS were reduced, and in none study psychiatric symptoms were modified. CONCLUSIONS Anodic tDCS over the contralateral M1 to the affected limb, with an intensity of 1-2 mA, for 15-20 minutes seems to significantly reduce PLP in people with amputation. Single-session treatment could modify PLP intensity for hours, and multi-session treatment could modify PLP for months. Limited evidence suggests that PLS and psychiatric disorders should be treated with different PLP electrode placements. Further studies with larger sample size and longer follow-up times are needed to establish the priority of tDCS application in the PLP management.
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Affiliation(s)
- Víctor Navarro-López
- Motion Analysis, Biomechanics, Ergonomy and Motor Control Laboratory (LAMBECOM group), Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, Alcorcón, Madrid, Spain
- International Doctoral School, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | | | - Diego Fernández-Vázquez
- Motion Analysis, Biomechanics, Ergonomy and Motor Control Laboratory (LAMBECOM group), Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, Alcorcón, Madrid, Spain
- International Doctoral School, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Pilar Fernández-González
- Motion Analysis, Biomechanics, Ergonomy and Motor Control Laboratory (LAMBECOM group), Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - María Carratalá-Tejada
- Motion Analysis, Biomechanics, Ergonomy and Motor Control Laboratory (LAMBECOM group), Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, Alcorcón, Madrid, Spain -
| | - Francisco Molina-Rueda
- Motion Analysis, Biomechanics, Ergonomy and Motor Control Laboratory (LAMBECOM group), Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, Alcorcón, Madrid, Spain
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21
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Sahoo S, Naskar C, Singh A, Rijal R, Mehra A, Grover S. Sensory Deprivation and Psychiatric Disorders: Association, Assessment and Management Strategies. Indian J Psychol Med 2022; 44:436-444. [PMID: 36157017 PMCID: PMC9460009 DOI: 10.1177/02537176211033920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Sensory deprivation (SD) is a widely prevalent condition that leads to various health-related consequences and is also an important cause of disability worldwide. Earlier, SD experiments were used as research modalities to alter human behavior. In recent years, the focus has shifted to understand how SD can affect the mental health of individuals (with congenital or acquired sensory impairments). This narrative review focuses on the current understanding about the association of SD and psychiatric disorders. METHODS A comprehensive literature search was done PubMed, Scopus, PsycINFO, and Google Scholar and in the cross-references of relevant articles. Keywords included "sensory deprivation," "blindness," "deafness," "mental illness," "psychiatric disorders," "prevalence," "assessment," and "management" in various combinations. Only original articles (abstract and full text) published in English till October 2020 were included. RESULTS The prevalence of anxiety, depression, dementia, suicidality, and psychosis in persons with SD is higher than the general population (highest being in persons with dementia with comorbid SD). Several mechanisms/hypotheses have been proposed to explain these associations. Assessment of SD includes a thorough history taking, with adequate awareness about the difficulties faced during a psychiatric interview in this population. Modifications in the psychometric assessment procedures are warranted. Management depends on a multi-disciplinary approach that includes proper referral to specialties, pharmacological management (depending on diagnosis as well as taking care of ototoxic/ocular side-effect profile of the drugs), and nonpharmacological supportive measures. CONCLUSIONS SD is a complex condition, and evidence suggests that persons with SD have higher psychiatric morbidity. A comprehensive assessment, along with holistic management approach is warranted.
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Affiliation(s)
- Swapnajeet Sahoo
- Dept. of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Chandrima Naskar
- Dept. of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajaypal Singh
- Dept. of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rika Rijal
- Dept. of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aseem Mehra
- Dept. of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Grover
- Dept. of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Schone HR, Baker CI, Katz J, Nikolajsen L, Limakatso K, Flor H, Makin TR. Making sense of phantom limb pain. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2021-328428. [PMID: 35609964 PMCID: PMC9304093 DOI: 10.1136/jnnp-2021-328428] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 04/04/2022] [Indexed: 01/01/2023]
Abstract
Phantom limb pain (PLP) impacts the majority of individuals who undergo limb amputation. The PLP experience is highly heterogenous in its quality, intensity, frequency and severity. This heterogeneity, combined with the low prevalence of amputation in the general population, has made it difficult to accumulate reliable data on PLP. Consequently, we lack consensus on PLP mechanisms, as well as effective treatment options. However, the wealth of new PLP research, over the past decade, provides a unique opportunity to re-evaluate some of the core assumptions underlying what we know about PLP and the rationale behind PLP treatments. The goal of this review is to help generate consensus in the field on how best to research PLP, from phenomenology to treatment. We highlight conceptual and methodological challenges in studying PLP, which have hindered progress on the topic and spawned disagreement in the field, and offer potential solutions to overcome these challenges. Our hope is that a constructive evaluation of the foundational knowledge underlying PLP research practices will enable more informed decisions when testing the efficacy of existing interventions and will guide the development of the next generation of PLP treatments.
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Affiliation(s)
- Hunter R Schone
- NIMH, National Institutes of Health, Bethesda, Maryland, USA
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Chris I Baker
- NIMH, National Institutes of Health, Bethesda, Maryland, USA
| | - Joel Katz
- Department of Psychology, York University, Toronto, Ontario, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | - Lone Nikolajsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Katleho Limakatso
- Department of Anaesthesia and Perioperative Medicine, Pain Management Unit, Neuroscience Institute, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Herta Flor
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health/Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Center for Neuroplasticity and Pain, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Tamar R Makin
- Institute of Cognitive Neuroscience, University College London, London, UK
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Zwierzchowska A, Gawel E, Celebanska D, Rosolek B. Musculoskeletal pain as the effect of internal compensatory mechanisms on structural and functional changes in body build and posture in elite Polish sitting volleyball players. BMC Sports Sci Med Rehabil 2022; 14:49. [PMID: 35346336 PMCID: PMC8962485 DOI: 10.1186/s13102-022-00439-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 03/17/2022] [Indexed: 02/04/2023]
Abstract
Background With the dynamic development of professional Paralympic sport, the prevalence of musculoskeletal pain and structural and/or functional disturbances in Para athletes constantly increases. The aim of the study was to evaluate the impact of internal compensatory mechanisms on selected aspects of body structure and function in elite sitting volleyball players. Methods The study included eighteen elite sitting volleyball players (male; n = 12, female; n = 6, age; 36.0 ± 6.1, body mass; 76.6 ± 16.1, body height; 179.3 ± 0.1) from the Polish national team. Retrospective and direct participatory observation methods were used in the study. NMQ-7 was used to assess the current prevalence and location of musculoskeletal pain. The evaluation of spinal curvature and pelvic inclination was performed using a non-invasive Medi Mouse method (Idiag M360) in three different trunk positions. All statistical analyses were performed using Statistica 13.3 software package. Results Lumbar hypolordosis was a predominant sagittal deviation of spinal curvature (n = 15;83%). Low back pain (LBP) and neck pain were the most frequent complaints (50%). Statistically significant differences in the values of thoracic kyphosis angle, pelvic inclination, and spine length (SL) in sagittal standing flexion and extension were found. However, there was no statistically significant difference in sagittal standing flexion for the lumbar lordosis angle with a simultaneous significant change in pelvic inclination (66.9°). Moreover, a tendency to interpenetration of relationships between variables that characterize (a) body structure and (b) function of the spine and musculoskeletal pain were observed. Shoulder pain correlated with SL (R = 0.6; p < 0.05) and body height (R = 0.5; p < 0.05). Pelvic inclination correlated with shoulder pain, LBP (R = 0.5; p < 0.05/R = 0.6; p < 0.01), and body trunk fat mass (R = − 0.6; p < 0.05). Conclusions Trunk fat mass induces internal compensatory mechanisms to maintain optimal pelvic inclination and sagittal spinal balance. Furthermore, the level of pelvic mobility may determine musculoskeletal pain in Para athletes with lower limb impairment.
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Affiliation(s)
- Anna Zwierzchowska
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, Mikołowska 72A, 40-065, Katowice, Poland
| | - Eliza Gawel
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, Mikołowska 72A, 40-065, Katowice, Poland.
| | - Diana Celebanska
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, Mikołowska 72A, 40-065, Katowice, Poland
| | - Barbara Rosolek
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, Mikołowska 72A, 40-065, Katowice, Poland
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24
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Klinisches Update zu Phantomschmerz. Schmerz 2022; 37:195-214. [DOI: 10.1007/s00482-022-00629-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 10/18/2022]
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25
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The Impact of Internal Compensatory Mechanisms on Musculoskeletal Pain in Elite Polish Sitting Volleyball Players – A Preliminary Study. J Hum Kinet 2022; 81:277-288. [PMID: 35291641 PMCID: PMC8884867 DOI: 10.2478/hukin-2022-0023] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
The purpose of the study was to evaluate the impact of (1) maximal muscular strength of the upper body and (2) fat mass on musculoskeletal pain and sagittal spinal curvature deviations in elite Polish sitting volleyball players. The study examined twelve players (age = 35.4 ± 6.9 years). The assessments were performed based on objective (anthropometric examinations, Medi Mouse, 1RM test) and subjective (NMQ = 7) measurements. All statistical analyses were performed using the SPSS. The lower back, the upper back and the neck were the most frequent painful areas. Statistical analyses showed a significant relationship between lumbar lordosis (LL) sagittal standing extension (r = 0.62; p = 0.03) and thoracic kyphosis (TK) sagittal standing flexion (r = -0.63; p = 0.28) with the 1RM. Furthermore, correlations between a body adiposity index and TK sagittal standing flexion and extension (r = -0.65; p = 0.05, r = - 0.58; p = 0.0.05) as well as LL sagittal standing flexion (r = 0.61; p = 0.05) were found. The body mass index correlated with wrist pain, whereas a very high relationship was found between pain in the wrists and knee joints. Neck pain positively correlated with TK and LL sagittal standing. Low back pain correlated with LL sagittal standing flexion and TK sagittal standing extension. Fat mass impacts the depth of anteroposterior spinal curvatures, what may cause pain in the neck and the lower back. The 1 RM bench press may influence the prevalence and location of musculoskeletal pain, whereas its values might be predicted by the depth of TK. A lower 1RM in the bench press may impact sagittal spinal curvature deviations. Deepen TK and LL significantly contribute to the prevalence of the neck pain.
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Lee MO, Lee SK, Park JE, Jin SY. The recurrence of phantom limb pain with spinal anesthesia. Niger J Clin Pract 2022; 25:728-730. [DOI: 10.4103/njcp.njcp_1875_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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27
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Prevention is better than cure: Surgical methods for neuropathic pain prevention following amputation - A systematic review. J Plast Reconstr Aesthet Surg 2021; 75:948-959. [PMID: 34955394 DOI: 10.1016/j.bjps.2021.11.076] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/08/2021] [Accepted: 11/14/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pain after amputation can be known as residual limb pain (RLP) or phantom limb pain (PLP); however, both can be disabling in daily life with reported incidences of 8% for finger amputations and up to 85% for major limb amputations. The current treatment is focused on reducing the pain after neuropathic pain occurs. However, surgical techniques to prevent neuropathic pain after amputation are available and effective, but they are underutilized. The purpose of the review is to investigate the effects of techniques during amputation to prevent neuropathic pain. METHODS A systematic review was performed in multiple databases (Embase, Medline, Web of Science, Scopus, Cochrane, and Google Scholar) and following the PRISMA guidelines. Studies that reported surgical techniques to prevent neuropathic pain during limb amputation were included. RESULTS Of the 6188 selected studies, 13 eligible articles were selected. Five articles reported techniques for finger amputation: neurovascular island flap, centro-central union (CCU), and epineural ligatures, and flaps. For finger amputations, the use of prevention techniques resulted in a decrease of incidences from 8% to 0-3% with CCU being the most beneficial. For major limb amputations, the incidences for RLP were decreased to 0 to 55% with TMR and RPNI and compared to 64-91% for the control group. Eight articles reported techniques for amputations on major limbs: targeted muscle reinnervation (TMR), targeted nerve implantation, concomitant nerve coaptation, and regenerative peripheral nerve interface (RPNI). CONCLUSIONS Based on the current literature, we state that during finger and major limb amputation, the techniques to prevent neuropathic pain and PLP should be performed.
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Guo Q, Di Z, Tian HF, Zhang QA. Contralateral Acupuncture for the Treatment of Phantom Limb Pain and Phantom Limb Sensation in Oncologic Lower Limb Amputee: A Case Report. Front Neurosci 2021; 15:713548. [PMID: 34744604 PMCID: PMC8568952 DOI: 10.3389/fnins.2021.713548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 09/27/2021] [Indexed: 11/13/2022] Open
Abstract
Phantom limb pain (PLP) and phantom limb sensation (PLS) are common and distressing sequelae of amputation. Current pain management following amputation is challenging and unsatisfying. In this case study, a 74-year-old woman underwent above-knee amputation because of the rhabdomyosarcoma in the right leg. Despite several analgesics, pain was poorly controlled. The phantom limb pain and sensation were immediately reduced by the contralateral acupuncture, and abolished after the third session with no side-effects, no relapse during the next 9 months. Contralateral acupuncture showed positive effect on PLP and PLS in this case, but more robust evidence would be needed to support the efficacy of this treatment technique for indication.
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Affiliation(s)
- Qin Guo
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhong Di
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Hong-Fang Tian
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Quan-Ai Zhang
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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Lendaro E, Balouji E, Baca K, Muhammad AS, Ortiz-Catalan M. Common Spatial Pattern EEG decomposition for Phantom Limb Pain detection. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:726-729. [PMID: 34891394 DOI: 10.1109/embc46164.2021.9630561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Phantom Limb Pain (PLP) is a chronic condition frequent among individuals with acquired amputation. PLP has been often investigated with the use of functional MRI focusing on the changes that take place in the sensorimotor cortex after amputation. In the present study, we investigated whether a different type of data, namely electroencephalographic (EEG) recordings, can be used to study the condition. We acquired resting state EEG data from people with and without PLP and then used machine learning for a binary classification task that differentiates the two. Common Spatial Pattern (CSP) decomposition was used as the feature extraction method and two validation schemes were followed for the classification task. Six classifiers (LDA, Log, QDA, LinearSVC, SVC and RF) were optimized through grid search and their performance compared. Two validation approaches, namely all-subjects validation and leave-one-out cross-validation (LOOCV), resulted in high classification accuracy. Most notably, the 93.7% accuracy achieved with SVC in LOOCV holds promise for good diagnostic capabilities using EEG biomarkers. In conclusion, our findings indicate that EEG data is a promising target for future research aiming at elucidating the neural mechanisms underlying PLP and its diagnosis.
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30
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Fuchs X, Diers M, Trojan J, Kirsch P, Milde C, Bekrater-Bodmann R, Rance M, Foell J, Andoh J, Becker S, Flor H. Phantom limb pain after unilateral arm amputation is associated with decreased heat pain thresholds in the face. Eur J Pain 2021; 26:114-132. [PMID: 34288253 DOI: 10.1002/ejp.1842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The mechanisms underlying chronic phantom limb pain (PLP) are complex and insufficiently understood. Altered sensory thresholds are often associated with chronic pain but quantitative sensory testing (QST) in PLP has so far been inconclusive due to large methodological variation between studies and small sample sizes. METHODS In this study, we applied QST in 37 unilateral upper-limb amputees (23 with and 14 without PLP) and 19 healthy controls. We assessed heat pain (HPT), pressure pain, warmth detection and two-point discrimination thresholds at the residual limb, a homologous point and the thenar of the intact limb as well as both corners of the mouth. RESULTS We did not find significant differences in any of the thresholds between the groups. However, PLP intensity was negatively associated with HPT at all measured body sites except for the residual limb, indicating lower pain thresholds with higher PLP levels. Correlations between HPT and PLP were strongest in the contralateral face (r = -0.65, p < 0.001). Facial HPT were specifically associated with PLP, independent of residual limb pain (RLP) and various other covariates. HPT at the residual limb, however, were significantly associated with RLP, but not with PLP. CONCLUSION We conclude that the association between PLP and, especially facial, HPT could be related to central mechanisms. SIGNIFICANCE Phantom limb pain (PLP) is still poorly understood. We show that PLP intensity is associated with lower heat pain thresholds, especially in the face. This finding could be related to central nervous changes in PLP.
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Affiliation(s)
- Xaver Fuchs
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Biopsychology and Cognitive Neuroscience, Faculty of Psychology and Sports Science, Bielefeld University, Bielefeld, Germany
| | - Martin Diers
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jörg Trojan
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Pinar Kirsch
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christopher Milde
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of Psychology, University of Koblenz-Landau, Landau, Germany
| | - Robin Bekrater-Bodmann
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Mariela Rance
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jens Foell
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Jamila Andoh
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Heidelberg, Germany
| | - Susanne Becker
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Integrative Spinal Research, Research Chiropractic, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Herta Flor
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Santer J, MacDonald S, Rizzone K, Biehler S, Beiswenger T. Strategies for Gait Retraining in a Collegiate Runner with Transfemoral Amputation: A Case Report. Int J Sports Phys Ther 2021; 16:862-869. [PMID: 34123538 PMCID: PMC8169020 DOI: 10.26603/001c.23671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 11/27/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND More than fifty percent of people with limb amputations participate in sports or physical activity following amputation. Athletes with limb amputations may face additional challenges including phantom limb pain (PLP), psychological barriers, prosthetic complications, and gait abnormalities. Prevalence of PLP in the general amputee population is estimated to be as high as 85%. Despite the high prevalence of PLP, there is little research regarding the use of gait training as a treatment for PLP among both the general amputee population and athletes. CASE DESCRIPTION A 20-year old female collegiate track and field athlete presented with phantom knee pain brought on with running. The athlete demonstrated deficits in core and hip strength as well as decreased single leg stability bilaterally. Running gait analysis revealed circumduction with the prosthesis for limb advancement and increased vaulting with push off on the sound (uninvolved) limb. Gait retraining strategies were implemented to address video analysis findings and create a more efficient running gait and address phantom limb pain symptoms. OUTCOMES Rehabilitation and gait retraining strategies were effective in improving several clinical and functional outcomes in this case. Significant improvements were noted in PLP, running gait mechanics, and the patient's psychological and functional status as measured with a standardized outcome tool, the Patient-Reported Outcomes Measurement Information System® (PROMIS®). DISCUSSION Running gait training following amputation could be a crucial component of rehabilitation for athletes in an attempt to lessen pain while running, especially in those experiencing phantom limb pain (PLP). Utilization of a multidisciplinary team in the gait retraining process is recommended. There is a need for further research to determine the effects of running gait retraining for management of PLP in athletes with amputation. LEVEL OF EVIDENCE 5.
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Limakatso K, Parker R. Treatment Recommendations for Phantom Limb Pain in People with Amputations: An Expert Consensus Delphi Study. PM R 2021; 13:1216-1226. [PMID: 33460508 PMCID: PMC8597012 DOI: 10.1002/pmrj.12556] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/18/2020] [Accepted: 01/05/2021] [Indexed: 12/25/2022]
Abstract
Background Phantom limb pain (PLP) is common and often accompanied by serious suffering. Current systematic‐review evidence suggests that recommended treatments are no more effective than placebo for reducing PLP. Given the difficulty in conducting a meta‐analysis for nonpharmacological treatments and the weak evidence for pharmacological treatments for PLP, consensus on the first‐line management of PLP needs to be reached using alternative methods. Objective To reach expert consensus and make recommendations on the effective management of PLP. Design A three‐round Delphi design was used. Setting The study was conducted using e‐mail and Google survey tool as the main methods of communication and providing feedback. Participants The study included 27 clinicians and researchers from various health disciplines who are experts in PLP management. Method Data were collected using three sequential rounds of anonymous online questionnaires where experts proposed and ranked the treatments for PLP. A consensus was reached on the treatments that were endorsed by 50% or more of the experts. Results Thirty‐seven treatments were proposed for the management of PLP at the beginning of the study. Consensus was reached on seven treatments that were considered effective for managing PLP and on two treatments that were considered ineffective. Graded motor imagery, mirror therapy, amitriptyline, sensory discrimination training, and use of a functional prosthesis were endorsed by most experts because of the available backing scientific evidence and their reported efficacy in clinical practice. Cognitive behavioral therapy and virtual reality training were endorsed by most experts because of their reported efficacy in clinical practice despite indicating a dearth of scientific evidence to support their ranking. Citalopram and dorsal root ganglion pulsed radiofrequency were rejected owing to a lack of relevant scientific evidence. Conclusion The results of this study suggest that the nonpharmacological treatments endorsed in this study may have an important role in the management of PLP.
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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
| | - Romy Parker
- Department of Anaesthesia and Perioperative Medicine, Pain Management Unit Neuroscience Institute, University of Cape Town Cape Town South Africa
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Abstract
Phantom limb pain is highly prevalent after amputation. Treatment results will probably benefit from an interdisciplinary team and individually adapted surgical, prosthetic and pain medicine approaches. Introduction: Most patients with amputation (up to 80%) suffer from phantom limb pain postsurgery. These are often multimorbid patients who also have multiple risk factors for the development of chronic pain from a pain medicine perspective. Surgical removal of the body part and sectioning of peripheral nerves result in a lack of afferent feedback, followed by neuroplastic changes in the sensorimotor cortex. The experience of severe pain, peripheral, spinal, and cortical sensitization mechanisms, and changes in the body scheme contribute to chronic phantom limb pain. Psychosocial factors may also affect the course and the severity of the pain. Modern amputation medicine is an interdisciplinary responsibility. Methods: This review aims to provide an interdisciplinary overview of recent evidence-based and clinical knowledge. Results: The scientific evidence for best practice is weak and contrasted by various clinical reports describing the polypragmatic use of drugs and interventional techniques. Approaches to restore the body scheme and integration of sensorimotor input are of importance. Modern techniques, including apps and virtual reality, offer an exciting supplement to already established approaches based on mirror therapy. Targeted prosthesis care helps to obtain or restore limb function and at the same time plays an important role reshaping the body scheme. Discussion: Consequent prevention and treatment of severe postoperative pain and early integration of pharmacological and nonpharmacological interventions are required to reduce severe phantom limb pain. To obtain or restore body function, foresighted surgical planning and technique as well as an appropriate interdisciplinary management is needed.
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DI Pino G, Piombino V, Carassiti M, Ortiz-Catalan M. Neurophysiological models of phantom limb pain: what can be learnt. Minerva Anestesiol 2021; 87:481-487. [PMID: 33432796 DOI: 10.23736/s0375-9393.20.15067-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Phantom Limb Pain (PLP) is a dysesthesic painful sensations perceived in the lost limb, resulting from complex interactions between structural and functional nervous systems changes. We analyze its main pathogenetic models and speculate on candidate therapeutic targets. The neuroma model considers PLP to arise from spontaneous activity of residual limb injured axons. Other peripheral-origin models attribute PLP to damage of somatosensory receptors or vascular changes. According to the cortical remapping model, the loss of bidirectional nervous flow and the need to enhance alternative functions trigger reorganization and arm and face skin afferents "invade" the hand territory. On the contrary, the persistent representation model suggests that continued inputs preserve the lost limb representation and that, instead to a shrinkage, PLP is associated with larger representation and stronger cortical activity. In the neuromatrix model, the mismatch between body representation, which remains intact despite limb amputation, and real body appearance generates pain. Another hypothesis is that proprioceptive memories associate specific limb positions with pre-amputation pain and may be recalled by those positions. Finally, the stochastic entanglement model offers a direct relationship between sensorimotor neural reorganization and pain. Amputation disrupts motor and somatosensory circuits, allowing for maladaptive wiring with pain circuits and causing pain without nociception. Relief of PLP depends solely on motor and somatosensory circuitry engagement, making anthropomorphic visual feedback dispensable. Existing and apparently contradicting theories might not be mutually exclusive. All of them involve several intertwined potential mechanisms by which replacing the amputated limb by an artificial one could counteract PLP.
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Affiliation(s)
- Giovanni DI Pino
- Research Unit of Neurophysiology and Neuroengineering of Human-Technology Interaction (NeXTlab), Campus Bio-Medico University, Rome, Italy -
| | - Valeria Piombino
- Research Unit of Neurophysiology and Neuroengineering of Human-Technology Interaction (NeXTlab), Campus Bio-Medico University, Rome, Italy
| | - Massimiliano Carassiti
- Unit of Anesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Max Ortiz-Catalan
- Center for Bionics and Pain Research, Mölndal, Sweden.,Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden.,Operational Area 3, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Balakhanlou E, Webster J, Borgia M, Resnik L. Frequency and Severity of Phantom Limb Pain in Veterans with Major Upper Limb Amputation: Results of a National Survey. PM R 2020; 13:827-835. [DOI: 10.1002/pmrj.12485] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 08/20/2020] [Accepted: 08/31/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Ellie Balakhanlou
- School of Medicine at Virginia Commonwealth University Richmond VA USA
| | - Joseph Webster
- School of Medicine at Virginia Commonwealth University Richmond VA USA
- Hunter Homes McGuire Veterans Affairs Medical Center Richmond VA USA
| | - Matthew Borgia
- Research Department Providence VA Medical Center Providence RI USA
| | - Linda Resnik
- Research Department Providence VA Medical Center Providence RI USA
- Health Services, Policy and Practice Brown University Providence RI USA
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Makin TR, Flor H. Brain (re)organisation following amputation: Implications for phantom limb pain. Neuroimage 2020; 218:116943. [PMID: 32428706 PMCID: PMC7422832 DOI: 10.1016/j.neuroimage.2020.116943] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 05/10/2020] [Accepted: 05/11/2020] [Indexed: 12/11/2022] Open
Abstract
Following arm amputation the region that represented the missing hand in primary somatosensory cortex (S1) becomes deprived of its primary input, resulting in changed boundaries of the S1 body map. This remapping process has been termed 'reorganisation' and has been attributed to multiple mechanisms, including increased expression of previously masked inputs. In a maladaptive plasticity model, such reorganisation has been associated with phantom limb pain (PLP). Brain activity associated with phantom hand movements is also correlated with PLP, suggesting that preserved limb functional representation may serve as a complementary process. Here we review some of the most recent evidence for the potential drivers and consequences of brain (re)organisation following amputation, based on human neuroimaging. We emphasise other perceptual and behavioural factors consequential to arm amputation, such as non-painful phantom sensations, perceived limb ownership, intact hand compensatory behaviour or prosthesis use, which have also been related to both cortical changes and PLP. We also discuss new findings based on interventions designed to alter the brain representation of the phantom limb, including augmented/virtual reality applications and brain computer interfaces. These studies point to a close interaction of sensory changes and alterations in brain regions involved in body representation, pain processing and motor control. Finally, we review recent evidence based on methodological advances such as high field neuroimaging and multivariate techniques that provide new opportunities to interrogate somatosensory representations in the missing hand cortical territory. Collectively, this research highlights the need to consider potential contributions of additional brain mechanisms, beyond S1 remapping, and the dynamic interplay of contextual factors with brain changes for understanding and alleviating PLP.
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Affiliation(s)
- Tamar R Makin
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom; Wellcome Centre for Human Neuroimaging, University College London, London, UK.
| | - Herta Flor
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Department of Psychology, School of Social Sciences, University of Mannheim, Germany; Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Münger M, Pinto CB, Pacheco-Barrios K, Duarte D, Gunduz ME, Simis M, Battistella LR, Fregni F. Protective and Risk Factors for Phantom Limb Pain and Residual Limb Pain Severity. Pain Pract 2020; 20:578-587. [PMID: 32176435 PMCID: PMC7363546 DOI: 10.1111/papr.12881] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/29/2020] [Accepted: 03/04/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The exact mechanisms underlying the development and maintenance of phantom limb pain (PLP) are still unclear. This study aimed to identify the factors affecting pain intensity in patients with chronic, lower limb, traumatic PLP. METHODS This is a cross-sectional analysis of patients with PLP. We assessed amputation-related and pain-related clinical and demographic variables. We used univariate and multivariate models to evaluate the associated factors modulating PLP and residual limb pain (RLP) intensity. RESULTS We included 71 unilateral traumatic lower limb amputees. Results showed that (1) amputation-related perceptions were experienced by a large majority of the patients with chronic PLP (sensations: 90.1%, n = 64; residual pain: 81.7%, n = 58); (2) PLP intensity has 2 significant protective factors (phantom limb movement and having effective treatment for PLP previously) and 2 significant risk factors (phantom limb sensation intensity and age); and (3) on the other hand, for RLP, risk factors are different: presence of pain before amputation and level of amputation (in addition to the same protective factors). CONCLUSION These results suggest different neurobiological mechanisms to explain PLP and RLP intensity. While PLP risk factors seem to be related to maladaptive plasticity, since phantom sensation and older age are associated with more pain, RLP risk factors seem to have components leading to neuropathic pain, such as the amount of neural lesion and previous history of chronic pain. Interestingly, the phantom movement appears to be protective for both phenomena.
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Affiliation(s)
- Marionna Münger
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Neuropsychology, Institute of Psychology, University of Zurich, 8050 Zurich, Switzerland
| | - Camila B. Pinto
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts, USA
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud. Lima, Peru
| | - Dante Duarte
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Muhamed Enes Gunduz
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marcel Simis
- Department of Physical Medicine and Rehabilitation, Instituto de Reabilitação Lucy Montoro
| | | | - Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts, USA
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Abstract
In this case study, we investigated the efficacy of mirror therapy and online counseling in the management of phantom limb pain. The patient was a 28-year-old woman who experienced phantom limb pain after a traumatic transhumeral amputation three and a half months before initiating therapy. After a 40-minute educational session with a nurse researcher experienced in pain management and surgical nursing, the patient practiced mirror therapy at home for four weeks and kept in contact with the nurse using a mobile chat application. The patient scored the intensity of her pain before and after each practice session on a 0-to-10 numeric pain scale. The first week was difficult for her because of tiredness and the pain. In the second week she experienced less pain during the day than at night but claimed to feel much better than before. In the fourth week, she reported having difficulty sleeping, but she stated that her pain had decreased. The intensity of the pain didn't change following mirror therapy in the first week; however, her average pain score was 1.15 points lower after mirror therapy in the second week (from 4.57 to 3.42), and 1.57 points lower in the third and fourth weeks (from 5.42 to 3.85 and 4.85 to 3.28). Online counseling for mirror therapy is easy, economical, and time-saving for patient and nurse alike. However, physical and physiological problems experienced during this process may reduce the effectiveness of the therapy, highlighting the importance of a multidisciplinary approach to phantom limb pain management, which may include care from a psychologist, massage therapist, physiotherapist, and specialist in alternative therapies for relaxation, in addition to the surgeon and the nurse.
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Kawashita T, Dunnsiri T, Shu S, Tran P, Agustines D. Losing Legs to Losing Everything: How Neglecting Holistic Health Devastated a Lower-limb Amputee. Cureus 2019; 11:e6275. [PMID: 31911868 PMCID: PMC6939962 DOI: 10.7759/cureus.6275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Holistic care means addressing the patient as a person; providing high-quality care by focusing on individual needs. Our goal is to implement a survey that quantifies the patients’ physical, mental, and spiritual health to enable improvements in client-centered therapy in lower-limb amputees. For this, we worked with a 43-year-old Hispanic male with a medical history of insulin-dependent diabetes complicated by sequential lower limb amputations. The second amputation cost him his job and left him homeless. The patient was hospitalized after developing severe depression, to the point that he had command auditory hallucinations to kill himself. He was discharged back into the community after a three-week hospitalization. However, he was readmitted to the hospital a week later due to a resurgence of suicidal ideation. Our team engaged the patient using the “Holistic Health and Wellness Survey” of Raymond W. Smith, which we used to assess and address various domains of his mental, spiritual, and physical health. We were able to create obtainable goals for the patient for each category on which he scored low in the health and wellness survey. The patient’s overall health and attitude improved substantially through his client-centered therapy, which addressed his quantified health needs; and he began to take an active role in developing short- and long-term goals that he found attainable as he adjusted to life as a double-amputee. This case illustrates the potential for improving client-centered therapy in lower-limb amputees. We believe that providers may benefit from implementing this health and wellness survey to better assess how to provide client-centered care for their patients.
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Affiliation(s)
- Takumi Kawashita
- Physical Medicine and Rehabilitation, Western University of Health Sciences, Irvine, USA
| | - Teevit Dunnsiri
- Psychiatry, Olive View - University of California, Los Angeles Medical Center, Los Angeles, USA
| | - Sara Shu
- Internal Medicine, Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Pomona, USA
| | - Patrick Tran
- Psychiatry, David Geffen School of Medicine at the University of California, Los Angeles, USA
| | - Davin Agustines
- Psychiatry, Olive View - University of California Los Angeles Medical Center, Los Angeles, USA
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Abstract
PURPOSE OF REVIEW Phantom sensations are incompletely understood phenomena which take place following an amputation or deafferentation of a limb. They can present as kinetic, kinesthetic, or exteroceptive perceptions. It is estimated that phantom limb pain (PLP) affects anywhere from 40 to 80% of amputees. RECENT FINDINGS Psychiatric illnesses such as depression, anxiety, and mood disorders have higher prevalence in amputees than in the general population. Pharmacologic treatment has been used as first-line therapy for amputees suffering from PLP with agents including gabapentinoids, amitriptyline, and other tricyclic anti-depressants, opioids, and local anesthetics. Non-invasive treatment modalities exist for PLP including sensory motor training, mirror visual therapy, and non-invasive neuromodulation. Non-invasive neuromodulation includes interventions like transcutaneous electrical nerve stimulation (TENS) and transcranial magnetic stimulation. While many promising therapies for PLP exist, more clinical trials are required to determine the efficacy and protocols needed for maximum benefit in patients suffering from PLP.
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Wong SS, Svingos AM, Heaton SC. Behavioral Therapy for Acute Post‐Surgical Phantom Limb Pain in a Young Adult With Osteosarcoma. Pain Pract 2019; 19:571-572. [DOI: 10.1111/papr.12768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Shan S. Wong
- Department of Social Sciences & Health Policy Wake Forest School of Medicine Winston‐Salem North Carolina U.S.A
| | - Adrian M. Svingos
- Department of Clinical & Health Psychology University of Florida Gainesville Florida U.S.A
| | - Shelley C. Heaton
- Department of Clinical & Health Psychology University of Florida Gainesville Florida U.S.A
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