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Dr. J. Halbert, Dr. M. Crotty and Dr. I.D. Cameron
Department of Rehabilitation and Aged Care, Flinders University,
Bedford Park, South Australia, Australia
OBJECTIVES: The objective was to examine the evidence to determine the optimal
management of phantom limb pain in the preoperative and postoperative phase of
amputations. METHODS: Trials were identified by a systematic search of
MEDLINE, review articles, and references of relevant trials from the period
1966-1999, including only English-language articles. Included trials involved a
control group, any intervention, and reported phantom pain as an outcome.
RESULTS: Twelve trials were identified, including 375 patients whose follow-ups
ranged in duration from 1 week to 2 years. Only three randomized, controlled studies
with parallel groups and three randomized crossover trials were identified. Eight
trials examined treatment of acute phantom pain, including epidural treatments (three
trials), regional nerve blocks (three trials), treatment with calcitonin (one trial), and
transcutaneous electrical nerve stimulation (one trial). Three trials demonstrated a
positive impact of the intervention on phantom limb pain, but the remainder
demonstrated no difference between the intervention and control groups. Four trials
examined late postoperative interventions, including transcutaneous electrical nerve
stimulation (two trials) and the use of Farabloc (a metal threaded sock) and ketamine
(one trial each). With regard to late postoperative interventions, three of the four trials
showed modest short-term reduction of phantom limb pain. There was no relation
between the quality of the trial and a positive result of the intervention.
CONCLUSIONS: Although up to 70% of patients have phantom limb pain after
amputation, there is little evidence from randomized trials to guide clinicians with
treatment. Evidence on preemptive epidurals, early regional nerve blocks, and
mechanical vibratory stimulation provides inconsistent support for these treatments.
There is currently a gap between research and practice in the area of phantom limb
pain.
PMID: 17216399 [PubMed - indexed for MEDLINE] |
