Introduction: The perception of one's own body, its mental representation, and emotional attitude to it are the components of socalled "body image" [1]. The aim of the research was to analyse phantom pain and non-painful phantom sensations as results of limb loss and to explain them in terms of body image distortion.Material and method: Three methods were used in the study of 22 amputees (7 women and 15 men, between 43 and 76 years old, M = 61, SD = 11.3): (1) Results: The prevalence of phantom limb pain was 59%. Some various non-painful phantom sensations after amputation were experienced by 77% of respondents. There was a statistically significant relationship between phantom pain and non-painful phantom sensations in a group of participants experiencing phantom limb phenomenon at the moment of the research.Conclusions: Deformation of body image in the form of phantom pain and non-painful phantom sensations is a frequent experience after limb loss. We suggest that phantom limb is a form of out-of-date or inadequate body image as an effect of the brain activity trying to keep a kind of status quo. A co-occurrence of non-painful phantom sensations and phantom pain suggests that these both forms of post-amputation sensations may share neural mechanisms. Results indicate, that there exists somatosensory memory which may be manifested in similarities between pre-and post-amputation sensations.
Objectives We investigated the influence of spinal cord stimulation (SCS) on IFN-γ, IL-1β, IL-6, TNF-α, IL-10, and TGF-β serum levels in failed back surgery syndrome (FBSS) patients. The study will try to give new insights into the mechanism of SCS action and the role of IFN-γ and other cytokines in neuropathic pain (NP) development. Materials and Methods Clinical and biochemical assessment was conducted in four groups of patients: group 0 consisted of 24 FBSS patients qualified to SCS therapy, group 1 included 17 patients who were one month after implantation, group 2 featured 12 patients who were 3 months after the implantation, and group C (the control group) with no NP. Clinical status was assessed with the use of Numeric Rating Scale (NRS), the Pain Rating Index of McGill Pain Questionnaire (SF-MPQ), the Oswestry Disability Index (ODI), and Beck Depression Inventory (BDI). The plasma concentrations of IFN-γ were ascertained by an immunoenzymatic method. Results We found a significant difference between the patients before SCS and controls' serum level of IFN-γ. Similarly, a significantly higher level of TNF-α and significantly lower level of IL-10 in FBSS patients than controls were observed. The significant differences were not observed between SCS patients 3 months after the procedure and controls' serum level of IFN-γ and other cytokines. We noticed a positive correlation between IFN-γ concentration with NRS back value before SCS and positive correlation between IFN-γ concentration after SCS with NRS leg value before SCS. Higher IFN-γ concentrations accompanied higher NRS values. Levels of TGF-β and IL-10 may correlate with physical ability and depressive behavior. Conclusions SCS did not influence serum cytokine levels significantly. Serum concentration of IFN-γ may be recognized as an occasional pain factor because of its significantly higher level in FBSS patients versus controls and higher IFN-γ value accompanying higher pain intensity.
Objectives. To compare the viability of the numerical rating scale (NRS) and the visual analogue scale (VAS) as a pain assessment tools among a large cohort of patients who underwent microdiscectomy. Summary of Background Data. The pain intensity (PI) reduction is a parameter of surgical treatment efficacy. The two most commonly used scales of PI are NRS and VAS. Many studies have shown strong similarities between those two scales, but the direct interchange is difficult. Methods. Patients, who underwent microdiscectomy, were prospectively enrolled into the study and assessed using VAS and NRS for the back (NRS-B) and the leg (NRS-L), Short Form of McGill Pain Questionnaire (SF-MPQ) included Pain Rating Index (PRI) and Oswestry Disability Index (ODI) 1 day before and 1 month and 3 months after the procedure. Results. 131 patients were included in the study. NRS-L, NRS-B, VAS, and ODI were significantly lower ( p < 0.001 ) 1 month after microdiscectomy. NRS-L and NRS-B ratings remained at a similar level while VAS and ODI decreased after 3 months. The rate of decline of PI measured by NRS-L correlated statistically significant (rs = 0.366; p < 0.001 ) with ODI 1 month after surgery. Before surgery, the most significant correlation was found between ODI and NRS-L (rs = 0.494; p < 0.001 ), the lowest with NRS-B (rs = 0.319; p < 0.001 ). 3 months after surgery, there was higher correlations between ODI and VAS (rs = 0.634) than NRS-L (rs = 0.265). PRI correlated significantly ( p < 0.001 ) and more stronger with VAS than with NRS-L and NRS-B in every points of assessment. Conclusion. The results showed that PI measurements by NRS-L/NRS-B and VAS mutually correlate and impair functionality evaluated by ODI (convergent validity) but in different modes (differential validity). NRS and VAS are not parallel scales and assess different aspects of pain. The measurement of NRS-L 1 month after microdiscectomy seems to give quick insight into the effectiveness of the procedure.
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