Management Phantom pain

1 management

1.1 nonsurgical techniques

1.1.1 mirror box therapy
1.1.2 pharmacological treatment


1.2 surgical techniques

1.2.1 deep-brain stimulation

management

various methods have been used treat phantom limb pain. doctors may prescribe medications reduce pain. antidepressants or antiepileptics have been shown have beneficial effect on reducing phantom limb pain. physical methods such light massage, electrical stimulation, , hot , cold therapy have been used variable results.

there many different treatment options phantom limb pain actively being researched. treatments not take account mechanisms underlying phantom pains, , therefore ineffective. however, there few treatment options have been shown alleviate pain in patients, these treatment options have success rate less 30%. important note rate of success not exceed placebo effect. important note because degree of cortical reorganization proportional phantom limb pains, perturbations amputated regions may increase pain perception.

nonsurgical techniques
mirror box therapy

mirror box therapy allows illusions of movement , touch in phantom limb inducing somatosensory , motor pathway coupling between phantom , real limb. many patients experience pain result of clenched phantom limb, , because phantom limbs not under voluntary control, unclenching becomes impossible. theory proposes phantom limb feels paralyzed because there no feedback phantom brain inform otherwise. vilayanur s. ramachandran believes if brain received visual feedback limb had moved, phantom limb become unparalyzed.

although use of mirror therapy has been shown effective in cases there still no accepted theory of how works. in 2010 study of phantom limb pain, martin diers , colleagues found in randomized controlled trial used graded motor imagery...and mirror training, patients complex regional pain syndrome or phantom limb pain showed decrease in pain improvement in function post-treatment , @ 6-month follow-up. , shown order of treatment mattered. study found mirrored imagery produced no significant cortical activity in patients phantom limb pain , concluded optimal method alter pain , brain representation, , brain mechanisms underlying effects [of] mirror training or motor imagery, still unclear.

a number of small scale research studies have shown encouraging results, there no current consensus effectiveness of mirror therapy. recent reviews of published research literature mosely , ezendam concluded of evidence supporting mirror therapy anecdotal or comes studies had weak methodological quality. in 2011, large scale review of literature on mirror therapy rothgangel summarized current research follows:

stroke there moderate quality of evidence mt [mirror therapy] additional intervention improves recovery of arm function, , low quality of :evidence regarding lower limb function , pain after stroke. quality of evidence in patients complex regional pain syndrome , phantom limb pain low. :firm conclusions not drawn. little known patients benefit mt, , how mt should preferably applied. future studies :with clear descriptions of intervention protocols should focus on standardized outcome measures , systematically register adverse effects.

pharmacological treatment

pharmacological techniques continued in conjunction other treatment options. doses of pain medications needed drop substantially when combined other techniques, discontinued completely. tricyclic antidepressants, such amitriptyline, , sodium channel blockers, carbamazepine, used relieve chronic pain, , have been used in attempt reduce phantom pains. pain relief may achieved through use of opioids, ketamine, calcitonin, , lidocaine.

surgical techniques
deep-brain stimulation

deep brain stimulation surgical technique used alleviate patients phantom limb pain. prior surgery, patients undergo functional brain imaging techniques such pet scans , functional mri determine appropriate trajectory of pain originating. surgery carried out under local anesthetic, because patient feedback during operation needed. in study conducted bittar et al., radiofrequency electrode 4 contact points placed on brain. once electrode in place, contact locations altered according patient felt greatest relief pain. once location of maximal relief determined, electrode implanted , secured skull. after primary surgery, secondary surgery under general anesthesia conducted. subcutaneous pulse generator implanted pectoral pocket below clavicle stimulate electrode. found 3 patients studied had gained satisfactory pain relief deep brain stimulation. pain had not been eliminated, intensity had been reduced on 50% , burning component had vanished.