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A wide variety of treatment approaches have been employed, but mechanism-based specific treatment guidelines are yet to evolve. Phantom limb pain is considered a neuropathic pain, and most treatment recommendations are based on recommendations for neuropathic pain syndromes.
What are the treatment guidelines for phantom limb pain?
Phantom limb pain is considered a neuropathic pain, and most treatment recommendations are based on recommendations for neuropathic pain syndromes. Mirror therapy, a relatively recently proposed therapy for phantom limb pain, has mixed results in randomized controlled trials.
Is mirror therapy effective for phantom limb pain?
Background Phantom limb pain (PLP) occurs in 50% and 80% of amputees. Although it is often classified as a neuropathic pain, few of the large-scale trials of treatments for neuropathic pain included sufficient numbers of PLP sufferers to have confidence that they are effective in this condition.
Is phantom limb pain (PLP) neuropathic pain?
Profound pain reduction after induction of memantine treatment in two patients with severe phantom limb pain. Anesthesia and Analgesia. 2008;107(4):1377–1379.
Does memantine reduce pain in patients with phantom limb pain?
What is the most effective treatment for phantom limb pain?
Medications used in the treatment of phantom pain include: Over-the-counter (OTC) pain relievers. Acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve) might relieve phantom pain. Take these medications only as directed by your doctor.
How do you treat phantom limb pain?
Treatment for phantom limb pain focuses on easing symptoms. They include: Nonsteroidal anti-inflammatory drugs (NSAIDs) or prescription pain relievers. Antidepressants....These include:Neurostimulation.Spinal cord stimulation.Transcutaneous electrical nerve stimulation (TENS).
What treatment seems to help alleviate phantom limb pain and how does it work?
Drugs such as amitriptyline (Elavil), nortriptyline (Pamelor), and tramadol (Conzip, Ultram) can ease nerve pain by changing chemicals in your body that send pain signals. Anticonvulsants. These drugs treat seizures, but some can also help with nerve pain.
Can physical therapy treat phantom limb syndrome?
Physical therapists use a variety of treatment options to help people with phantom limb pain. Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation.
What is mirror therapy for phantom limb pain?
Mirror therapy is a type of therapy that uses vision to treat the pain that people with amputated limbs sometimes feel in their missing limbs. Mirror therapy does this by tricking the brain: it gives the illusion that the missing limb is moving, as the person looks at the real, remaining limb in a mirror.
Can hypnosis help with phantom pain?
Review of studies using hypnotherapy is introduced as an opportunity for practicing hypnotherapist to familiarize themselves with possible proceedings. The outcome reports for hypnotherapy have been mainly positive and show a reduction in phantom limb pain as can be also seen in four author´s case studies included.
How does mirror therapy work?
Mirror therapy uses a mirror to create the illusion that the arm or leg affected by the stroke is moving. After a stroke, mirror therapy can improve movement in affected upper or lower limbs and activities of daily living, and appears useful as a supplement to other stroke rehabilitation activities.
What type of pain is phantom limb pain?
Phantom limb pain is considered a neuropathic pain, and most treatment recommendations are based on recommendations for neuropathic pain syndromes.
What are phantom exercises?
One of the less investigated strategies for the management of PLP is phantom motor execution (PME), also known as phantom exercises. PME involves the imaginary movement of phantom limb in the brain along with the performance of certain actual physical movements.
Does exercise help phantom pain?
CONCLUSION: Phantom exercises appear to be effective in reducing phantom pain, but further research is required to confirm this. The results of this study indicate that phantom exercises can be used safely to alleviate phantom limb pain in lower and upper limb amputees.
How do you assess phantom limb pain?
Phantom pain may be elicited by tapping over existing neuromas. The examination should evaluate other potential sources of pain, including neuromas, wounds on the residual limb, fractures, stroke, lumbar radiculopathy, myofascial pain and other peripheral nerve syndromes.
What databases use phantom limb?
MEDLINE, EMBASE, CINAHL, British Nursing Index, Cochrane and psycINFO database s were searched using “Phantom limb” initially as a MeSH term to identify treatments that had been tried. Then, a secondary search combining phantom limb with each treatment was performed to find papers specific to each therapy. Each paper was assessed for its research strength using the GRADE system.
How many treatments were used to treat PLP?
In 1980, Sherman identified that 43 treatments had been used to control PLP13and since that time, multiple drugs, surgery and complementary therapies have been added to the list. According to a recent Cochrane review of pharmacologic interventions for PLP, there is inconclusive evidence for any single therapy.14
How many therapies were identified for mirror therapy?
Thirty-eight therapies were identified. Overall, the quality of evidence was low. There was one high-quality study which used repetitive transcutaneous magnetic stimulation and found a statistical reduction in pain at day 15 but no difference at day 30. Significant results from single studies of moderate level quality were available for gabapentin, ketamine and morphine; however, there was a risk of bias in these papers. Mirror therapy and associated techniques were assessed through two systematic reviews, which conclude that there is insufficient evidence to support their use.
What is phantom limb pain?
Phantom limb pain (PLP), any painful sensation that refers to an absent limb, is frequently found among persons who have experienced the loss of any body part through amputation [1]. It is estimated that more than 80% of patients with total or partial loss of a limb develop PLP [2]. It seems that PLP is more intense in the distal portion of the phantom limbs and can have different qualities such as shooting, burning, throbbing or cramping pain [1]. In patients with an amputation, PLP can be a distressing and enduring experience. Usually spontaneous resolution of phantom limb pain is very slow, taking many months and often years, and in many cases, the pain becomes chronic with a significant impact on the patient's quality of life [3,4]. The prevalence of limb loss in the United States was 1.6 million in 2005, which is projected to increase by more than double to 3.6 million by 2050 [5]. Given that the prevalence of limb loss is estimated to double in the next four decades, and the negative impacts of phantom pain in these patients, the importance of identifying accessible and cost-effective treatments for phantom pain is increasing [6]. The pathophysiology of PLP is still unknown and is not completely understood, therefore provides a challenge to those involved in the management and treatment of this pain [7]. It has been shown that a range of treatments such as pharmacological treatment, neuromodulation, physical treatment, nerve block and surgical treatment has been unsuccessful in treating PLP and any efficacious methods have yet to be proven [1,8].
What is the pain of PLP?
It seems that PLP is more intense in the distal portion of the phantom limbs and can have different qualities such as shooting, burning, throbbing or cramping pain [1]. In patients with an amputation, PLP can be a distressing and enduring experience.
What is mirror therapy?
Mirror therapy, a non-pharmacological and alternative treatment strategy that has been proven successful in managing phantom pain, is a neurorehabilitation technique designed to remodulate cortical mechanisms of pain. With this technique, patients perform movements using the unaffected limb while watching its mirror reflection superimposed over the (unseen) affected limb, thus creating a visual illusion (and therefore positive feedback to the motor cortex) of movement of the affected limb. The visual illusion of movement of the affected limb generates positive feedback to the motor cortex, which might in turn interrupt the pain cycle [9].
Is mirror therapy effective for PLP?
A few studies on the effectiveness of mirror therapy as a pain management intervention for patients with PLP exist. In a case study by MacLachlan et al., mirror therapy was used to treat PLP in a patient with a lower limb amputation (amputation through the hip due to necrotizing fasciitis) who presented PLP at the time of treatment. The authors showed that during the intervention, there was a significant reduction in the patient's PLP, an increase in the sense of motor control over the phantom limb and a change in the aspects of the phantom limb that was experienced [3]. In addition, Darnall reported a case in which a 35-year-old man with an acquired above-knee amputation of the left lower limb had success with home-based patient-delivered mirror therapy after failing to respond to conventional treatment for PLP; with mirror therapy, his phantom pain resolved, and his nerve pain was well managed [10]. In another pilot study by Darnall et al., 40 patients with unilateral amputations and PLP were studied to evaluate the feasibility and preliminary efficacy of self-delivered home-based mirror therapy for PLP. Patients received an explanation of mirror therapy and were asked to self-treat for 25 minutes daily. Patients completed the home therapy and posted answers to sets of outcomes questionnaires at months 1 and 2 post-treatment. The results of the study showed a significant reduction in average phantom pain intensity at month 1 (n = 31, P= 0.0002) and month 2 (n = 26, P= 0.002). However, patients with higher education levels experienced a greater reduction in pain intensity compared to patients with lower education levels [6].