Phantom limb pain: a report of two cases.

Abstract

The efficacy of pre-emptive analgesia for phantom limb pain is still unclear. It is generally accepted that pre hyphen;amputation pain increases the incidence of phantom and stump pain, even if pre-emptive analgesia is performed before and during surgery and in the postoperative period. Two cases of traumatic upper limb amputations are described here with no pre-existing pain. Both received similar antinociceptive treatment by continuous block of the brachial plexus through infusion of ropivacaine 0.375% at 5 ml/h for 10 days. Treatment of case 1 was initiated immediately after surgery; however, this amputee developed intensive phantom limb pain which persisted at 6 months. Early use of the prosthesis after surgery was not possible for this patient. The intensity of phantom limb pain in case 2 decreased significantly after 6 months, even though brachial plexus blockade was not started until 5 weeks post-trauma. This patient used a functional prosthesis intensively beginning early after amputation. Serial magnetoencephalographic recordings were performed in both patients. Only case 2 showed significant changes of cortical reorganization. In case 1 markedly less cortical plasticity was found. A combination of relevant risk factors such as a painful neuroma, behavioural and cognitive coping strategies and the early functional use of prostheses are discussed as important mechanisms contributing to the development of phantom pain and cortical reorganization.

• Authors: S Töpfner, K Wiech, R T Kiefer, K Unertl, N Birbaumer
• Journal: European journal of pain (London, England) (Eur J Pain) Vol. 5 Issue 4 Pg. 449-55 ( 2001) ISSN: 1090-3801 [Print] England
• PMID: 11743711 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright 2001 European Federation of Chapters of the International Association for the Study of Pain.

Chemical References

• Amides
• Anesthetics, Local
• Ropivacaine

Topics

• Adult
• Amides (administration & dosage)
• Anesthetics, Local (administration & dosage)
• Artificial Limbs
• Cerebral Cortex (physiology)
• Female
• Humans
• Male
• Middle Aged
• Neuronal Plasticity (physiology)
• Pain (drug therapy, physiopathology, psychology)
• Phantom Limb (physiopathology, psychology, rehabilitation)
• Ropivacaine