Stumpf- und Phantomschmerzen

Dwornik, G.; Weiß, Thomas; Hofmann, Gunther O.; Brückner, Lutz

doi:10.1007/s00132-015-3122-z

Cited by 4 publications

(5 citation statements)

References 24 publications

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“…Phantom pain is described as painful sensations in the area of the missing limb, whereas residual limb or stump pain is defined as pain originating from the residual limb [6, 27]. Residual limb pain is considered a multifactorial condition, and there is a need for cooperation between postoperative residual limb care teams and patient-mobilization experts, as a poorly fitted prosthesis may lead to pressure marks, ulcerations, and the inability to perform ADLs [5]. Addressing chronic pain may be especially important for patients who undergo major amputation because of malignant tumors when surviving the disease because these patients tend to be younger and thus may have more recreational or occupational demands in terms of ADLs than patients who are older or who undergo amputations for diabetes or vascular insufficiency [20, 21].…”

Section: Introductionmentioning

confidence: 99%

How Common Are Chronic Residual Limb Pain, Phantom Pain, and Back Pain More Than 20 Years After Lower Limb Amputation for Malignant Tumors?

Döring

Trost

Hofer

et al. 2021

Clin Orthop Relat Res

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Background After major lower limb amputation, persistent pain is common, with up to 85% of patients reporting recurring phantom or residual-limb pain. Although pain management is an important factor of quality of life in patients with lower limb amputations, there are few long-term data regarding the frequency of persistent pain and how it impacts prosthesis use. Questions/purposes (1) How prevalent are different types of pain at long-term follow-up after amputation for malignant tumors? (2) What association do different pain types have with daily prosthesis use? Methods Between 1961 and 1995, 124 major amputations for malignant tumors were performed at one center in Austria in patients (1) who spoke German and (2) whose surgical date resulted in the possibility of a minimum follow-up time of 20 years at the time of this survey; those patients were considered potentially eligible for this retrospective study. The indications for major amputation were to achieve local tumor control in limbs that the surgeon deemed unsalvageable without amputation. Of those 124 patients, 71% (88) had died, 9% (11) could not be reached, and 3% (4) declined to participate. Thus, 58% (21 of 36) of those living at the time of this study and who underwent lower limb amputation between 1961 and 1993 with a median (range) follow-up duration of 41 years (23 to 55) completed a standardized questionnaire, including an assessment of pain and daily prosthesis use during the year before the survey. Phantom pain, residual limb pain, and back pain were each further subclassified into pain frequency, intensity, and restrictions in activities of daily living (ADL) due to the specific pain form and rated on a 5- (pain frequency) and 10-point (pain intensity, restrictions in ADL) numerical rating scale. Before multivariate regression analysis, daily prosthesis use was correlated with pain parameters using Spearman correlation testing. Results Seventeen of 21 patients reported phantom limb and back pain, and 15 patients reported residual limb pain in the past year. Median (range) phantom pain intensity was 7 (1 to 10) points, median residual limb pain intensity was 4 (1 to 9) points, and median back pain intensity was 5 (1 to 10) points. After controlling for relevant confounding variables such as age at amputation, age at survey, and stump length, we found that less intense residual limb pain (defined on a 10-point scale with 1 representing no pain at all and 10 representing extremely strong pain [95% CI 0.3 to 1.0]; r = 0.8; p = 0.003) was associated with greater daily prosthesis use. Higher amputation levels showed a decreased daily prosthesis use compared with patients with lower amputation levels (defined as transfemoral amputation versus knee disarticulation versus transtibial amputation [95% CI 0.3 to 5.1]; r = 0.5; p = 0.03). Conclusion Decades after surgery, many patients with lower limb amputations experience pain that restricts them in terms of ADLs and decreases their daily prosthesis use. This information supports the need for regular residual limb inspections and careful prosthesis fitting even at long-term follow-up, as effective prosthesis fitting is a modifiable cause of residual limb pain. Future studies evaluating long-term treatment effects of pain relief surgery and therapeutic alternatives to conservative pain treatments should be performed, as these approaches may help alleviate pain in patients with refractory postamputation pain. Level of Evidence Level IV, therapeutic study.

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Section: Introductionmentioning

confidence: 99%

How Common Are Chronic Residual Limb Pain, Phantom Pain, and Back Pain More Than 20 Years After Lower Limb Amputation for Malignant Tumors?

Döring

Trost

Hofer

et al. 2021

Clin Orthop Relat Res

View full text Add to dashboard Cite

show abstract

“…RLP represents acute nociceptive pain [4,5]. Most reported pain still present six months after an amputation is RLP, with many cases related to a poorly fitting prosthesis [6,7]. Both RLP and phantom limb pain negatively affect a patient's overall satisfaction with life [4].…”

Section: Introductionmentioning

confidence: 99%

“…Both RLP and phantom limb pain negatively affect a patient's overall satisfaction with life [4]. Dwornik et al described as many as 23 possible causes of RLP (Table 1) [6]. Most causes represent mechanical problems: either intrinsic anatomical aberrations in the residual limb, or extrinsic aberrations caused by prosthetic misfittings, liners that have been used too long, poor liner handling, or silicone allergies.…”

Section: Introductionmentioning

confidence: 99%

“…Most causes represent mechanical problems: either intrinsic anatomical aberrations in the residual limb, or extrinsic aberrations caused by prosthetic misfittings, liners that have been used too long, poor liner handling, or silicone allergies. All of these mechanical aberrations can be resolved by treating the underlying mechanical challenges [6].…”

Section: Introductionmentioning

confidence: 99%

“…Another reported cause of RLP is peripheral arterial disease (PAD) [ 6 ]. Unfortunately, the literature on PAD-related perfusion adaption in the residual limb and its effect on RLP is scarce.…”

Section: Introductionmentioning

confidence: 99%

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Resting TcPO2 levels decrease during liner wear in persons with a transtibial amputation

Berli

Jundt-Ecker

Meier³

et al. 2020

PLoS ONE

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Background In our clinic, a substantial number of patients present with transtibial residual limb pain of no specific somatic origin. Silicone liner induced tissue compression may reduce blood flow, possibly causing residual limb pain. Thus, as a first step we investigated if the liner itself has an effect on transcutaneous oxygen pressure (TcPO2). Methods Persons with unilateral transtibial amputation and residual limb pain of unknown origin were included. Medical history, including residual limb pain, was recorded, and the SF-36 administered. Resting TcPO2 levels were measured in the supine position and without a liner at 0, 10, 20 and 30 minutes using two sensors: one placed in the Transverse plane over the tip of the Tibia End (= TTE), the other placed in the Sagittal plane, distally over the Peroneal Compartment (= SPC). Measurements were repeated with specially prepared liners avoiding additional pressure due to sensor placement. Statistical analyses were performed using SPSS. Results Twenty persons (9 women, 11 men) with a mean age of 68.65 years (range 47-86 years) participated. The transtibial amputation occurred on average 43 months prior to study entry (range 3-119 months). With liner wear, both sensors measured TcPO2 levels that were significantly lower than those measured without a liner (TTE: p < 0.001; SPC: p = 0.002) after 10, 20 and 30 minutes. No significant differences were found between TcPO2 levels over time between the sensors. There were no significant associations between TcPO2 levels and pain, smoking status, age, duration of daily liner use, mobility level, and revision history.

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Effect of electrical stimulation of receptive fields in people with lower limb amputation on variables of gait

et al. 2020

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People with amputation may perceive phantom limb sensations or pain in the amputated body part when ipsilateral body-regions are stimulated. These body-regions are called receptive fields. This study assessed whether receptive fields change in size and position over the course of one month in people with trans-tibial amputation and whether electrical stimulation of these fields in synchrony with walking affects phantom sensations and variables of gait. Thirty-one subjects participated in this study. Receptive fields were mapped seven times over a one month period. Thereafter, the effect of electrical stimulation in synchrony with walking was compared to placebo stimulation in an acute setting with a randomized, single-blind gait analysis in 18 participants. Results showed that receptive field size and position presented an adequate degree of consistency (difference in point of first response position of 4.9 ± 4.8 cm and overlap of total receptive field area of 54.3 ± 35.0 %) for future use of electrical stimulation. Gait parameters for everyday activities (speed, gait width, % stance and swing phase) as well as perception of phantom pain were not altered to a clinically relevant degree by electrical stimulation and no negative effects were reported. In conclusion: Location and size of receptive fields are consistent enough for daily electrical stimulation without laborious daily assessment. If applied acutely, no significant effect on gait or pain could be detected. However, results are promising enough to test chronic application of electrical stimulation during gait in a long-term setting.

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Stumpf- und Phantomschmerzen

Cited by 4 publications

References 24 publications

How Common Are Chronic Residual Limb Pain, Phantom Pain, and Back Pain More Than 20 Years After Lower Limb Amputation for Malignant Tumors?

How Common Are Chronic Residual Limb Pain, Phantom Pain, and Back Pain More Than 20 Years After Lower Limb Amputation for Malignant Tumors?

Resting TcPO2 levels decrease during liner wear in persons with a transtibial amputation

Effect of electrical stimulation of receptive fields in people with lower limb amputation on variables of gait

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