Phantom limb pain: A report of two cases

Stephanie Töpfner, Katja Wiech, Ralph Thomas Kiefer, Klaus Unertl, Niels Birbaumer

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)449-455
Number of pages7
JournalEuropean Journal of Pain (United Kingdom)
Volume5
Issue number4
DOIs
Publication statusPublished - 2001

Keywords

  • Cortical reorganization
  • Functional use of prostheses
  • Painful neuroma
  • Preventive analgesia
  • Psychological factors in pain

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Neurology
  • Neuropsychology and Physiological Psychology

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