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幻肢痛临床治疗研究进展 总被引:10,自引:0,他引:10
截肢后幻肢痛的危害逐渐受到重视.幻肢痛的发病机制尚未完全阐明,治疗仍很困难.该文综合分析了国内外近年研究进展,总结出一些常用、最新的治疗方法,包括药物治疗、物理治疗、手术治疗和心理治疗等.药物治疗中以三环类抗抑郁药、抗惊厥药、N-甲基-D天冬氨酸受体拮抗剂、镇痛药等最为常用,已证实它们对神经性疼痛有很好的疗效,但对幻肢痛的疗效仍存在争议,尚需作大样本研究.物理治疗似有较好的研究前景,具有操作方便、创伤小等优点,其中假肢使用及生物反馈疗法都有较好的临床效果.对一些特定病变引起的幻肢痛,手术治疗可能有效,但幻肢痛易复发、创伤大,其应用受到限制.心理治疗、行为治疗仍有较好的疗效,可能与逆转了大脑皮质功能重组有关. 相似文献
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目的:探讨多专科协作干预方案对截肢患者术后幻肢痛(PLP)的影响。方法:采用便利抽样法选取2018年1月-2018年12月收治的28例单侧上肢截肢术后出现PLP患者为试验组,实施多专科协作干预方案;2019年1月-2019年12月的28例患者为对照组,采用常规护理干预。比较两组PLP出现次数、焦虑自评量表(SAS)、匹... 相似文献
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目的 研究探讨针刺复合神经阻滞治疗上肢截肢术后幻肢痛(phantom limb pain,PLP)的疗效. 方法 80例上肢PLP患者采用随机数字表法分为4组(每组20例):基本治疗组(A组)、针刺+基本治疗组(B组)、神经阻滞+基本治疗组(C组)、神经阻滞+针刺+基本治疗组(D组).治疗前后分别采用视觉模拟评分法(visual analogue scales,VAS)、简明健康状况调查表(the MOS item short from health survy,SF-36)和综合疗效评估,并分别进行治疗前后和组间比较. 结果 4组患者治疗前后VAS评分及SF-36评分差异均有统计学意义(P<0.05),治疗后VAS评分降低,SF-36评分明显升高;与A组(52±6)比较,B组(42±8)、C组(42±8)、D组(32±6)治疗后VAS评分明显降低,差异有统计学意义(P<0.05);与A组[(精神评分(58±9),身体评分(36±5)]比较,B组[(精神评分(67±9),身体评分(43±4)]、C组[(精神评分(66±6),身体评分(43±5)]、D组[(精神评分(77±10),身体评分(50±6)]治疗后SF-36评分明显升高,差异有统计学意义(P<0.05);与B组、C组比较,D组治疗后VAS评分明显降低,SF-36评分明显升高,差异有统计学意义(P<0.05);4组患者综合疗效比较:治疗5周后,与A组(70%)比较,B组(85%)、C组(85%)、D组(100%)的综合疗效差异有统计学意义(P<0.05),提示B组、C组、D组疗效优于A组,D组疗效优于B组和C组. 结论 采用基本药物和心理治疗联合交感神经阻滞治疗、针刺治疗的中西结合治疗方案能明显提高上肢截肢术后的PLP的疗效,改善患者的生活质量. 相似文献
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外科手术治疗幻肢痛的临床研究 总被引:6,自引:0,他引:6
目的研究立体定向脑内靶点毁损术和脊髓后根入髓区(DREZ)毁损术治疗幻肢痛的临床应用。方法共15例幻肢痛患者,男性14例,女性1例。按手术方式不同分为两组,A组4例,为同期联合毁损对侧中脑脊髓丘脑束加双侧扣带回前部,B组11例,采用患侧对应脊髓节段的DREZ毁损术,包括颈5~胸1 10例,腰2~骶1 1例。采用直观模拟疼痛量表(VAS)和McGill疼痛问卷量表(MPQ)分别在术前和术后进行疼痛状况评分,采用自身配对t检验将术前、术后不同时间的评分进行比较。结果15例患者术后疼痛均消失,A组3个月之内止痛效果稳定,VAS评分和MPQ评分较术前显著降低(P〈0.01);长期随访患者分别在术后4、6、12和18个月疼痛复发。B组1例术后2个月死于严重肺部感染,另10例随访12~24个月,平均14.5个月,止痛效果稳定,VAS评分和MPQ评分较术前均显著降低(P〈0.05)。结论一侧中脑加双侧扣带回前部联合毁损术和脊髓DREZ毁损术均能有效消除幻肢痛,近期疗效确切,DREZ毁损术的长期疗效更为稳定。 相似文献
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Robert J. Hackworth ;Kyle A.Tokarz ;Ian M. Fowler ;Scott C. Wallace ;Eric T. Stedje-Larsen ;俞欣译 ;方向明校 《麻醉与镇痛》2009,(6):102-104
本文报道2例因下肢严重创伤后并发难治性幻肢痛(PLP)大剂量阿片类药物和辅助镇痛药物治疗无效的病例。2例患者均接受大剂量口服美沙酮、静脉PCA二氢吗啡酮和辅助性药物(包括三环类抗抑郁药、非甾体抗炎药和抗癫痫类药物)的治疗,幻肢痛未得到控制。而口服NMDA受体拮抗剂美金刚后,幻肢痛得到缓解,且没有明显的副作用。 相似文献
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幻肢痛是截肢后病人感到已失去的肢体依然存在,且某一部分仍有疼痛。幻肢痛的发病率为50~90%、有2%的病人幻肢发生剧烈的疼痛,性质呈闪电样,烧灼样。常在情绪激动或精神异常时发生。目前对幻肢痛的发生机制有多种学说,治疗方法较多,但效果各异。国内杂志报道也较少,现将我们治疗的1例患者报告如下:1病历资料患者,男,53岁,1991年因车祸致左臂丛神经损伤,在上海长征医院行右腓神经移植左臂丛神经修复术,术后出现左上肢疼痛,并向前臂手指放射,伴有上肢功能障碍及前臂轻度肌肉萎缩。由于剧烈疼痛严重影响患者生活、工作,于2001年行左上肢截肢术… 相似文献
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Santiago Jaramillo Lizeth Jazmin Ramirez Carlos Eduardo Restrepo-Garces Carlos Mario Gómez B Juan Felipe Vargas Silva 《Techniques in Regional Anesthesia and Pain Management》2012,16(4):201-204
Phantom limb pain is a type of chronic pain existing in different organs, not just limbs. The incidence is very high in the postamputation period and treatment can be a challenge. The pharmaceutical treatment strategies in addition to psychological rehabilitative strategies and interventional management play a successful role in the management of these patients. For this article, we conducted a review of literature about pain management for phantom limb pain to identify the treatment modalities, which involved interventional pain management, and an algorithmic approach is proposed. 相似文献
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Since the phantom limb sensation was first described by the French military surgeon Ambroise Pare in the 16th century, the number of studies surrounding phantom limb pain has increased every year. Especially in recent decades, scientists have achieved a better understanding of the mechanism and treatment of phantom limb pain. Although many hypotheses have been agreed and many treatments have been proven effective, scientists still do not have a very systematic understanding of the phantom limbs. The purpose of this review article is to summarize recent researches focusing on phantom limb in order to discuss its definition, mechanisms, and treatments. 相似文献
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Regional anaesthesia for repeat Caesarean section in a patient with phantom limb pain 总被引:1,自引:0,他引:1
D. R. Uncles MB BS FRCA FFARCSI C. J. Glynn MB BS MSc FRCA L. E. S. Carrie MB ChB FRCA DA 《Anaesthesia》1996,51(1):69-70
The triggering of phantom limb pain by subarachnoid or epidural anaesthesia has been well described leading to the suggestion that neuraxial regional anaesthesia is relatively contraindicated in lower limb amputees. We report our experience of the provision of anaesthesia for repeat Caesarean section on two occasions in such a patient. Intrathecal fentanyl and morphine supplementation of bupivacaine successfully abolished peri-operative phantom limb pain, whereas epidural anaesthesia was associated with recurrence of phantom limb pain upon regression of the block 相似文献
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《Journal of hand therapy》2020,33(2):254-262
IntroductionAffordable virtual reality (VR) technology is now widely available. Billions of dollars are currently being invested into improving and mass producing VR and augmented reality products.Purpose of the StudyThe purpose of the present study is to explore the potential of immersive VR to make physical therapy/occupational therapy less painful, more fun, and to help motivate patients to cooperate with their hand therapist.DiscussionThe following topics are covered: a) psychological influences on pain perception, b) the logic of how VR analgesia works, c) evidence for reduction of acute procedural pain during hand therapy, d) recent major advances in VR technology, and e) future directions—immersive VR embodiment therapy for phantom limb (chronic) pain.ConclusionVR hand therapy has potential for a wide range of patient populations needing hand therapy, including acute pain and potentially chronic pain patients. Being in VR helps reduce the patients’ pain, making it less painful for patients to move their hand/fingers during hand therapy, and gamified VR can help motivate the patient to perform therapeutic hand exercises, and make hand therapy more fun. In addition, VR camera–based hand tracking technology may be used to help therapists monitor how well patients are doing their hand therapy exercises, and to quantify whether adherence to treatment increases long-term functionality. Additional research and development into using VR as a tool for hand therapist is recommended for both acute pain and persistent pain patient populations. 相似文献
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BACKGROUND: Chronic neuropathic pain after leg amputation is a significant problem, with a reported incidence during the first year as high as 70%. Intra-operative handling of the nerves during amputation has not been discussed in the literature on post-amputation pain and, in major textbooks, it is recommended that the ischial nerve be ligated, despite the fact that the experimental literature uses nerve ligations to produce neuropathic pain. The purpose of this study was to investigate the clinical practice of nerve handling during leg amputation. METHODS: Trainees with at least 2 years of practice received a questionnaire regarding handling of the nerves during leg amputation; 128 of 149 questionnaires sent (86%) were returned. RESULTS: Ligation of the nerves was used by 31% of surgeons. CONCLUSION: There is no consistency in the management of the large nerves during lower leg amputation. The recommendations in major textbooks may not be appropriate when compared with the experimental literature on nerve ligature models to produce neuropathic pain. Future studies on post-amputation pain should consider intra-operative nerve management. 相似文献