1/16. phantom limb pain: a report of two cases.The efficacy of pre-emptive analgesia for phantom limb pain is still unclear. It is generally accepted that pre hyphen;amputation pain increases the incidence of phantom and stump pain, even if pre-emptive analgesia is performed before and during surgery and in the postoperative period. Two cases of traumatic upper limb amputations are described here with no pre-existing pain. Both received similar antinociceptive treatment by continuous block of the brachial plexus through infusion of ropivacaine 0.375% at 5 ml/h for 10 days. Treatment of case 1 was initiated immediately after surgery; however, this amputee developed intensive phantom limb pain which persisted at 6 months. Early use of the prosthesis after surgery was not possible for this patient. The intensity of phantom limb pain in case 2 decreased significantly after 6 months, even though brachial plexus blockade was not started until 5 weeks post-trauma. This patient used a functional prosthesis intensively beginning early after amputation. Serial magnetoencephalographic recordings were performed in both patients. Only case 2 showed significant changes of cortical reorganization. In case 1 markedly less cortical plasticity was found. A combination of relevant risk factors such as a painful neuroma, behavioural and cognitive coping strategies and the early functional use of prostheses are discussed as important mechanisms contributing to the development of phantom pain and cortical reorganization.- - - - - - - - - - ranking = 1keywords = amputee (Clic here for more details about this article) |
2/16. chronic pain in land mine accident survivors in cambodia and Kurdistan.The aims of the study were to study chronic pain in land mine accident survivors, and to study the impact of trauma and trauma care parameters on chronic pain. The level of chronic pain was registered (patient-rated and by clinical examination) in 57 severely injured adult land mine accident survivors in cambodia and Northern iraq more than one year after the accident. As all study patients had been managed by a standardized trauma system, we could assess the impact of injury severity and primary trauma care on chronic pain. 64% of the study patients (n=36) had chronic pain syndromes (non-significant difference between the two countries). 68% of the amputees (19 out of 28) had phantom limb pain. Pre-injury trauma exposure, the severity of the actual trauma, and the quality of trauma care had no impact on end point chronic pain. In 85% of cases (n=48), the economic standing of the patients' family had deteriorated after the accident. Patient-rated loss of income correlated with the rate of chronic pain syndromes.- - - - - - - - - - ranking = 1keywords = amputee (Clic here for more details about this article) |
3/16. acupuncture treatment of phantom limb pain and phantom limb sensation in amputees.Three case histories are presented in which amputees with acute or chronic phantom limb pain and phantom limb sensation were treated with Western medical acupuncture, needling the asymptomatic intact limb. Two out of the three cases reported complete relief of their phantom limb pain and phantom limb sensation. acupuncture was successful in treating phantom phenomena in two of these cases, but a larger cohort study would be needed to provide more evidence for the success rate of this treatment technique for this indication.- - - - - - - - - - ranking = 5keywords = amputee (Clic here for more details about this article) |
4/16. phantom limb pain induced in amputee by strong magnetic fields.An amputee (traumatic) experienced increased phantom limb pain when exposed to the magnetic fields of two magnetic resonance imagers. With a visual analog scale used to measure pain, electric stimulation studies demonstrated that the residual limb was unusually sensitive to subthreshold (for muscle twitch) levels of current. The painful symptoms produced mimicked those experienced in the presence of the imagers.- - - - - - - - - - ranking = 5keywords = amputee (Clic here for more details about this article) |
5/16. Can immersive virtual reality reduce phantom limb pain?This paper describes the design and implementation of a case-study based investigation using immersive virtual reality as a treatment for phantom limb pain. The authors' work builds upon prior research which has found the use of a mirror box (where the amputee sees a mirror image of their remaining anatomical limb in the phenomenal space of their amputated limb) can reduce phantom limb pain and voluntary movement to paralyzed phantom limbs for some amputees. The present project involves the transposition of movements made by amputees' anatomical limb into movements of a virtual limb which is presented in the phenomenal space of their phantom limb. The three case studies presented here provide qualitative data which provide tentative support for the use of this system for phantom pain relief. The authors suggest the need for further research using control trials.- - - - - - - - - - ranking = 3keywords = amputee (Clic here for more details about this article) |
6/16. Intractable muscle pain syndrome, osteomalacia, and axonopathy in long-term use of phenytoin.Muscle pain syndrome is a complicated situation in that even an extensive work-up may overlook the primary etiology. A patient with multiple medical problems, including a history of partial gastrectomy due to trauma, a below-knee amputation from arteriosclerotic disease, and chronic phenytoin therapy for a seizure disorder, developed intractable, generalized muscle pain, with total dependency in mobility and self care. He was admitted to an acute care hospital and was eventually discharged with a diagnosis of occult malignancy. After being referred to our amputee clinic for prosthetic management, the patient was admitted for inpatient rehabilitation. Electrodiagnostic studies and muscle biopsy revealed typical neuropathic findings and nonspecific myopathic changes. Laboratory studies showed a vitamin d deficiency with secondary hyperparathyroidism. Discontinuation of phenytoin and treatment with calcium and vitamin D resulted in rapid relief of muscle pain and marked improvement in mobility and self care. This case illustrates an unusual combination of phenytoin-induced axonopathy and osteomalacia that incapacitated an otherwise functional person with below-knee amputation.- - - - - - - - - - ranking = 1keywords = amputee (Clic here for more details about this article) |
7/16. An association between phantom limb sensations and stump skin conductance during transcutaneous electrical nerve stimulation (TENS) applied to the contralateral leg: a case study.This report describes a placebo-controlled study of transcutaneous electrical nerve stimulation (TENS) applied to the contralateral lower leg and outer ears of an amputee with non-painful phantom sensations. The subject received TENS or placebo stimulation on separate sessions in which baseline periods of no stimulation alternated with periods of TENS (or placebo). Throughout the two sessions, continuous measures of stump skin conductance, surface skin temperature and phantom intensity were obtained. The results showed that TENS applied to the contralateral leg was significantly more effective than a placebo in decreasing the intensity of phantom sensations, whereas stimulation of the outer ears led to a non-significant increase. The pattern of electrodermal activity on the TENS session was consistently linear during baseline periods, indicating a progressive increase in sympathetic sudomotor activity. In contrast, during periods of electrical stimulation the pattern of electrodermal activity was consistently curvilinear indicating an initial decrease followed by an increase in sudomotor responses. Changes in stump skin conductance correlated significantly with changes in phantom sensations both in TENS and placebo sessions suggesting a relationship between sympathetic activity at the stump and paresthesias referred to the phantom. Two hypotheses are presented to account for these findings.- - - - - - - - - - ranking = 1keywords = amputee (Clic here for more details about this article) |
8/16. Pain and its absence in an unfortunate family of amputees.A family is described in which 5 male members sustained major traumatic injuries of their limbs. Two of these men had amputations of two of their limbs. The one surviving amputee is left handed. The development of phantom sensations, phantom pain and stump pain was unpredictable, despite their being first-degree relatives, and was independent of handedness.- - - - - - - - - - ranking = 5keywords = amputee (Clic here for more details about this article) |
9/16. Limb amputation and re-amputation in association with chronic pain syndrome.A small group of patients is reported in whom amputation or re-amputation of the upper or lower limb has been performed at increasingly higher levels in an unsuccessful attempt to relieve the patients' unrecognized chronic pain syndrome. The possibility of self mutilation should also be considered. The etiological factors and management of this uncommon but difficult problem are discussed. It is hoped that members of an experienced amputee team will recognize this rare problem and help to avoid multiple surgical procedures, which are harmful to the patient and costly to society.- - - - - - - - - - ranking = 1keywords = amputee (Clic here for more details about this article) |
10/16. phantom limb pain during spinal anaesthesia. recurrence in amputees.phantom limb pain following amputation is a well known but comparatively rare phenomenon. Spinal anaesthesia in amputees may cause reappearance of phantom pain in previously pain-free patients despite complete sensory analgesia. Two such cases are described.- - - - - - - - - - ranking = 5keywords = amputee (Clic here for more details about this article) |
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