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Phantom limb pain PLP

Maria Jenelyn M Alviar, Tom Hale, Monalisa Dungca
BACKGROUND: This is an updated version of the original Cochrane review published in Issue 12, 2011. Phantom limb pain (PLP) is pain that arises in the missing limb after amputation and can be severe, intractable, and disabling. Various medications have been studied in the treatment of phantom pain. There is currently uncertainty in the optimal pharmacologic management of PLP. OBJECTIVES: This review aimed to summarise the evidence of effectiveness of pharmacologic interventions in treating PLP...
October 14, 2016: Cochrane Database of Systematic Reviews
Jessie Barbin, Vanessa Seetha, Jean-Marie Casillas, Jean Paysant, Dominic Perennou
OBJECTIVE: Phantom limb pain (PLP) is a major problem after limb amputation. Mirror therapy (MT) is a non-pharmacological treatment using representations of movement, the efficacy of which in reducing PLP remains to be clarified. Here, we present the first systematic review on MT efficacy in phantom limb pain (PLP) and phantom limb movement (PLM) in amputees (lower or upper limb). MATERIAL/PATIENTS AND METHODS: A search on MEDLINE, COCHRANE DATABASE and EMBASE, crossing the key words "phantom limb" and "mirror therapy" found studies which were read and analyzed according the PRISMA statement...
September 2016: Annals of Physical and Rehabilitation Medicine
Katleho Limakatso, Lieselotte Corten, Romy Parker
BACKGROUND: Phantom limb pain (PLP) is characterized by the anatomical shifting of neighbouring somatosensory and motor areas into a deafferented cortical area of the brain contralateral to the amputated limb. It has been shown that maladaptive neuroplasticity is positively correlated to the perception of PLP in amputees. Recent studies support the use of graded motor imagery (GMI) and its component to alleviate the severity of PLP and disability. However, there is insufficient collective empirical evidence exploring the effectiveness of these treatment modalities in amputees with PLP...
2016: Systematic Reviews
Esmé G Trevelyan, Warren A Turner, Nicola Robinson
BACKGROUND: Phantom limb pain (PLP) is a prevalent complication post-amputation. Currently, qualitative literature exploring the experience of PLP in amputees is sparse, and little is known about whether the educational needs of amputees are being met. OBJECTIVES: To explore lower limb amputees' descriptive lived experiences of PLP, to understand how PLP affects quality of life and to determine whether amputees feel they are provided with adequate information about PLP...
May 2016: British Journal of Pain
Camila Bonin Pinto, Faddi Ghassan Saleh Velez, Nadia Bolognini, David Crandell, Lotfi B Merabet, Felipe Fregni
BACKGROUND: Despite the multiple available pharmacological and behavioral therapies for the management of chronic phantom limb pain (PLP) in lower limb amputees, treatment for this condition is still a major challenge and the results are mixed. Given that PLP is associated with maladaptive brain plasticity, interventions that promote cortical reorganization such as non-invasive brain stimulation and behavioral methods including transcranial direct current stimulation (tDCS) and mirror therapy (MT), respectively, may prove to be beneficial to control pain in PLP...
2016: JMIR Research Protocols
M Osumi, A Ichinose, M Sumitani, N Wake, Y Sano, A Yozu, S Kumagaya, Y Kuniyoshi, S Morioka
BACKGROUND AND OBJECTIVE: We developed a quantitative method to measure movement representations of a phantom upper limb using a bimanual circle-line coordination task (BCT). We investigated whether short-term neurorehabilitation with a virtual reality (VR) system would restore voluntary movement representations and alleviate phantom limb pain (PLP). METHODS: Eight PLP patients were enrolled. In the BCT, they repeatedly drew vertical lines using the intact hand and intended to draw circles using the phantom limb...
July 5, 2016: European Journal of Pain: EJP
Mahtab Poor Zamany Nejatkermany, Ehsan Modirian, Mohammadreza Soroush, Mehdi Masoumi, Maryam Hosseini
OBJECTIVE: To determine the frequency of phantom limb sensation (PLS) and phantom limb pain (PLP) in children and young adults suffering landmine-related amputation. MATERIALS & METHODS: All youths with amputation due to landmine explosions participated in this study. The proportions of patients with phantom limb sensation/pain, intensity and frequency of pain were reported. Chi square test was used to examine the relationship between variables. Comparison of PLP and PLS between upper and lower amputation was done by unpaired t-test...
2016: Iranian Journal of Child Neurology
Alejandra Malavera, Federico Arturo Silva, Felipe Fregni, Sandra Carrillo, Ronald G Garcia
UNLABELLED: We evaluated the effects of repetitive transcranial magnetic stimulation (rTMS) in the treatment of phantom limb pain (PLP) in land mine victims. Fifty-four patients with PLP were enrolled in a randomized, double-blinded, placebo-controlled, parallel group single-center trial. The intervention consisted of real or sham rTMS of M1 contralateral to the amputated leg. rTMS was given in series of 20 trains of 6-second duration (54-second intertrain, intensity 90% of motor threshold) at a stimulation rate of 10 Hz (1,200 pulses), 20 minutes per day, during 10 days...
August 2016: Journal of Pain: Official Journal of the American Pain Society
J Barbin, V Seetha, J M Casillas, J Paysant, D Pérennou
BACKGROUND AND OBJECTIVE: Phantom limb pain (PLP) is a major problem after limb amputation. Mirror therapy (MT) is a non-pharmacological treatment using representations of movement, the efficacy of which in reducing PLP remains to be clarified. Here, we present the first systematic review on MT efficacy in PLP and phantom limb movement (PLM) in amputees (lower or upper limb). METHODS: A search on Medline, Cochrane Database and Embase, crossing the keywords "Phantom Limb" and "Mirror Therapy" found studies which were read and analyzed according the PRISMA statement...
September 2016: Annals of Physical and Rehabilitation Medicine
Qing-Qing Jin, Dan-Dan Tang, Wei-Wei Peng, Li Hu
Phantom limb pain (PLP) is a hallucination that the patient feels the existence off the limb after its loss and experiences somewhat pain of the missing limb. Such a pain normally appears in the distal end of the missing limb. Currently, the pathomechanism of PLP is still unclear, and the clinical research of PLP mainly relies on the subjective report of the patients and the psychophysical measurements. In this paper, we discuss extensively the pathomechanism of PLP, and summarize comprehensively the advanced methods for studying the pathomechanism of PLP...
October 2015: Sheng Li Ke Xue Jin Zhan [Progress in Physiology]
Paul F Pasquina, Briana N Perry, Aimee L Alphonso, Sacha Finn, Kevin F Fitzpatrick, Jack W Tsao
OBJECTIVE: To investigate the use of rimabotulinumtoxinB (BoNT/B [Myobloc]) compared with placebo in treating hyperhidrosis in the residual limbs of individuals with amputation. DESIGN: Randomized, double-blind, placebo-controlled pilot study. SETTING: Military medical center. PARTICIPANTS: Male participants (N=9) with 11 major amputations of the lower limbs and who complained of excessive sweating in their residual limbs were enrolled in the study between September 24, 2008 to October 28, 2011...
May 2016: Archives of Physical Medicine and Rehabilitation
Giovanni De Caridi, Mafalda Massara, Raffaele Serra, Claudia Risitano, Massimiliano Giardina, Ignazio Eduardo Acri, Pietro Volpe, Antonio David
Phantom limb pain (PLP) is a chronic condition experienced by about 80% of patients who have undergone amputation. In most patients, both the frequency and the intensity of pain attacks diminish with time, but severe pain persists in about 5-10%. Probably, factors in both the peripheral and central nervous system play a role in the occurrence and persistence of pain in the amputated lower limb. The classical treatment of PLP can be divided into pharmacologic, surgical, anesthetic, and psychological modalities...
April 2016: Annals of Vascular Surgery
Jong-Hoo Lee, Jeong-Hyun Byun, Yu-Ri Choe, Seung-Kyu Lim, Ka-Young Lee, In-Sung Choi
A 37-year-old man with a right transfemoral amputation suffered from severe phantom limb pain (PLP). After targeting the affected supplementary motor complex (SMC) or primary motor cortex (PMC) using a neuro-navigation system with 800 stimuli of 1 Hz repetitive transcranial magnetic stimulation (rTMS) at 85% of resting motor threshold, the 1 Hz rTMS over SMC dramatically reduced his visual analog scale (VAS) of PLP from 7 to 0. However, the 1 Hz rTMS over PMC failed to reduce pain. To our knowledge, this is the first case report of a successfully treated severe PLP with a low frequency rTMS over SMC in affected hemisphere...
August 2015: Annals of Rehabilitation Medicine
Ariana Gover-Chamlou, Jack W Tsao
BACKGROUND: In response to rising healthcare costs and the social and economic burden of outpatient rehabilitation services, telepain management has emerged as an exciting alternative method of clinical care. Patients with limb amputations who experience phantom limb pain (PLP) are typically treated unsuccessfully using medications, injections, or additional surgeries. Mirror therapy is a noninvasive, cost-effective alternative to current treatment options for PLP. PATIENTS AND METHODS: We report 2 patients who self-administered mirror therapy at home after receiving detailed instructions from a physician by e-mail...
August 21, 2015: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
Michihiro Osumi, Masahiko Sumitani, Naoki Wake, Yuko Sano, Akimichi Ichinose, Shin-Ichiro Kumagaya, Yasuo Kuniyoshi, Shu Morioka
The relation between phantom limb pain (PLP) and the movement representation of a phantom limb remains controversial in several areas of neurorehabilitation, although there are a few studies in which the representation of phantom limb movement was precisely evaluated. We evaluated the structured movement representation of a phantom limb objectively using a bimanual circle-line coordination task. We then investigated the relation between PLP and the structured movement representation. Nine patients with a brachial plexus avulsion injury were enrolled who perceived a phantom limb and had neuropathic pain...
September 25, 2015: Neuroscience Letters
Sam Eldabe, Katja Burger, Heinrich Moser, Daniel Klase, Stefan Schu, Anders Wahlstedt, Bernard Vanderick, Eric Francois, Jeffery Kramer, Jeyakumar Subbaroyan
OBJECTIVES: Phantom limb pain (PLP) is a neuropathic condition in which pain is perceived as arising from an amputated limb. PLP is distinct from, although associated with, pain in the residual limb and nonpainful phantom sensations of the missing limb. Its treatment is extremely challenging; pharmaceutical options, while commonly employed, may be insufficient or intolerable. Neuromodulatory interventions such as spinal cord stimulation have generated mixed results and may be limited by poor somatotopic specificity...
October 2015: Neuromodulation: Journal of the International Neuromodulation Society
Katherine A Raichle, Travis L Osborne, Mark P Jensen, Dawn M Ehde, Douglas G Smith, Lawrence R Robinson
OBJECTIVES: The current study examined the relationship between preoperative anxiety and acute postoperative phantom limb pain (PLP), residual limb pain (RLP), and analgesic medication use in a sample of persons undergoing lower limb amputation. MATERIALS AND METHODS: Participants included 69 adults admitted to a large level 1 trauma hospital for lower limb amputation. Participants' average pain and anxiety during the previous week were assessed before amputation surgery...
August 2015: Clinical Journal of Pain
Shengai Li, Danielle H Melton, Sheng Li
PURPOSE: To examine whether there is central sensitization in patients with phantom limb pain (PLP) after traumatic limb amputation. METHODS: Seventeen patients after unilateral lower limb amputation secondary to trauma were enrolled. Ten patients had chronic PLP, while the other seven patients had no PLP. Tactile-sensation threshold, cold- and warm-sensation thresholds, cold- and heat-pain thresholds, electrical-sensation threshold (EST), and electrical-pain threshold on the distal residual limb and the symmetrical site on the sound limb were measured in all tested patients...
2015: Journal of Pain Research
Andreas Rothgangel, Susy Braun, Luc de Witte, Anna Beurskens, Rob Smeets
OBJECTIVE: To describe the development and content of a clinical framework for mirror therapy (MT) in patients with phantom limb pain (PLP) following amputation. METHODS: Based on an a priori formulated theoretical model, 3 sources of data collection were used to develop the clinical framework. First, a review of the literature took place on important clinical aspects and the evidence on the effectiveness of MT in patients with phantom limb pain. In addition, questionnaires and semi-structured interviews were used to analyze clinical experiences and preferences of physical and occupational therapists and patients suffering from PLP regarding the application of MT...
April 2016: Pain Practice: the Official Journal of World Institute of Pain
Nadia Bolognini, Viviana Spandri, Francesco Ferraro, Andrea Salmaggi, Alessandro C L Molinari, Felipe Fregni, Angelo Maravita
UNLABELLED: The study explored the analgesic effects of transcranial direct current stimulation (tDCS) over the motor cortex on postamputation phantom limb pain (PLP). Eight subjects with unilateral lower or upper limb amputation and chronic PLP were enrolled in a crossover, double-blind, sham-controlled treatment program. For 5 consecutive days, anodal (active or sham) tDCS was applied over the motor cortex for 15 minutes at an intensity of 1.5 mA. The 5-day treatment with active, but not sham, tDCS induced a sustained decrease in background PLP and in the frequency of PLP paroxysms, which lasted for 1 week after the end of treatment...
July 2015: Journal of Pain: Official Journal of the American Pain Society
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