Phantom Limb Pain: A Systematic Neuroanatomical-Based Review of Pharmacologic Treatment

McCormick, Zachary L.; Chang-Chien, George C; Marshall, Benjamin; Huang, Mark E.; Harden, R. Norman

doi:10.1111/pme.12283

Cited by 95 publications

(73 citation statements)

References 158 publications

(189 reference statements)

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“…As Jess’s exercise levels and food intake maintained her in a good body condition and she had regular health checks, she would have experienced the pleasures of being physically fit and healthy, operating without difficulty within the agility constraints imposed by her amputation [71] and exposed to minimal risk of obesity-induced arthritis in her intact hind leg in later life [72]. She exhibited no extra attention to her amputated limb, so she was not likely to have experienced pain or other unpleasant sensations in the stump or a phantom limb, common in a high proportion of human amputees [73]. The salient affective health outcomes were therefore graded “A/++”, no compromise with mid-level enhancement (Table 2; [1,18]).…”

Section: Welfare Impacts Of a Traumatic Injury In A Farm Dogmentioning

confidence: 99%

Changes in the Welfare of an Injured Working Farm Dog Assessed Using the Five Domains Model

Littlewood

Mellor

2016

Animals

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Simple SummaryThe Five Domains Model is now increasingly used to assess the welfare status of a wide range of species in markedly different circumstances. Particular strengths are that the Model facilitates structured, systematic and comprehensive evaluations of animals’ negative and positive mental experiences, the overall balance of which underlies their welfare status or quality of life. Importantly, the Model also clarifies the specific internal and external factors that give rise to those experiences. The welfare evaluation published here is the first to use the most up-to-date version of the Model, and stands as a detailed example that may assist others undertaking such welfare evaluations in other species and contexts. Moreover, it is the first such evaluation of a companion animal. It employs a fictitious scenario involving a working farm dog before, during and after it sustains a serious hind leg injury requiring amputation and its subsequent rehoming as a pet. A wide range of negative and positive experiences are graded, interactions between them are revealed, and the balance between negative and positive states at different stages of the scenario is described. Such Model evaluations can highlight current practices that merit re-evaluation. More generally, when major welfare issues are identified, use of the Model could enhance expert witness participation in related prosecutions by highlighting scientifically supported connections between indicative physical/functional states and behaviours and their associated negative experiences in ill-treated animals. Five Domains Model evaluations can also facilitate quality of life assessments and end-of-life decisions.AbstractThe present structured, systematic and comprehensive welfare evaluation of an injured working farm dog using the Five Domains Model is of interest in its own right. It is also an example for others wanting to apply the Model to welfare evaluations in different species and contexts. Six stages of a fictitious scenario involving the dog are considered: (1) its on-farm circumstances before one hind leg is injured; (2) its entanglement in barbed wire, cutting it free and transporting it to a veterinary clinic; (3) the initial veterinary examination and overnight stay; (4) amputation of the limb and immediate post-operative recovery; (5) its first four weeks after rehoming to a lifestyle block; and (6) its subsequent life as an amputee and pet. Not all features of the scenario represent average-to-good practice; indeed, some have been selected to indicate poor practice. It is shown how the Model can draw attention to areas of animal welfare concern and, importantly, to how welfare enhancement may be impeded or facilitated. Also illustrated is how the welfare implications of a sequence of events can be traced and evaluated, and, in relation to specific situations, how the degrees of welfare compromise and enhancement may be graded. In addition, the choice of a companion animal, contrasting its welfare status as a working dog and pet, and consider...

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Section: Welfare Impacts Of a Traumatic Injury In A Farm Dogmentioning

confidence: 99%

Changes in the Welfare of an Injured Working Farm Dog Assessed Using the Five Domains Model

Littlewood

Mellor

2016

Animals

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“…B. auf die Reduktion der Erregbarkeit der läsionierten peripheren Neuronen (etwa durch Gabapentin, Carbamazepin oder durch trizyklische Antidepressiva bei Dauerschmerzen) oder die Reduktion sympathischer Aktivierung ab. Eine hohe Evidenz existiert auch für die Therapie mit Opioiden [1,26]. Die Therapie erfolgt mit retardierten Opioiden strikt nach Zeitschema.…”

Section: » Ein Großteil Derunclassified

“…Die besten Ergebnisse erbringen bislang Morphin und Ketamin i.v. mit kurzfristigem Erfolg (Evidenzniveau 2) und Medikation mit Opioiden per os für mittel-bis län-gerfristige Effekte (8 Wochen bis 1 Jahr; [1,26].…”

Section: » Ein Großteil Derunclassified

Stumpf- und Phantomschmerzen

et al. 2015

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“…While it is the most common therapeutic approach, pharmaceutical treatment of PLP is supported mainly by circumstantial reports and studies have not demonstrated efficacy placebo-controlled, randomized studies 13,14. A promising alternative for unilateral amputees is mirror therapy, which allows patients to “see” their phantom limb as a reflection of the intact limb.…”

Section: Introductionmentioning

confidence: 99%

Observation of limb movements reduces phantom limb pain in bilateral amputees

Tung

Murphy

Griffin

et al. 2014

Ann Clin Transl Neurol

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BackgroundMirror therapy has been demonstrated to reduce phantom limb pain (PLP) experienced by unilateral limb amputees. Research suggests that the visual feedback of observing a limb moving in the mirror is critical for therapeutic efficacy.ObjectiveSince mirror therapy is not an option for bilateral lower limb amputees, the purpose of this study was to determine if direct observation of another person’s limbs could be used to relieve PLP.MethodsWe randomly assigned 20 bilateral lower limb amputees with PLP to visual observation (n = 11) or mental visualization (n = 9) treatment. Treatment consisted of seven discrete movements which were mimicked by the amputee’s phantom limbs moving while visually observing the experimenter’s limbs moving, or closing the eyes while visualizing and attempting the movements with their phantom limbs, respectively. Participants performed movements for 20 min daily for 1 month. Response to therapy was measured using a 100-mm visual analog scale (VAS) and the McGill Short-Form Pain Questionnaire (SF-MPQ).ResultsDirect visual observation significantly reduced PLP in both legs (P < 0.05). Amputees assigned to the mental visualization condition did not show a significant reduction in PLP.InterpretationDirect visual observation therapy is an inexpensive and effective treatment for PLP that is accessible to bilateral lower limb amputees.

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Phantom Limb Pain: A Systematic Neuroanatomical-Based Review of Pharmacologic Treatment

Cited by 95 publications

References 158 publications

Changes in the Welfare of an Injured Working Farm Dog Assessed Using the Five Domains Model

Changes in the Welfare of an Injured Working Farm Dog Assessed Using the Five Domains Model

Stumpf- und Phantomschmerzen

Observation of limb movements reduces phantom limb pain in bilateral amputees

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