Pathophysiology and treatment of phantom limb pain

Angarita, Mayra Alejandra Malavera; Villa, Sandra Carrillo; Ribero, Omar Fernando Gomezese; García, Ronald G.; Sieger, Federico Arturo Silva

doi:10.1016/j.rcae.2013.10.002

Cited by 7 publications

(4 citation statements)

References 52 publications

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“…Stump pain and phantom limb pain are common in amputees, which can be extremely debilitating. Complex factors involving peripheral nerve system, central nerve system, psychological factor, and genetic predisposition are associated with stump pain and phantom limb pain …”

Section: Discussionmentioning

confidence: 99%

“…The discovery that neuroma can generate ectopic impulse discharge suggests the stump is one of the pain generators. After nerve sectioning, a neuroma in the residual limb may be formed as a result of the injury, edema, axon retrograde regeneration and shortening of afferent neurons with an increased rate of spontaneous activity that related to stump pain and phantom limb pain . Ectopic activity from stump neuroma could spontaneously upload to the dorsal root ganglion.…”

Section: Discussionmentioning

confidence: 99%

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Coblation of Femoral and Sciatic Nerve for Stump Pain and Phantom Limb Pain: A Case Report

et al. 2015

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Coblation of Femoral and Sciatic Nerve for Stump Pain and Phantom Limb Pain: A Case Report

et al. 2015

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“…is known as sprouting and gives rise to neuroma formation, i.e., expanded and disorganized A and C fiber-endings with ectopic firing that increases during the mechanical and chemical stimulus [29]. The nerves become hyper-excitable due to an increase in sodium channels and resulting in spontaneous discharges [30].…”

Section: Open Access Journal Of Neurology and Neurosurgerymentioning

confidence: 99%

Phantom Limb Pain: Current Concepts and Treatment Strategies

Nieto‐Salazar

2023

OAJNN

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Phantom limb syndrome (PLS) is described as the perception of feelings originating from a limb that has been amputated or is otherwise absent [1]. Despite this physical absence, patients may experience various sensory and motor sensations as if the limb were still present. Phantom limb symptoms encompass a range of sensations, including the missing limb's presence, movements such as wiggling toes or opening and closing the hand, pressure, tingling, itching, temperature changes, and pain [1-3]. Phantom limb pain (PLP) is commonly encountered in these patients, and it can vary in intensity, duration, and quality, ranging from throbbing or stabbing sensations to burning or cramping feelings. There is a high statistical heterogeneity across prevalence studies due to the different time windows assessed [4-10]. However, it is estimated that approximately 60-80% of individuals who have undergone limb amputation may experience phantom limb sensations, and around 50-85% of those individuals may also experience phantom limb pain [11,12]. Several factors have been identified as potential risk factors for developing this type of pain, including the level of amputation, pre-existing pain, post-amputation pain, chronic pain history, and psychological factors (i.e., anxiety, depression, post-traumatic stress disorder) [12,13].

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“… 3 4 Besides that, psychogenic factors such as depression, anxiety and increased stress are counted as PLP triggers. 15 16 …”

Section: Introductionmentioning

confidence: 99%

Mindful SensoriMotor Therapy combined with brain modulation for the treatment of pain in individuals with disarticulation or nerve injuries: a single-arm clinical trial

2023

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IntroductionNeuropathic pain is a complex and demanding medical condition that is often difficult to treat. Regardless of the cause, the impairment, lesion or damage to the nervous system can lead to neuropathic pain, such as phantom limb pain (PLP). No treatment has been found widely effective for PLP, but plasticity-guided therapies have shown the least severe side effects in comparison to pharmacological or surgical interventions. Phantom motor execution (PME) is a plasticity-guided intervention that has shown promising results in alleviating PLP. The potential mechanism underlying the effectiveness of PME can be explained by the Stochastic Entanglement hypothesis for neurogenesis of neuropathic pain resulting from sensorimotor impairment. We have built on this hypothesis to investigate the efficacy of enhancing PME interventions by using phantom motor imagery to facilitate execution and with the addition of sensory training. We refer to this new treatment concept as Mindful SensoriMotor Therapy (MiSMT). In this study, we further complement MiSMT with non-invasive brain modulation, specifically transcranial direct current stimulation (tDCS), for the treatment of neuropathic pain in patients with disarticulation or peripheral nerve injury.Methods and analysisThis single-arm clinical trial investigates the efficacy of MiSMT and tDCS as a treatment of neuropathic pain resulting from highly impaired extremity or peripheral nerve injury in eight participants. The study consists of 12 sessions of MiSMT with anodal tDCS in the motor cortex, pretreatment and post-treatment assessments, and follow-up sessions (up to 6 months). The primary outcome is the change in pain intensity as measured by the Pain Rating Index between the first and last treatment sessions.Ethics and disseminationThe study is performed under the approval of the governing ethical committee in Sweden (approval number 2020-07157) and in accordance with the Declaration of Helsinki.Trial registration numberNCT04897425.

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Pathophysiology and treatment of phantom limb pain

Cited by 7 publications

References 52 publications

Coblation of Femoral and Sciatic Nerve for Stump Pain and Phantom Limb Pain: A Case Report

Coblation of Femoral and Sciatic Nerve for Stump Pain and Phantom Limb Pain: A Case Report

Phantom Limb Pain: Current Concepts and Treatment Strategies

Mindful SensoriMotor Therapy combined with brain modulation for the treatment of pain in individuals with disarticulation or nerve injuries: a single-arm clinical trial

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