超声引导下残端神经瘤毁损治疗截肢后疼痛回顾性分析

目的:截肢后疼痛是截肢术后病人常见的神经病理性疼痛,包括残肢痛、幻肢痛和幻肢觉。残端神经瘤形成是引起疼痛的重要外周发病机制,针对痛性神经瘤进行毁损治疗简单易行。旨在研究超声引导下残端神经瘤毁损治疗截肢后神经病理性疼痛病人的短期与长期疗效。方法:回顾分析2016年6月至2019年10月在上海市第六人民医院疼痛科就诊的截肢后残肢痛和/或幻肢痛的病人共53例,其中36例病人最终纳入分析。治疗前记录病人的年龄、性别、截肢位置、病程、残肢痛的疼痛数字评分法(numerical rating scale, NRS)评分、是否伴有幻肢痛。在末次治疗后随访至12个月,记录末次治疗后2周、6月和12月后残肢痛的NRS评分、残肢爆发痛发作次数、幻肢痛的变化,并观察治疗的并发症。结果:共36例病人,治疗后残肢痛NRS评分和幻肢痛均较治疗前缓解,爆发痛的发作次数降低。在术后2周时有效率86.1%,术后6月和12月时有效率均为77.8%。所有病人均无并发症发生。结论:对截肢后疼痛的病人,可以用超声技术寻找是否有残端神经瘤;射频消融和无水乙醇注射毁损痛性神经瘤能有效缓解截肢病人的残端疼痛和幻肢痛(随访12个月),...     

神经妥乐平治疗截肢后幻肢痛的临床观察

目的：评价神经妥乐平对截肢后幻肢痛的疗效及安全性.方法：对17例截肢后幻肢痛患者使用神经妥乐平,采用疼痛视觉模拟评分法（VAS法）来评定疗效并进行统计学分析.结果：治疗后患者疼痛强度有显著性降低（P＜0.01）,无严重的不良反应.结论：神经妥乐平可安全有效治疗截肢后幻肢痛.     

对电击伤截肢后幻肢痛病人的心理因素分析及行为治疗

目的分析电击伤截肢后幻肢痛病人的心理因素及观察对其施以行为治疗的疗效。方法取42例电击伤截肢后出现幻肢痛的患者,随机分为观察组与对照组。两组病人在截肢手术后及出院前分别采用麦基尔疼痛量表和情境一特质焦虑量表进行测评。对照组常规药物止痛;观察组则在此基础上增加认知行为调整及放松训练等。结果经过3～4周的治疗,观察幻肢痛减轻或消失,两组比较差异有显著性P<0.05。结论电击伤截肢病人的焦虑程度与幻肢痛相关;行为治疗对幻肢痛的疗效明显。     

肌筋膜触发点电刺激对下肢截肢后幻肢痛的效果

目的 观察镜像疗法基础上肌筋膜触发点电刺激对下肢截肢后幻肢痛的临床疗效。方法 2020年5月至11月,本院下肢截肢后幻肢痛患者50例随机分为对照组(n = 25)和试验组(n = 25)。对照组采用镜像疗法,试验组于镜像疗法治疗前行肌筋膜触发点电刺激,共4周。治疗前后采用简化McGill疼痛问卷(SF-MPQ)、匹兹堡睡眠质量指数(PSQI)、汉密尔顿焦虑量表(HAMA)、计时“起立-行走”测试(TUGT)和6分钟步行测试(6MWT)进行评估。结果 治疗后,两组各项评定成绩均有显著改善(|t| > 8.210, P < 0.001);除SF-MPQ中现有疼痛强度外,试验组各项评分显著优于对照组(|t| > 5.103, P < 0.001)。结论 单纯镜像疗法可以减轻下肢截肢后幻肢痛患者的疼痛,提高睡眠质量,减轻焦虑,提高行走能力;加用肌筋膜触发点电刺激可进一步提高疗效。     

截肢后幻肢痛的综合康复治疗

目的:探讨以药物为主的综合疗法治疗截肢后幻肢痛的效果。方法:对13例伴有幻肢痛的截肢患者采用三环类抗抑郁药阿米替林和抗癫痫药卡马西平,并配合心理支持治疗,针灸,经皮神经电刺激(TENS)、石蜡疗法、运动疗法等物理疗法进行治疗,用视觉模拟评分法(VAS)、ZUNG抑郁状态自评量表(SDS)于治疗前后对幻肢痛及抑郁状态进行评定。结果:治疗后患者疼痛的强度有显著性降低(P<0.01,t=39.08),患者抑郁评分与治疗前相比也有显著性降低(P<0.01,t=15.55)。结论:采取综合疗法治疗幻肢痛是切实有效的,并初步探讨了其作用的可能机制。     

孟宪杰自拟方剂应用于糖尿病足截肢术后幻肢痛效果分析

目的:分析糖尿病足截肢术后幻肢痛患者应用孟宪杰名老中医自拟方剂治疗后疗效。方法:将符合标准的80例糖尿病足截肢术后幻肢痛患者采用随机数字表法分组,对照组40例给予康复治疗,观察组40例联合姜黄葛根汤口服,2组患者均治疗6周后对比治疗后临床疗效、负性情绪及幻肢痛改善效果。结果:观察组总有效率95.00%高于对照组80.00%,SF-MPQ及HAMA评分均低于对照组(P<0.05)。结论:在康复治疗基础上联合应用孟宪杰教授自拟方剂能够更为有效减轻疼痛,改善负性情绪,进一步提升治疗效果。     

截肢后幻肢痛的综合康复治疗

目的：探讨以药物为主的综合疗法治疗截肢后幻肢痛的效果。方法：对13例伴有幻肢痛的截肢患者采用三环类抗抑郁药阿米替林和抗癫痫药卡马西平，并配合心理支持治疗，针灸，经皮神经电刺激(TENS)、石蜡疗法、运动疗法等物理疗法进行治疗，用视觉模拟评分法(VAS)、ZUNG抑郁状态自评量表(SDS)于治疗前后对幻肢痛及抑郁状态进行评定。结果：治疗后患者疼痛的强度有显著性降低(P&;lt;0.01，t=39．08)，患者抑郁评分与治疗前相比也有显著性降低(P&;lt;0.01，t=15．55)。结论：采取综合疗法治疗幻肢痛是切实有效的，并初步探讨了其作用的可能机制。     

针灸联合康复治疗汶川地震伤员截肢后幻肢痛疗效观察

目的探讨针灸联合康复对幻肢痛的治疗效果。方法将44例存在幻肢痛的5.12汶川地震伤员分为治疗组和对照组各22例,治疗组采用针灸联合康复方法综合治疗,对照组单纯采用康复方法治疗。以简明McGill疼痛问卷表（SF-MPQ）评分作为评价指标,观察两组治疗效果。结果治疗组总有效率为100%,对照组总有效率为81.9%,两组比较差异有显著性意义（P〈0.05）;两组治疗前后组内SF-MPQ评分比较,差异均有显著性意义（P〈0.01）;治疗后组间SF-MPQ评分比较,差异有显著性意义（P〈0.01）。结论针灸和康复治疗联合运用对幻肢痛有很好的疗效,远期疗效稳定。     

脊髓后根入髓区切开术治疗幻肢痛患者的术后护理

幻肢痛是指位于已截除肢体的疼痛,发生于54%～85%的截肢患者[1-2].幻肢痛的机制目前仍不明确,其治疗是临床的一大难题.对于幻肢痛程度并不严重的患者,可尝试药物、神经阻滞、生物反馈等治疗手段.然而对于疼痛剧烈的患者,临床上一直缺乏有效的治疗手段.最新研究[3]表明幻肢痛应用脊髓后根人髓区切开术治疗疗效良好,我科2005年8月至2008年1月共有19例幻肢痛患者接受此手术治疗,现报道如下.     

脊髓后根入髓区切开术治疗幻肢痛患者的术后护理

幻肢痛是指位于已截除肢体的疼痛,发生于54%～85%的截肢患者[1-2].幻肢痛的机制目前仍不明确,其治疗是临床的一大难题.对于幻肢痛程度并不严重的患者,可尝试药物、神经阻滞、生物反馈等治疗手段.然而对于疼痛剧烈的患者,临床上一直缺乏有效的治疗手段.最新研究[3]表明幻肢痛应用脊髓后根人髓区切开术治疗疗效良好,我科2005年8月至2008年1月共有19例幻肢痛患者接受此手术治疗,现报道如下.     

Transcutaneous Electrical Nerve Stimulation for Phantom Pain and Stump Pain in Adult Amputees

Abstract Following amputation, 50% to 90% of individuals experience phantom and/or stump pain. Transcutaneous electrical nerve stimulation (TENS) may prove to be a useful adjunct analgesic intervention, although a recent systematic review was unable to judge effectiveness owing to lack of quality evidence. The aim of this pilot study was to gather data on the effect of TENS on phantom pain and stump pain at rest and on movement. Ten individuals with a transtibial amputation and persistent moderate‐to‐severe phantom and/or stump pain were recruited. Inclusion criteria was a baseline pain score of ≥3 using 0 to 10 numerical rating scale (NRS). TENS was applied for 60 minutes to generate a strong but comfortable TENS sensation at the site of stump pain or projected into the site of phantom pain. Outcomes at rest and on movement before and during TENS at 30 minutes and 60 minutes were changes in the intensities of pain, nonpainful phantom sensation, and prosthesis embodiment. Mean (SD) pain intensity scores were reduced by 1.8 (1.6) at rest (P < 0.05) and 3.9 (1.9) on movement (P < 0.05) after 60 minutes of TENS. For five participants, it was possible to project TENS sensation into the phantom limb by placing the electrodes over transected afferent nerves. Nonpainful phantom sensations and prosthesis embodiment remained unchanged. This study has demonstrated that TENS has potential for reducing phantom pain and stump pain at rest and on movement. Projecting TENS sensation into the phantom limb might facilitate perceptual embodiment of prosthetic limbs. The findings support the delivery of a feasibility trial.     

Phantom limb pain: relief by application of TENS to contralateral extremity

Three adult patients with below-knee amputation of various etiologies were treated at Norristown's Sacred Heart Hospital and Rehabilitation Center in the fall of 1983. The patients ranged in age from 48 to 64 years and two were men. All three had complaints of phantom limb pain originating from various anatomic sites of the amputated extremity. In all three cases the phantom limb pain was severe and hampered prosthetic training. The patients were treated solely by application of the TENS unit to the contralateral extremity at the sites where the phantom pain originated on the amputated limb. All three patients responded to treatment and were able to continue their prosthetic training. A six-month follow-up showed no pain recurrence of phantom limb pain in all three cases.     

Auricular transcutaneous electrical nerve stimulation (TENS) reduces phantom limb pain

The present paper evaluates the efficacy of low frequency, high intensity auricular transcutaneous electrical nerve stimulation (TENS) for the relief of phantom limb pain. Auricular TENS was compared with a no-stimulation placebo condition using a controlled crossover design in a group of amputees with (1) phantom limb pain (Group PLP), (2) nonpainful phantom limb sensations (Group PLS), and (3) no phantom limb at all (Group No PL). Small, but significant, reductions in the intensity of nonpainful phantom limb sensations were found for Group PLS during the TENS but not the placebo condition. In addition, 10 min after receiving auricular TENS, Group PLP demonstrated a modest, yet statistically significant decrease in pain as measured by the McGill Pain Questionnaire. Ratings of mood, sleepiness, and anxiety remained virtually unchanged across test occasions and sessions, indicating that the decrease in pain was not mediated by emotional factors. Further placebo-controlled trials of auricular TENS in patients with phantom limb pain are recommended in order to evaluate the importance of electrical stimulation parameters such as pulse width and rate, and to establish the duration of pain relief.     

Phantom pain and risk factors: a multivariate analysis

Phantom pain has been given considerable attention in literature. Phantom pain reduces quality of life, and patients suffering from phantom pain make heavy use of the medical system. Many risk factors have been identified for phantom pain in univariate analyses, including phantom sensations, stump pain, pain prior to the amputation, cause of amputation, prosthesis use, and years elapsed since amputation. Multivariate analyses are lacking in the literature and, therefore, no estimation of an overall risk for phantom pain can be made. The aim of this study was to analyze risk factors in a multivariate analysis in 536 subjects (19% upper limb amputees and 81% lower limb amputees). These subjects filled out a questionnaire in which the following items were assessed; side, date, level, and reason of amputation, pre-amputation pain, presence or absence of phantom pain, phantom sensations and or stump pain, and prosthesis use. The prevalence of phantom pain was 72% (95% CI: 68 to 76%) for the total group, 41% (95% CI: 31 to 51%) in upper limb amputees and 80% (95% CI: 76 to 83%) in lower limb amputees. The most important risk factors for phantom pain were “bilateral amputation” and “lower limb amputation.” The risk for phantom pain ranged from 0.33 for a 10-year-old patient with a distal upper limb amputation to 0.99 for a subject of 80 years with a bilateral lower limb amputation of which one side is an above knee amputation.     

Phantom pain and phantom sensations in upper limb amputees: an epidemiological study

Phantom pain in subjects with an amputated limb is a well-known problem. However, estimates of the prevalence of phantom pain differ considerably in the literature. Various factors associated with phantom pain have been described including pain before the amputation, gender, dominance, and time elapsed since the amputation. The purposes of this study were to determine prevalence and factors associated with phantom pain and phantom sensations in upper limb amputees in The Netherlands. Additionally, the relationship between phantom pain, phantom sensations and prosthesis use in upper limb amputees was investigated. One hundred twenty-four upper limb amputees participated in this study. Subjects were asked to fill out a self-developed questionnaire scoring the following items: date, side, level, and reason of amputation, duration of experienced pain before amputation, frequencies with which phantom sensations, phantom pain, and stump pain are experienced, amount of trouble and suffering experienced, respectively, related to these sensations, type of phantom sensations, medical treatment received for phantom pain and/or stump pain, and the effects of the treatment, self medication, and prosthesis use. The response rate was 80%. The prevalence of phantom pain was 51%, of phantom sensations 76% and of stump pain 49%; 48% of the subjects experienced phantom pain a few times per day or more; 64% experienced moderate to very much suffering from the phantom pain. A significant association was found between phantom pain and phantom sensations (relative risk 11.3) and between phantom pain and stump pain (relative risk 1.9). No other factors associated with phantom pain or phantom sensations could be determined. Only four patients received medical treatment for their phantom pain. Phantom pain is a common problem in upper limb amputees that causes considerable suffering for the subjects involved. Only a minority of subjects are treated for phantom pain. Further research is needed to determine factors associated with phantom pain.     

Immediate and long-term phantom limb pain in amputees: incidence, clinical characteristics and relationship to pre-amputation limb pain

In a prospective study 58 patients undergoing limb amputation were interviewed the day before operation about their pre-amputation limb pain and 8 days, 6 months and 2 years after limb loss about their stump and phantom limb pain. All but one patient had experienced pain in the limb prior to amputation. Pre-amputation limb pain lasted less than 1 month in 25% of patients and more than 1 month in the remaining 75% of patients. At the first examination the day before amputation 29% had no limb pain. The incidence of phantom pain 8 days, 6 months and 2 years after amputation was 72, 65 and 59%, respectively. Within the first half year after limb loss phantom pain was significantly more frequent in patients with long-lasting pre-amputation limb pain and in patients with pain in the limb immediately prior to amputation. Phantom pain and pre-amputation pain were similar in both localization and character in 36% of patients immediately after amputation but in only 10% of patients later in the course. Both the localization and character of phantom pain changed within the first half year; no further change occurred later in the course. The incidence of stump pain 8 days, 6 months and 2 years after limb loss was 57, 22 and 21%, respectively. It is suggested that preoperative limb pain plays a role in phantom pain immediately after amputation, but probably not in late persistent phantom pain.     

Phantom limb pain in amputees during the first 12 months following limb amputation, after preoperative lumbar epidural blockade

The similarities between phantom limb pain and preoperative limb pain have been noted, and this raises the possibility of modulating the pain by a preoperative blockade. The aim of this study was to investigate if it was possible to reduce postoperative phantom limb pain by giving lumbar epidural blockade (LEB) with bupivacaine and morphine for 72 h prior to the operation. 25 patients were interviewed about their limb pain before limb amputation, and about their phantom limb pain 7 days, 6 months and 1 year after limb loss. 11 patients, of mean age 77 years (52-93), received an LEB, so that they were pain-free for 3 days prior to operation. The control group, 14 patients of mean age 73.4 years (63.86), all had preoperative limb pain. Seven days after operation, 3 patients in the LEB group and 9 patients in the control group had phantom limb pain (P less than 0.10). After 6 months all patients in the LEB group were pain-free, whilst 5 patients in the control group had pain (P less than 0.05). After 1 year, all the patients in the LEB group were still pain-free, and 3 patients in the control group had phantom limb pain (P less than 0.20). Preoperative lumbar epidural blockade with bupivacaine and morphine reduces the incidence of phantom limb pain in the first year after operation.     

Phantom limb, phantom pain and stump pain in amputees during the first 6 months following limb amputation

The incidence and clinical picture of non-painful and painful phantom limb sensations as well as stump pain was studied in 58 patients 8 days and 6 months after limb amputation. The incidence of non-painful phantom limb, phantom pain and stump pain 8 days after surgery was 84, 72 and 57%, respectively. Six months after amputation the corresponding figures were 90, 67 and 22%, respectively. Kinaesthetic sensations (feeling of length, volume or other spatial sensation of the affected limb) were present in 85% of the patients with phantom limb both immediately after surgery and 6 months later. However, 30% noticed a clear shortening of the phantom during the follow-up period; this was usually among patients with no phantom pain. Phantom pain was significantly more frequent in patients with pain in the limb the day before amputation than in those without preoperative limb pain. Of the 67% having some phantom pain at the latest interview 50% reported that pains were decreasing. Four patients (8%), however, reported that phantom pains were worse 6 months after amputation than originally. During the follow-up period the localization of phantom pains shifted from a proximal and distal distribution to a more distal localization. While knifelike, sticking phantom pains were most common immediately after surgery, squeezing or burning types of phantom pain were usually reported later in the course. Possible mechanisms for the present findings either in periphery, spinal cord or in the brain are discussed.