Phantom limb pain(PLP)is not only a physical pain experience but also poses a significant challenge to mental health and quality of life.Currently,the mechanism of PLP treatment is still unclear,and there are many met...Phantom limb pain(PLP)is not only a physical pain experience but also poses a significant challenge to mental health and quality of life.Currently,the mechanism of PLP treatment is still unclear,and there are many methods with varying effects.This article starts with the application research of extended reality technology in PLP treatment,through describing the application of its branch technologies(virtual reality,augmented reality,and mixed reality technology),to lay the foundation for subsequent research,in the hope of finding advanced and effective treatment methods,and providing a basis for future product transformation.展开更多
Phantom limb pain(PLP),a common sequela of amputation,affects up to 86%of amputees and significantly impairs quality of life.PLP is thought to stem from complex central and peripheral nervous system plasticity.Current...Phantom limb pain(PLP),a common sequela of amputation,affects up to 86%of amputees and significantly impairs quality of life.PLP is thought to stem from complex central and peripheral nervous system plasticity.Current treatments,including pharmacological and non-pharmacological approaches,have limited efficacy.Recently,extended reality technologies have emerged as promising tools for PLP management,leveraging immersive sensory input to modulate cortical reorganization.Of note,emerging neural modulation techniques also offer promising alternatives,including peripheral nerve stimulation,repetitive transcranial magnetic stimulation and transcranial direct current stimulation.These approaches demonstrate clinical efficacy in relieving pain,improving functional outcomes and reducing opioid usage.Future research could prioritize large-scale trials to validate the efficacy of nerve stimulation techniques and explore their integration with extended reality technologies for PLP.展开更多
BACKGROUND Supernumerary phantom limb(SPL)sensation is the experience of additional limbs,either single or a pair of limbs.Unique to traumatic spinal cord injuries,we report effect of transcranial direct current stimu...BACKGROUND Supernumerary phantom limb(SPL)sensation is the experience of additional limbs,either single or a pair of limbs.Unique to traumatic spinal cord injuries,we report effect of transcranial direct current stimulation(tDCS)on SPL pain in a patient with cervical cord injury.CASE SUMMARY The subject was a 57-year-old man who was diagnosed with complete spinal cord injury(C6/C5,motor level;C5/C5,sensory level;AIS-A)approximately three months ago.After a period of 2 wk,we administered anodal tDCS over the motor cortex for 15 minutes at an intensity of 1.5 mA.Following that treatment,the patient experienced a decrease of SPL pain intensity and frequency,which lasted for 1 week after the end of treatment.CONCLUSION Targeting the motor cortex through neuromodulation appears to be a promising option for the management of SPL pain.展开更多
Traumatic amputations remain one of the most frequent and disturbing wounds of armed conflict.In this scenario,most amputees develop residual and phantom limb pain,impacting their quality of life.There are several ele...Traumatic amputations remain one of the most frequent and disturbing wounds of armed conflict.In this scenario,most amputees develop residual and phantom limb pain,impacting their quality of life.There are several elective surgical procedures available for both conditions,such as neuroma excision followed by nerve reconstruction,nerve relocation,e.g.,surgically implanting a transected nerve into a muscle,nerve transfers in cases of associated paralysis,and most recently,regenerative peripheral nerve interface surgery.Whenever possible in the post-conflict phase,a coordinated effort between traveling humanitarian surgeons specializing in reconstructive microsurgery and local healthcare providers is essential for successfully treating phantom and chronic residual limb pain in post-conflict amputees.While providing a detailed logistical framework for global humanitarian missions is beyond the scope of this article,we provide a brief perspective on a topic of utmost importance for reconstructive surgeons worldwide:the high-quality care and treatment of refugees and those whose lives have been impacted by conflict,disaster,or displacement.展开更多
Phantom limb pain is a chronic pain syndrome that is difficult to cope with.Despite neurostimulation treatment is indicated for refractory neuropathic pain,there is scant evidence from randomized controlled trials to ...Phantom limb pain is a chronic pain syndrome that is difficult to cope with.Despite neurostimulation treatment is indicated for refractory neuropathic pain,there is scant evidence from randomized controlled trials to recommend it as the treatment choice.Thus,a systematic review was performed to analyze the efficacy of central nervous system stimulation therapies as a strategy for pain management in patients with phantom limb pain.A literature search for studies conducted between 1970 and September 2020 was carried out using the MEDLINE and Embase databases.Principles of The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline were followed.There were a total of 10 full-text articles retrieved and included in this review.Deep brain stimulation,repetitive transcranial magnetic stimulation,transcranial direct current stimulation,and motor cortex stimulation were the treatment strategies used in the selected clinical trials.Repetitive transcranial magnetic stimulation and transcranial direct current stimulation were effective therapies to reduce pain perception,as well as to relieve anxiety and depression symptoms in phantom limb pain patients.Conversely,invasive approaches were considered the last treatment option as evidence in deep brain stimulation and motor cortex stimulation suggests that the value of phantom limb pain treatment remains controversial.However,the findings on use of these treatment strategies in other forms of neuropathic pain suggest that these invasive approaches could be a potential option for phantom limb pain patients.展开更多
The way we experience the world is determined by the way our brain works.The phantom limb phenomenon,which is a delusional belief of the presence of a non-existent limb,has a particular fascination in neurology.This p...The way we experience the world is determined by the way our brain works.The phantom limb phenomenon,which is a delusional belief of the presence of a non-existent limb,has a particular fascination in neurology.This positive phenomenon of the phantom limb raises theoretical questions about its nature.After a stroke,some patients experience the perception of an extra limb in addition to the regular set of two arms and two legs.This complex cognitive and perceptual distortion is called supernumerary phantom limb.Here,we review the pathogenesis and historical aspects,and report a new case.展开更多
About 0.5%of the US population(1.7 million)is living with a lost limb and this number is expected to double by 2050.This number is much higher in other parts of the world.Within days to weeks of an extremity amputatio...About 0.5%of the US population(1.7 million)is living with a lost limb and this number is expected to double by 2050.This number is much higher in other parts of the world.Within days to weeks of an extremity amputation,up to 80%of these individuals develop neuropathic pain presenting as phantom limb pain(PLP).The level of PLP increases significantly by one year and remains chronic and severe for about 10%of individuals.PLP has a serious negative impact on individuals’lives.Current pain treatment therapies,such pharmacological approaches provide limited to no pain relief,some other techniques applied to the central nervous system(CNS)and peripheral nervous system(PNS)reduce or block PLP,but none produces long-term pain suppression.Therefore,new drugs or novel analgesic methods must be developed that prevent PLP from developing,or if it develops,to reduce the level of pain.This paper examines the potential causes of PLP,and present techniques used to prevent the development of PLP,or if it develops,to reduce the level of pain.Finally it presents a novel technique being developed that eliminates/reduces chronic neuropathic pain and which may induce the long-term reduction/elimination of PLP.展开更多
When working at K(?)tzting Hospital of Traditional Chinese Medicine near Munich, Germany from March 1991 to May 1993, the author had treated 9 cases of phantom limb pain by means of acupuncture with satisfactory thera...When working at K(?)tzting Hospital of Traditional Chinese Medicine near Munich, Germany from March 1991 to May 1993, the author had treated 9 cases of phantom limb pain by means of acupuncture with satisfactory therapeutic effect as reported in the following. Clinical Data In this series, all the 9 cases were male, aged 60-79 years, with the course of disease ranging from 3-49 years. Five cases were amputated because of wound in war, 1 case embolism of femoral artery, 1 case tumor in the knee joint, 1 case comminuted展开更多
With the development of neuroscience, substantial advances have been achieved in peripheral nerve regeneration over the past decades. However, peripheral nerve injury remains a critical public health problem because o...With the development of neuroscience, substantial advances have been achieved in peripheral nerve regeneration over the past decades. However, peripheral nerve injury remains a critical public health problem because of the subsequent impairment or absence of sensorimotor function. Uncomfortable complications of peripheral nerve injury, such as chronic pain, can also cause problems for families and society. A number of studies have demonstrated that the proper functioning of the nervous system depends not only on a complete connection from the central nervous system to the surrounding targets at an anatomical level, but also on the continuous bilateral communication between the two. After peripheral nerve injury, the interruption of afferent and efferent signals can cause complex pathophysiological changes, including neurochemical alterations, modifications in the adaptability of excitatory and inhibitory neurons, and the reorganization of somatosensory and motor regions. This review discusses the close relationship between the cerebral cortex and peripheral nerves. We also focus on common therapies for peripheral nerve injury and summarize their potential mechanisms in relation to cortical plasticity. It has been suggested that cortical plasticity may be important for improving functional recovery after peripheral nerve damage. Further understanding of the potential common mechanisms between cortical reorganization and nerve injury will help to elucidate the pathophysiological processes of nerve injury, and may allow for the reduction of adverse consequences during peripheral nerve injury recovery. We also review the role that regulating reorganization mechanisms plays in functional recovery, and conclude with a suggestion to target cortical plasticity along with therapeutic interventions to promote peripheral nerve injury recovery.展开更多
Background: Limb amputation is considered the last resort when the limb is no longer salvageable or when the limb is dead or dying, viable but nonfunctional or endangering the patient’s life. It is associated with pr...Background: Limb amputation is considered the last resort when the limb is no longer salvageable or when the limb is dead or dying, viable but nonfunctional or endangering the patient’s life. It is associated with profound economic, social, and psychological effects on the patients. The aim of this study is to evaluate the quality of life of major limb amputees in a rural setting in western Cameroon. Methods: This was a cross-sectional descriptive and analytical study carried out at the BATSENGLA-DSCHANG community in the West Region of Cameroon. Participants were interviewed and data collected using a pre-defined accredited questionnaire of the WHOQOL-BREF to assess the quality of life. Results: There were 63 participants, and a majority (60.32%) reported trauma as the cause of amputation. Participants with prostheses had a better quality of life. Conclusion: The age range of the study participants was 18 to 85 years with a mean of 46.73 ± 18.31 years. The majority were males (74.6%). Most of them (41.27%) had attained at least a secondary level of education, a majority (80.95%) were unemployed and more than half (55.56%) have less than the guaranteed inter-professional minimum wage. Major limb amputations were mostly due to traumatic causes (72%) and involved the lower limbs. Only a few (12.70%) used prostheses. Almost all of them (90.48%) had symptoms consistent with a phantom limb. The quality of life after major limb amputation in this study was generally fair according to the WHO quality of life tool.展开更多
Objective To review the mechanisms and current clinical application of pharmacological interventions for phantom limb pain. Data sources Both Chinese and English language literatures were searched using MEDLINE （1982...Objective To review the mechanisms and current clinical application of pharmacological interventions for phantom limb pain. Data sources Both Chinese and English language literatures were searched using MEDLINE （1982-2011）, Pubmed （1982-2011） and the Index of Chinese Language Literature （1982-2011 ）. Study selection Data from published articles about pharmacological management of phantom limb pain in recent domestic and foreign literature were selected. Data extraction Data were mainly extracted from 96 articles which are listed in the reference section of this review. Results By reviewing the mechanisms and current clinical application of pharmacological interventions for phantom limb pain, including anticonvulsants, antidepressants, local anaesthetics, N-methyI-D-aspartate receptor antagonists, non-steroidal anti-inflammatory drugs, tramadol, opioids, calcitonin, capsaicin, beta-adrenergic blockers, clonidine, muscle relaxants, and emerging drugs, we examined the efficacy and safety of these medications, outlined the limitations and future directions. Conclusions Although there is lack of evidence-based consensus guidelines for the pharmacological management of phantom limb pain, we recommend tricyclic antidepressants, gabapentin, tramadol, opioids, local anaesthetics and N-methyI-D-aspartate receptor antagonists as the rational options for the treatment of phantom limb pain.展开更多
Phantom limb pain(PLP)is a complex medical condition that is often difficult to treat,and thus can become detrimental to patients’quality of life.No standardized clinical treatments exist and there is no conclusive u...Phantom limb pain(PLP)is a complex medical condition that is often difficult to treat,and thus can become detrimental to patients’quality of life.No standardized clinical treatments exist and there is no conclusive understanding of the underlying mechanisms causing it.Noninvasive brain stimulation(NIBS)has been used to find correlations between changes in brain activity and various brain conditions,including neurological disease,mental illnesses,and brain disorders.Studies have also shown that NIBS can be effective in alleviating pain.Here,we examined the literature on a particular type of NIBS,known as transcranial direct current stimulation(tDCS),and its application to the treatment of PLP.We first discuss the current hypotheses on the working mech-anism of tDCS and then we examine published evidence of its efficacy to treat PLP.We conclude this article by discussing how tDCS alone,and in combination with brain imaging techniques such as electroencephalography(EEG)and magnetic resonance imagining,could be applied to further investigate the mechanisms underlying PLP.展开更多
People with diabetes are 30 times more likely to undergo amputation than the general population.A total of 3.2million people in the UK have been diagnosed with diabetes and by 2025 this number is estimated to be 5mill...People with diabetes are 30 times more likely to undergo amputation than the general population.A total of 3.2million people in the UK have been diagnosed with diabetes and by 2025 this number is estimated to be 5million.One potential complication post amputation is phantom limb pain(PLP),a prevalent and often chronic condition which is difficult to treat.To inform a展开更多
Introduction:Targeted muscle reinnervation(TMR)is increasingly common in the care of major limb amputation to limit amputation-related pain.This review aims to elucidate how chronic pain states and length of delay pri...Introduction:Targeted muscle reinnervation(TMR)is increasingly common in the care of major limb amputation to limit amputation-related pain.This review aims to elucidate how chronic pain states and length of delay prior to TMR affect its success and outcomes.Methods:Manuscripts were collected from three databases.Articles were first screened and excluded based on exclusion criteria.The remaining manuscripts were independently reviewed to determine inclusion.Article and patient demographics,as well as pain outcomes,were extracted.Data were analyzed based on pain condition,amputation vs.neuroma,and time from amputation/injury to surgery.Results:The literature search yielded 723 articles,with 41 meeting the inclusion criteria.Twenty-one articles included patients with residual limb pain(RLP)and phantom limb pain(PLP),including 14 on amputation and 6 on neuroma excision.Five articles included cancer-related amputation.Complex Regional Pain Syndrome(CRPS)was discussed in 3 articles,ischemia or infection in 2 articles,and neurofibromatosis 1 in 1 article.Twenty-two articles described TMR at the time of amputation.Conclusions:TMR is effective at preventing neuroma formation and limiting pain when performed at the time of amputation.Delayed patients had a greater improvement in RLP but less of an improvement in PLP,when assessed against immediate TMR patients who were compared to non-TMR standard amputees.In the presence of chronic pain states,such as CRPS,there is also improved analgesia.However,current clinical data are limited,indicating a need for further research into the use of TMR for chronic pain management.展开更多
Approximately 75%experience phantom(PLP),residual(RLP),or general(GLP)limb pain following lower extremity amputation.Targeted muscle reinnervation(TMR)is a peripheral nerve transfer that reroutes amputated nerves to m...Approximately 75%experience phantom(PLP),residual(RLP),or general(GLP)limb pain following lower extremity amputation.Targeted muscle reinnervation(TMR)is a peripheral nerve transfer that reroutes amputated nerves to motor endplates that can prevent or treat limb pain.This systematic review summarizes pain outcomes following primary and secondary treatment of lower extremity PLP,RLP,and GLP.Primary literature review of three databases-PubMed,EMBASE,MEDLINE-were used for all articles related to TMR and lower extremity limb pain,querying the same keywords:“targeted muscle reinnervation”AND“pain”.Citations were then reviewed and eliminated if only upper extremities were studied or the study lacked pain outcomes.Citations were categorized as primary or secondary TMR.Pain outcomes,including Numerical Rating Scales(NRS)and Patient-Reported Outcome Measurement Information System(PROMIS)Pain scores,were aggregated when appropriate.Ten studies met all inclusion and exclusion criteria after formal review for a total of 431 extremities,of which 79.1%(n=341 limbs)were lower extremities.Average primary TMR PROMIS scores for PLP and RLP were lower than amputees without primary TMR.Average NRS scores and PROMIS Pain scores in secondary TMR demonstrated improvements in PLP,RLP,and GLP.Primary and Secondary TMR does prevent and improve PLP,RLP,and GLP;however,a minority of studies report quantifiable pain outcomes.All future TMR studies should include validated pain outcomes to better quantify the expected pain and quality of life improvements after lower extremity TMR.展开更多
Upper limb loss results in significant physical and psychological impairment and is a major financial burden for both patients and healthcare services.Current myoelectric prostheses rely on electromyographic(EMG)signa...Upper limb loss results in significant physical and psychological impairment and is a major financial burden for both patients and healthcare services.Current myoelectric prostheses rely on electromyographic(EMG)signals captured using surface electrodes placed directly over antagonistic muscles in the residual stump to drive a single degree of freedom in the prosthetic limb(e.g.,hand open and close).In the absence of the appropriate muscle groups,patients rely on activation of biceps/triceps muscles alone(together with a mode switch)to control all degrees of freedom of the prosthesis.This is a non-physiological method of control since it is non-intuitive and contributes poorly to daily function.This leads to the high rate of prosthetic abandonment.Targeted muscle reinnervation(TMR)reroutes the ends of nerves in the amputation stump to nerves innervating“spare”muscles in the amputation stump or chest wall.These then become proxies for the missing muscles in the amputated limb.TMR has revolutionised prosthetic control,especially for high-level amputees(e.g.,after shoulder disarticulation),resulting in more intuitive,fluid control of the prosthesis.TMR can also reduce the intensity of symptoms such as neuroma and phantom limb pain.Regenerative peripheral nerve interface(RPNI)is another technique for increasing the number of control signals without the limitations of finding suitable target muscles imposed by TMR.This involves wrapping a block of muscle around the free nerve ending,providing the regenerating axons with a target organ for reinnervation.These RPNIs act as signal amplifiers of the previously severed nerves and their EMG signals can be used to control prosthetic limbs.RPNI can also reduce neuroma and phantom limb pain.In this review article,we discuss the surgical technique of TMR and RPNI and present outcomes from our experience with TMR.展开更多
Aim:Targeted muscle reinnervation(TMR)is a procedure pioneered to improve control of myoelectric prostheses and was fortuitously found to improve postamputation pain by transferring residual nerve ends from an amputat...Aim:Targeted muscle reinnervation(TMR)is a procedure pioneered to improve control of myoelectric prostheses and was fortuitously found to improve postamputation pain by transferring residual nerve ends from an amputated limb to reinnervate motor nerve units in denervated muscles.This study sought to perform a systematic review of the literature regarding the postamputation pain-related outcomes following TMR.Methods:PubMed database was queried using the key term“targeted muscle reinnervation”.Articles were chosen based on the following criteria:(1)clinical studies on TMR;(2)greater than one subject;(3)studies were case-controls,comparative cohort analyses,controlled trials,or randomized controlled trials;and(4)studies included one or more outcomes of interest:prosthetic use and functionality,improvement or persistence of pain,indications,complications,donor nerves,and technical aspects of TMR.Results:Overall,9 studies including 101 upper extremity and 252 lower extremity nerve transfers were analyzed,with nerve transfer type,amputation location,and specific neurotizations reported.Four studies assessed the efficacy of TMR in addressing phantom limb pain(PLP)and residual limb pain(RLP),with 3 out of 4 studies reporting significant improvements in PROMIS(Patient Reported Outcome Measurement Information System)scores in TMR subjects compared to controls.Five additional studies did not analyze PROMIS scores but reported subjective improvements in pain outcomes.Conclusion:Included studies demonstrated TMR had lower maximal pain and pain intensity,behavior and interference compared to the standard of care.Secondary TMR used to treat patients with established painful neuromas also reported improvement in pain compared to baseline.展开更多
文摘Phantom limb pain(PLP)is not only a physical pain experience but also poses a significant challenge to mental health and quality of life.Currently,the mechanism of PLP treatment is still unclear,and there are many methods with varying effects.This article starts with the application research of extended reality technology in PLP treatment,through describing the application of its branch technologies(virtual reality,augmented reality,and mixed reality technology),to lay the foundation for subsequent research,in the hope of finding advanced and effective treatment methods,and providing a basis for future product transformation.
基金Supported by the Project of Science and Technology of Xuzhou,No.KC23185.
文摘Phantom limb pain(PLP),a common sequela of amputation,affects up to 86%of amputees and significantly impairs quality of life.PLP is thought to stem from complex central and peripheral nervous system plasticity.Current treatments,including pharmacological and non-pharmacological approaches,have limited efficacy.Recently,extended reality technologies have emerged as promising tools for PLP management,leveraging immersive sensory input to modulate cortical reorganization.Of note,emerging neural modulation techniques also offer promising alternatives,including peripheral nerve stimulation,repetitive transcranial magnetic stimulation and transcranial direct current stimulation.These approaches demonstrate clinical efficacy in relieving pain,improving functional outcomes and reducing opioid usage.Future research could prioritize large-scale trials to validate the efficacy of nerve stimulation techniques and explore their integration with extended reality technologies for PLP.
文摘BACKGROUND Supernumerary phantom limb(SPL)sensation is the experience of additional limbs,either single or a pair of limbs.Unique to traumatic spinal cord injuries,we report effect of transcranial direct current stimulation(tDCS)on SPL pain in a patient with cervical cord injury.CASE SUMMARY The subject was a 57-year-old man who was diagnosed with complete spinal cord injury(C6/C5,motor level;C5/C5,sensory level;AIS-A)approximately three months ago.After a period of 2 wk,we administered anodal tDCS over the motor cortex for 15 minutes at an intensity of 1.5 mA.Following that treatment,the patient experienced a decrease of SPL pain intensity and frequency,which lasted for 1 week after the end of treatment.CONCLUSION Targeting the motor cortex through neuromodulation appears to be a promising option for the management of SPL pain.
文摘Traumatic amputations remain one of the most frequent and disturbing wounds of armed conflict.In this scenario,most amputees develop residual and phantom limb pain,impacting their quality of life.There are several elective surgical procedures available for both conditions,such as neuroma excision followed by nerve reconstruction,nerve relocation,e.g.,surgically implanting a transected nerve into a muscle,nerve transfers in cases of associated paralysis,and most recently,regenerative peripheral nerve interface surgery.Whenever possible in the post-conflict phase,a coordinated effort between traveling humanitarian surgeons specializing in reconstructive microsurgery and local healthcare providers is essential for successfully treating phantom and chronic residual limb pain in post-conflict amputees.While providing a detailed logistical framework for global humanitarian missions is beyond the scope of this article,we provide a brief perspective on a topic of utmost importance for reconstructive surgeons worldwide:the high-quality care and treatment of refugees and those whose lives have been impacted by conflict,disaster,or displacement.
文摘Phantom limb pain is a chronic pain syndrome that is difficult to cope with.Despite neurostimulation treatment is indicated for refractory neuropathic pain,there is scant evidence from randomized controlled trials to recommend it as the treatment choice.Thus,a systematic review was performed to analyze the efficacy of central nervous system stimulation therapies as a strategy for pain management in patients with phantom limb pain.A literature search for studies conducted between 1970 and September 2020 was carried out using the MEDLINE and Embase databases.Principles of The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline were followed.There were a total of 10 full-text articles retrieved and included in this review.Deep brain stimulation,repetitive transcranial magnetic stimulation,transcranial direct current stimulation,and motor cortex stimulation were the treatment strategies used in the selected clinical trials.Repetitive transcranial magnetic stimulation and transcranial direct current stimulation were effective therapies to reduce pain perception,as well as to relieve anxiety and depression symptoms in phantom limb pain patients.Conversely,invasive approaches were considered the last treatment option as evidence in deep brain stimulation and motor cortex stimulation suggests that the value of phantom limb pain treatment remains controversial.However,the findings on use of these treatment strategies in other forms of neuropathic pain suggest that these invasive approaches could be a potential option for phantom limb pain patients.
文摘The way we experience the world is determined by the way our brain works.The phantom limb phenomenon,which is a delusional belief of the presence of a non-existent limb,has a particular fascination in neurology.This positive phenomenon of the phantom limb raises theoretical questions about its nature.After a stroke,some patients experience the perception of an extra limb in addition to the regular set of two arms and two legs.This complex cognitive and perceptual distortion is called supernumerary phantom limb.Here,we review the pathogenesis and historical aspects,and report a new case.
文摘About 0.5%of the US population(1.7 million)is living with a lost limb and this number is expected to double by 2050.This number is much higher in other parts of the world.Within days to weeks of an extremity amputation,up to 80%of these individuals develop neuropathic pain presenting as phantom limb pain(PLP).The level of PLP increases significantly by one year and remains chronic and severe for about 10%of individuals.PLP has a serious negative impact on individuals’lives.Current pain treatment therapies,such pharmacological approaches provide limited to no pain relief,some other techniques applied to the central nervous system(CNS)and peripheral nervous system(PNS)reduce or block PLP,but none produces long-term pain suppression.Therefore,new drugs or novel analgesic methods must be developed that prevent PLP from developing,or if it develops,to reduce the level of pain.This paper examines the potential causes of PLP,and present techniques used to prevent the development of PLP,or if it develops,to reduce the level of pain.Finally it presents a novel technique being developed that eliminates/reduces chronic neuropathic pain and which may induce the long-term reduction/elimination of PLP.
文摘When working at K(?)tzting Hospital of Traditional Chinese Medicine near Munich, Germany from March 1991 to May 1993, the author had treated 9 cases of phantom limb pain by means of acupuncture with satisfactory therapeutic effect as reported in the following. Clinical Data In this series, all the 9 cases were male, aged 60-79 years, with the course of disease ranging from 3-49 years. Five cases were amputated because of wound in war, 1 case embolism of femoral artery, 1 case tumor in the knee joint, 1 case comminuted
基金supported by the Key Laboratory of Trauma and Neural Regeneration (Peking University),Ministry of Education of China,No. BMU2020XY005-03National Natural Science Foundation of China,No. 31771322+2 种基金Beijing Science&Technology New Star Cross Project of China,No. 201819Major R&D Program of National Ministry of Science and Technology of China,No. 2018YFB1105504a grant from National Center for Trauma Medicine,Beijing,China,No. BMU2020XY005-01 (all to PXZ)。
文摘With the development of neuroscience, substantial advances have been achieved in peripheral nerve regeneration over the past decades. However, peripheral nerve injury remains a critical public health problem because of the subsequent impairment or absence of sensorimotor function. Uncomfortable complications of peripheral nerve injury, such as chronic pain, can also cause problems for families and society. A number of studies have demonstrated that the proper functioning of the nervous system depends not only on a complete connection from the central nervous system to the surrounding targets at an anatomical level, but also on the continuous bilateral communication between the two. After peripheral nerve injury, the interruption of afferent and efferent signals can cause complex pathophysiological changes, including neurochemical alterations, modifications in the adaptability of excitatory and inhibitory neurons, and the reorganization of somatosensory and motor regions. This review discusses the close relationship between the cerebral cortex and peripheral nerves. We also focus on common therapies for peripheral nerve injury and summarize their potential mechanisms in relation to cortical plasticity. It has been suggested that cortical plasticity may be important for improving functional recovery after peripheral nerve damage. Further understanding of the potential common mechanisms between cortical reorganization and nerve injury will help to elucidate the pathophysiological processes of nerve injury, and may allow for the reduction of adverse consequences during peripheral nerve injury recovery. We also review the role that regulating reorganization mechanisms plays in functional recovery, and conclude with a suggestion to target cortical plasticity along with therapeutic interventions to promote peripheral nerve injury recovery.
文摘Background: Limb amputation is considered the last resort when the limb is no longer salvageable or when the limb is dead or dying, viable but nonfunctional or endangering the patient’s life. It is associated with profound economic, social, and psychological effects on the patients. The aim of this study is to evaluate the quality of life of major limb amputees in a rural setting in western Cameroon. Methods: This was a cross-sectional descriptive and analytical study carried out at the BATSENGLA-DSCHANG community in the West Region of Cameroon. Participants were interviewed and data collected using a pre-defined accredited questionnaire of the WHOQOL-BREF to assess the quality of life. Results: There were 63 participants, and a majority (60.32%) reported trauma as the cause of amputation. Participants with prostheses had a better quality of life. Conclusion: The age range of the study participants was 18 to 85 years with a mean of 46.73 ± 18.31 years. The majority were males (74.6%). Most of them (41.27%) had attained at least a secondary level of education, a majority (80.95%) were unemployed and more than half (55.56%) have less than the guaranteed inter-professional minimum wage. Major limb amputations were mostly due to traumatic causes (72%) and involved the lower limbs. Only a few (12.70%) used prostheses. Almost all of them (90.48%) had symptoms consistent with a phantom limb. The quality of life after major limb amputation in this study was generally fair according to the WHO quality of life tool.
文摘Objective To review the mechanisms and current clinical application of pharmacological interventions for phantom limb pain. Data sources Both Chinese and English language literatures were searched using MEDLINE （1982-2011）, Pubmed （1982-2011） and the Index of Chinese Language Literature （1982-2011 ）. Study selection Data from published articles about pharmacological management of phantom limb pain in recent domestic and foreign literature were selected. Data extraction Data were mainly extracted from 96 articles which are listed in the reference section of this review. Results By reviewing the mechanisms and current clinical application of pharmacological interventions for phantom limb pain, including anticonvulsants, antidepressants, local anaesthetics, N-methyI-D-aspartate receptor antagonists, non-steroidal anti-inflammatory drugs, tramadol, opioids, calcitonin, capsaicin, beta-adrenergic blockers, clonidine, muscle relaxants, and emerging drugs, we examined the efficacy and safety of these medications, outlined the limitations and future directions. Conclusions Although there is lack of evidence-based consensus guidelines for the pharmacological management of phantom limb pain, we recommend tricyclic antidepressants, gabapentin, tramadol, opioids, local anaesthetics and N-methyI-D-aspartate receptor antagonists as the rational options for the treatment of phantom limb pain.
文摘Phantom limb pain(PLP)is a complex medical condition that is often difficult to treat,and thus can become detrimental to patients’quality of life.No standardized clinical treatments exist and there is no conclusive understanding of the underlying mechanisms causing it.Noninvasive brain stimulation(NIBS)has been used to find correlations between changes in brain activity and various brain conditions,including neurological disease,mental illnesses,and brain disorders.Studies have also shown that NIBS can be effective in alleviating pain.Here,we examined the literature on a particular type of NIBS,known as transcranial direct current stimulation(tDCS),and its application to the treatment of PLP.We first discuss the current hypotheses on the working mech-anism of tDCS and then we examine published evidence of its efficacy to treat PLP.We conclude this article by discussing how tDCS alone,and in combination with brain imaging techniques such as electroencephalography(EEG)and magnetic resonance imagining,could be applied to further investigate the mechanisms underlying PLP.
文摘People with diabetes are 30 times more likely to undergo amputation than the general population.A total of 3.2million people in the UK have been diagnosed with diabetes and by 2025 this number is estimated to be 5million.One potential complication post amputation is phantom limb pain(PLP),a prevalent and often chronic condition which is difficult to treat.To inform a
文摘Introduction:Targeted muscle reinnervation(TMR)is increasingly common in the care of major limb amputation to limit amputation-related pain.This review aims to elucidate how chronic pain states and length of delay prior to TMR affect its success and outcomes.Methods:Manuscripts were collected from three databases.Articles were first screened and excluded based on exclusion criteria.The remaining manuscripts were independently reviewed to determine inclusion.Article and patient demographics,as well as pain outcomes,were extracted.Data were analyzed based on pain condition,amputation vs.neuroma,and time from amputation/injury to surgery.Results:The literature search yielded 723 articles,with 41 meeting the inclusion criteria.Twenty-one articles included patients with residual limb pain(RLP)and phantom limb pain(PLP),including 14 on amputation and 6 on neuroma excision.Five articles included cancer-related amputation.Complex Regional Pain Syndrome(CRPS)was discussed in 3 articles,ischemia or infection in 2 articles,and neurofibromatosis 1 in 1 article.Twenty-two articles described TMR at the time of amputation.Conclusions:TMR is effective at preventing neuroma formation and limiting pain when performed at the time of amputation.Delayed patients had a greater improvement in RLP but less of an improvement in PLP,when assessed against immediate TMR patients who were compared to non-TMR standard amputees.In the presence of chronic pain states,such as CRPS,there is also improved analgesia.However,current clinical data are limited,indicating a need for further research into the use of TMR for chronic pain management.
文摘Approximately 75%experience phantom(PLP),residual(RLP),or general(GLP)limb pain following lower extremity amputation.Targeted muscle reinnervation(TMR)is a peripheral nerve transfer that reroutes amputated nerves to motor endplates that can prevent or treat limb pain.This systematic review summarizes pain outcomes following primary and secondary treatment of lower extremity PLP,RLP,and GLP.Primary literature review of three databases-PubMed,EMBASE,MEDLINE-were used for all articles related to TMR and lower extremity limb pain,querying the same keywords:“targeted muscle reinnervation”AND“pain”.Citations were then reviewed and eliminated if only upper extremities were studied or the study lacked pain outcomes.Citations were categorized as primary or secondary TMR.Pain outcomes,including Numerical Rating Scales(NRS)and Patient-Reported Outcome Measurement Information System(PROMIS)Pain scores,were aggregated when appropriate.Ten studies met all inclusion and exclusion criteria after formal review for a total of 431 extremities,of which 79.1%(n=341 limbs)were lower extremities.Average primary TMR PROMIS scores for PLP and RLP were lower than amputees without primary TMR.Average NRS scores and PROMIS Pain scores in secondary TMR demonstrated improvements in PLP,RLP,and GLP.Primary and Secondary TMR does prevent and improve PLP,RLP,and GLP;however,a minority of studies report quantifiable pain outcomes.All future TMR studies should include validated pain outcomes to better quantify the expected pain and quality of life improvements after lower extremity TMR.
文摘Upper limb loss results in significant physical and psychological impairment and is a major financial burden for both patients and healthcare services.Current myoelectric prostheses rely on electromyographic(EMG)signals captured using surface electrodes placed directly over antagonistic muscles in the residual stump to drive a single degree of freedom in the prosthetic limb(e.g.,hand open and close).In the absence of the appropriate muscle groups,patients rely on activation of biceps/triceps muscles alone(together with a mode switch)to control all degrees of freedom of the prosthesis.This is a non-physiological method of control since it is non-intuitive and contributes poorly to daily function.This leads to the high rate of prosthetic abandonment.Targeted muscle reinnervation(TMR)reroutes the ends of nerves in the amputation stump to nerves innervating“spare”muscles in the amputation stump or chest wall.These then become proxies for the missing muscles in the amputated limb.TMR has revolutionised prosthetic control,especially for high-level amputees(e.g.,after shoulder disarticulation),resulting in more intuitive,fluid control of the prosthesis.TMR can also reduce the intensity of symptoms such as neuroma and phantom limb pain.Regenerative peripheral nerve interface(RPNI)is another technique for increasing the number of control signals without the limitations of finding suitable target muscles imposed by TMR.This involves wrapping a block of muscle around the free nerve ending,providing the regenerating axons with a target organ for reinnervation.These RPNIs act as signal amplifiers of the previously severed nerves and their EMG signals can be used to control prosthetic limbs.RPNI can also reduce neuroma and phantom limb pain.In this review article,we discuss the surgical technique of TMR and RPNI and present outcomes from our experience with TMR.
文摘Aim:Targeted muscle reinnervation(TMR)is a procedure pioneered to improve control of myoelectric prostheses and was fortuitously found to improve postamputation pain by transferring residual nerve ends from an amputated limb to reinnervate motor nerve units in denervated muscles.This study sought to perform a systematic review of the literature regarding the postamputation pain-related outcomes following TMR.Methods:PubMed database was queried using the key term“targeted muscle reinnervation”.Articles were chosen based on the following criteria:(1)clinical studies on TMR;(2)greater than one subject;(3)studies were case-controls,comparative cohort analyses,controlled trials,or randomized controlled trials;and(4)studies included one or more outcomes of interest:prosthetic use and functionality,improvement or persistence of pain,indications,complications,donor nerves,and technical aspects of TMR.Results:Overall,9 studies including 101 upper extremity and 252 lower extremity nerve transfers were analyzed,with nerve transfer type,amputation location,and specific neurotizations reported.Four studies assessed the efficacy of TMR in addressing phantom limb pain(PLP)and residual limb pain(RLP),with 3 out of 4 studies reporting significant improvements in PROMIS(Patient Reported Outcome Measurement Information System)scores in TMR subjects compared to controls.Five additional studies did not analyze PROMIS scores but reported subjective improvements in pain outcomes.Conclusion:Included studies demonstrated TMR had lower maximal pain and pain intensity,behavior and interference compared to the standard of care.Secondary TMR used to treat patients with established painful neuromas also reported improvement in pain compared to baseline.
