Pharmacologic interventions for treating phantom limb pain

Abstract

The short- and long-term effectiveness of opioids, NMDA receptor antagonists, anticonvulsants, antidepressants, calcitonins, and anaesthetics for clinically relevant outcomes that include pain, function, mood, sleep, quality of life, satisfaction and adverse effects remains unclear. Morphine, gabapentin and ketamine demonstrate trends towards short-term analgesic efficacy. Memantine and amitriptyline were ineffective for PLP. Results, however, are to be interpreted with caution as these were based mostly on a small number of studies with limited sample sizes that varied considerably and also lacked long-term efficacy and safety outcomes. The direction of efficacy of calcitonin, anaesthetics and dextromethorphan need further clarification. Larger and more rigorous randomised controlled trials are needed to make stronger recommendations about which medications would be useful for clinical practice.

Alpha2delta ligands, gabapentin, pregabalin and mirogabalin: a review of their clinical pharmacology and therapeutic use

“…Limited and generally low-quality evidence indicates a beneficial effect of gabapentin in reducing pain in women with chronic pelvic pain [104], patients with sciatica [105] and, in better-quality studies, in patients with phantom limb pain [106].…”

Systematic Review and Meta-analysis of the Efficacy of Perineural Local Anaesthetic Catheters after Major Lower Limb Amputation

“…11 Factors thought to increase postoperative phantom limb pain include acute postoperative pain, 12 pre-amputation pain, 12 noxious intraoperative inputs and female sex. 13e15 Although many pharmacological agents are available for treatment of phantom limb pain, their efficacy is variable, 16 and better or alternative postoperative analgesia may prevent hyperplastic peripheral changes and central neural sensitisation. 17,18 The American Society of Anesthesiologists recommends using multimodal analgesic strategies for managing postoperative pain.…”

Stumpf- und Phantomschmerzen

“…Therapieansätze zielt auf periphere Mechanismen ab Therapie In der Literatur werden mehr als 60 verschiedene Therapien von Phantomschmerzen beschrieben [1,31]. Leider zeigen groß angelegte Untersuchungen, dass die meisten Ansätze wenig effizient sind, wenn eine substanzielle permanente oder langfristige Reduktion der Schmerzen erreicht werden soll.…”

“…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.…”

“…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].…”