Residual limb pain: An evidence-based review

Stover, Gary; Prahlow, Nathan D.

doi:10.3233/nre-208005

Cited by 10 publications

(13 citation statements)

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“…Phantom limb pain (PLP), residual limb pain (RLP), and phantom limb sensation (PLS) are the most common clinical complications of amputations ( Woodhouse, 2005 ; Kaur and Guan, 2018 ; Stover and Prahlow, 2020 ). Recent studies indicate that 60–80% of amputees experience phantom pain and approximately 80–100% experience phantom sensation ( Jensen et al, 1983 ; Urits et al, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Parietal Lobe Reorganization and Widespread Functional Connectivity Integration in Upper-Limb Amputees: A rs-fMRI Study

et al. 2021

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The right parietal lobe plays an important role in body image, and disorders of body image emerge after lesions in the parietal lobe or with parietal lobe epilepsy. Body image disorder also often accompanies upper-limb amputation, in which the patient misperceives that their missing limb is still part of their body. Cortical reorganization is known to occur after upper-limb amputation, but it is not clear how widespread and to what degree functional connectivity (FC) is reorganized post-amputation, nor whether such changes might be related to misperceptions of body image. Twenty-four subjects who had a traumatically upper-limb amputees (ULAs) and 24 age-matched healthy controls (HCs) underwent resting-state functional magnetic resonance imaging (rs-fMRI) scans. Regions of interest (ROIs) in the right superior parietal gyrus (SPG_R) and right inferior parietal lobule (IPL_R) were defined using BrainNet Viewer. We calculated the amplitude of low-frequency fluctuations (ALFF) in ROIs and correlated the ROI mean amplitude of low-frequency fluctuations (mALFF) and mean scores on the phantom limb sensation (PLS) scale and beck depression index (BDI). We also calculated ROIs and whole-brain FC. Compared to the HC group, we observed significantly increased activation (mALFF) in ROIs of the ULA group. Moreover, correlation analyses revealed a significant positive correlation between ROI mALFF and scores on the PLS. There was a significant negative correlation between the SPG_R mALFF and BDI scores. Seed-based, whole-brain FC analysis revealed that FC in the ULA group significantly decreased in many brain regions across the entire brain. The right parietal lobe appears to be involved in some aspect of body awareness and depression in amputation patients. Upper-limb amputation results not only in reorganization in the local brain area formerly representing the missing limb, but also results in more widespread reorganization through FC changes in whole brain.

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Section: Introductionmentioning

confidence: 99%

Parietal Lobe Reorganization and Widespread Functional Connectivity Integration in Upper-Limb Amputees: A rs-fMRI Study

et al. 2021

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“…Besides direct damage, nerves may experience impaired central nervous system feedback from the absent limb or may form a neuroma in the remaining nerve endings. This may subsequently result in residual limb pain (RLP); which is pain experienced in the remaining portion of the amputated limb, 1 and/or phantom limb pain (PLP); which is pain that patients perceive in the portion of the limb that has been amputated. RLP prevalence after lower limb amputation is estimated to be a problem in 59% of all amputees, and 15% have symptomatic neuromata, 2 whereas PLP prevalence is 64% 3 .…”

Section: Introductionmentioning

confidence: 99%

Targeted muscle reinnervation in managing post‐amputation related pain: A systematic review and meta‐analysis

et al. 2023

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IntroductionLimb amputation can cause residual limb pain (RLP) and/or phantom limb pain (PLP). Although targeted muscle reinnervation (TMR) was initially introduced to facilitate the control of prosthetic limbs, it has been noted that these patients experience less pain and improved prosthetic functional outcomes. As a result, the use of TMR in managing neuroma‐related RLP is increasing. The aim of this review is to assess the quality and strength of the evidence supporting the effectiveness of TMR in managing amputation‐related pain.MethodsFive different databases, including MEDLINE (PubMed), Scopus, Web of Science, Cochrane Library, and Embase, were searched from inception to March 2022. The protocol for this systematic review has been registered in the PROSPERO database (CRD42020218242). To be included, studies needed to compare pre‐ and postoperative pain outcomes or different techniques for adult patients who underwent TMR following amputation. Eligible studies also needed to use patient‐reported outcome measures (PROMS) and be clinical trials or observational studies published in English. Excluded studies were case reports, case series, reviews, proof of concept studies, and conference proceedings. A meta‐analysis was performed on studies that had similar intervention and control groups to examine treatment effects using a random‐effects model. Studies were weighted using the inverse variance method, and a statistically significant p‐value was considered to be less than or equal to 0.05.ResultsThis review included five studies for qualitative analysis and four studies for quantitative analysis. Reviewed studies enrolled a total of 127 patients. The TMR group was compared with standard treatment at 12 months follow‐up. The TMR group showed significantly better PLP as assessed by the numerical rating score RLP, and PLP assessed using Patient‐Reported Outcomes Measurement Information System (PROMIS) also showed significantly lower pain intensity in the TMR group.ConclusionThere is limited evidence of good quality favoring TMR in reducing postamputation PLP and RLP pain compared with standard care. Randomized clinical trials are encouraged to compare the efficacy of different surgical techniques.

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“…Phantom limb pain is a centralized pain from the lost limb that is no longer present to generate sensory input. 4 Residual limb pain is defined as pain originating in the remaining limb. Neuromas are the most common etiology of RLP, with others including heterotopic ossification, complex regional pain syndrome, dermatologic pathologies, and prosthesis-induced RLP.…”

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confidence: 99%

“…Neuromas are the most common etiology of RLP, with others including heterotopic ossification, complex regional pain syndrome, dermatologic pathologies, and prosthesis-induced RLP. 4 First-line treatment for PAP typically includes conservative measures involving evaluation for proper prosthetic fit, wound healing, skin breakdown and neuroma formation, as well as therapies such as mirror therapy and desensitization. 5 Commonly used pharmacologic agents include gabapentinoids and serotonin and norepinephrine reuptake inhibitors, with some patients occasionally requiring long-term use of opioids.…”

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confidence: 99%

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Peripheral Nerve Stimulation for the Treatment of Post-Amputation Pain: A Systematic Review

Smith¹,

Twohey²,

Dean³

et al. 2023

Am J Phys Med Rehabil

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Despite numerous first-line treatment interventions, adequately managing a patient’s postamputation pain can be difficult. Peripheral nerve stimulation has emerged as a safe neuromodulatory intervention that can be used for many etiologies of chronic pain. We performed a systemic review to appraise the evidence of peripheral nerve stimulation use for improvement in postamputation pain. This was performed in Ovid, Cochrane databases, OVID, Scopus, Web of Science Core Collection, and PubMed. The primary outcome was improvement in postamputation pain after use of peripheral nerve stimulation. Secondary outcomes included improvements in functional status, opioid usage, and mood. Data extraction and risk of bias assessments were performed independently in a blinded manner. Of the 989 studies identified, 13 studies were included consisting of three randomized control trials, seven observational studies, and three case series. While large heterogeneity limited definitive conclusions, the included studies generally demonstrated favorable outcomes regarding pain reduction. Each included study that used an objective pain scale demonstrated clinically significant pain improvements. Per the Grading of Recommendations, Assessment, Development, and Evaluations criteria, there is very low-quality Grading of Recommendations, Assessment, Development, and Evaluations evidence supporting that peripheral nerve stimulation is associated with improvements in pain intensity for postamputation pain. Future prospective, comparative, and well-powered studies assessing the use of peripheral nerve stimulation for postamputation pain are warranted.

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Residual limb pain: An evidence-based review

Cited by 10 publications

References 90 publications

Parietal Lobe Reorganization and Widespread Functional Connectivity Integration in Upper-Limb Amputees: A rs-fMRI Study

Parietal Lobe Reorganization and Widespread Functional Connectivity Integration in Upper-Limb Amputees: A rs-fMRI Study

Targeted muscle reinnervation in managing post‐amputation related pain: A systematic review and meta‐analysis

Peripheral Nerve Stimulation for the Treatment of Post-Amputation Pain: A Systematic Review

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