1/23. electroconvulsive therapy for phantom limb pain.phantom limb pain is common in amputees. Although several treatments are available, a significant number of patients are refractory. electroconvulsive therapy (ECT), which is usually given to patients with psychiatric disorders such as major depression, has shown efficacy in patients with a variety of pain syndromes occurring along with depression. Two patients are described herein with severe phantom limb pain refractory to multiple therapies, without concurrent psychiatric disorder, who received ECT. Both patients enjoyed substantial pain relief. In one case, phantom pain was still in remission 3.5 years after ECT. It is concluded that phantom limb patients who are refractory to multiple therapies may respond to ECT.- - - - - - - - - - ranking = 1keywords = amputee (Clic here for more details about this article) |
2/23. 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) |
3/23. Caring for patients with phantom limb sensation.phantom limb pain is increasingly perceived as a complex condition that is likely to have multifactorial causes. Although acknowledgement of the existence of the condition is more prevalent than it was, its treatment remains elusive. nurses caring for people with phantom limb pain have a unique role to play in the overall holistic therapy of the amputee.- - - - - - - - - - ranking = 1keywords = amputee (Clic here for more details about this article) |
4/23. 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) |
5/23. Effects of botulinum toxin type B on stump pain and involuntary movements of the stump.patients who had previously undergone amputation of the arm (n = 2) or leg (n = 2) were treated with botulinum toxin type B injections at several trigger points of their stump musculature. We administered a total dose of 2500 IU of botulinum toxin type B (Neurobloc, Elan Pharma, Munich, germany) to the arm amputation stumps, 5000 IU for one amputation of the lower leg, and 2500 IU to the other lower leg amputation of a patient with a very low baseline body weight. Two patients reported that the injection was very painful. All patients experienced a reduction in stump pain, which lasted for many weeks. Other reports included a reduction in the frequency of pain attacks, cessation of "balloon feelings," improvement in stump allodynia, and decreased occurrence of involuntary stump movements. In addition, quality of sleep at night significantly improved in one patient. Botulinum toxin type B can therefore be regarded as a new treatment option for possible improvements in the rehabilitation of amputees.- - - - - - - - - - ranking = 1keywords = amputee (Clic here for more details about this article) |
6/23. 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) |
7/23. 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) |
8/23. Topiramate for phantom limb pain: a time-series analysis.There is growing evidence of topiramate's efficacy in treating neuropathic pain. This article reports a detailed analysis of the response of four amputee subjects with phantom limb pain. Individual time-series analyses revealed that three out of four amputee participants receiving topiramate had statistically significant decreases in pain, with the peak effect noted at 800 mg daily. This analysis supports a hypothesis that topiramate may be effective in reducing phantom limb pain, and suggests a definitive study is indicated.- - - - - - - - - - ranking = 2keywords = amputee (Clic here for more details about this article) |
9/23. 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) |
10/23. Cortical correlates of TMS-induced phantom hand movements revealed with concurrent TMS-fMRI.We studied an amputee patient who experiences a conscious sense of movement (SoM) in her phantom hand, without significant activity in remaining muscles, when transcranial magnetic stimulation (TMS) is applied at appropriate intensity over the corresponding sector of contralateral motor cortex. We used the novel methodological combination of TMS during fMRI to reveal the neural correlates of her phantom SoM. A critical contrast concerned trials at intermediate TMS intensities: low enough not to produce overt activity in remaining muscles; but high enough to produce a phantom SoM on approximately half such trials. Comparing trials with versus without a phantom SoM reported phenomenally, for the same intermediate TMS intensities, factored out any non-specific TMS effects on brain activity to reveal neural correlates of the phantom SoM itself. Areas activated included primary motor cortex, dorsal premotor cortex, anterior intraparietal sulcus, and caudal supplementary motor area, regions that are also involved in some hand movement illusions and motor imagery in normals. This adds support to proposals that a conscious sense of movement for the hand can be conveyed by activity within corresponding motor-related cortical structures.- - - - - - - - - - ranking = 1keywords = amputee (Clic here for more details about this article) |
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