Theraputic Alternatives for Phantom Limb Pain Following Surgery

Ryazankina, Alla; Karelov, Aleksey; Глущенко, В. А.; Розенгард, С. А.; Rogachev, Moscow Immunology named after Dmitry

doi:10.37469/0507-3758-2018-64-1-126-130

Problems in oncology

2018

DOI: 10.37469/0507-3758-2018-64-1-126-130

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Theraputic Alternatives for Phantom Limb Pain Following Surgery

Alla Ryazankina¹,

Aleksey Karelov²,

В. А. Глущенко³

et al.

Abstract: A study of different analgesic methods for phantom limb pain has been performed in 35 patients who had undergone limb amputation or exarticulation because of oncological disease or vascular disorders. Postoperative analgesia consisted of cyclooxygenese inhibitor and weak opioid. High intensive phantom limb pain appeared in 17 (48.6%) patients that required an administration of pregabalin followed by adenosine triphosphate infusion as analgotesting procedure: it had a success in 9 (52.9%) patients. Remaining 6 … Show more

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Cited by 3 publications

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Phantom limb pain: actual concepts of pathophysiology and treatment methods from the standpoint of evidence-based medicine

Mokienko,

Ivkina

2024

РНЖ

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Rationale. Despite a large number of studies on the eﬀectiveness of various pharmacological and non- pharmacological therapies, PLP treatment tactics have not yet been developed, which is largely due to the complex mechanism of the formation of this pathology. Although PLP is classiﬁed as neuropathic pain, standard methods of neuropathic pain therapy are not always eﬀective for this syndrome. To optimize the regimens of existing methods of PLP treatment, as well as the search and clinical trials of new therapeutic approaches, it is necessary to take into account the currently available evidence base.Material and methods. Our analysis included publications on phantom pain treatment methods with a high level of evidence (randomized controlled trials, systematic reviews and meta-analyses). Literature search was performed in Medline PubMed and eLIBRARY systems.Results. The review provides an evidence base for pharmacotherapy methods (opioids, NMDA-receptor antagonists, tricyclic antidepressants, anticonvulsants, local anesthetics), for methods based on the phantom illusion (mirror therapy, motion representation, virtual reality), for non-invasive (transcutaneous electrical neurostimulation, transcranial magnetic stimulation, transcranial electrical stimulation) and invasive (deep brain stimulation, motor cortex stimulation, spinal cord stimulation, dorsal root ganglion stimulation) neuromodulation. Data on the most studied dosing regimens of diﬀerent methods of pharmacological and non-pharmacological therapy are presented.

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Phantom limb pain: actual concepts of pathophysiology and treatment methods from the standpoint of evidence-based medicine

Mokienko,

Ivkina

2024

РНЖ

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Phantom limb pain: actual concepts of pathophysiology and therapeutic targets

Ivkina,

Mokienko

2024

РНЖ

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In the review, we present the main pathogenetic mechanisms of the development of phantom limb pain (PLP) after limb amputation, the prevalence of which can reach 87%. The exact mechanism of PLP remains unknown. The involvement of peripheral and central mechanisms of the formation of PLP is assumed. Peripheral mechanisms include increased excitability and the formation of ectopic activity in the amputation neuromas and in the ganglion cells of the dorsal roots of the spinal cord. The central mechanisms are represented by central sensitization in the dorsal horns of the spinal cord with the development of the “wind up” phenomenon, reorganization processes in the thalamus and cortex with thalamic and cortical remapping, and proprioceptive memory. Also signiﬁcant is the neuromatrix theory, the reduction of feedback from the visual and other sensory systems after deaﬀerentation. PLP therapy methods focused on central mechanisms are: spinal cord stimulation, transcutaneous electrical neurostimulation, deep brain stimulation, non-invasive and invasive methods of cerebral cortex stimulation, mirror therapy, virtual and augmented reality technologies, movement representation and its modiﬁcation “phantom exercises”. In addition, pharmacologic treatment options based on PLP mechanisms can be used: NMDA receptor antagonists, anticonvulsants, tricyclic antidepressants, opioids.

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Problem of Chronic Pain in Oncology and Approaches to Its Relief

Protasova¹,

Goncharova²,

Zhukova³

et al. 2020

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This article reviews modern ideas about the pathogenesis of chronic pain in cancer patients and describes main approaches to its relief. Special attention is focused on factors important for the development of a patient-specific approach to the pathophysiology and management of chronic pain syndrome. These factors include genetics, gender, age, early anamnesis, patients’ immunological and endocrine status, as well as those shedding light on the pathogenetic aspects of chronic pain thus facilitating the choice of an optimal therapeutic approach. The review identifies limitations of pharmacotherapy as the major method of chronic pain management and justifies the need for alternative approaches. The latter include monitoring of the circadian rhythms of pain and various nonspecific effects, such as physical factors, psychological methods or reflex therapy. The experience and possibilities of non–pharmacological methods in the complex pathogenetic therapy of chronic pain are analysed, along with preventive measures permitting the development of chronic pain to be avoided. The pathological disorganizing and stressful role of chronic pain is considered with regard to the theory of functional systems. The pathogenetic significance of chronic pain in carcinogenesis and cancer progression is illustrated by examples from scientific literature. The authors emphasize the necessity of effective pain prevention, including invasive methods, in order to ensure an acceptable quality of life for cancer patients at any stage of the malignant process.

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Theraputic Alternatives for Phantom Limb Pain Following Surgery

Cited by 3 publications

References 9 publications

Phantom limb pain: actual concepts of pathophysiology and treatment methods from the standpoint of evidence-based medicine

Phantom limb pain: actual concepts of pathophysiology and treatment methods from the standpoint of evidence-based medicine

Phantom limb pain: actual concepts of pathophysiology and therapeutic targets

Problem of Chronic Pain in Oncology and Approaches to Its Relief

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