4.7 Phantom Limb Pain Flashcards
1
Q
Clinical Signs and Symptoms
A
- Varying development phase
Immed post procedure
Days - weeks - months - even years - May be induced or exacerbated by central neuraxial block
despite previous asympto period
3. Neuropathic fts Shooting Stabbing burning aching
May be a/w stump px
- Location usually distal end of phantom limb
- Variation intensity duration person to person
some improve to point of cessation
other experience constant worsening pain
2
Q
Risk Factors
A
Greater if:
- LL > UL amputation
- Pre amputation pain present
- BL amputations
- Persistent stump pain exists
3
Q
Management
A
- Perioperative analgesic techniques
- Pharmacological Methods
3 Physical Methods
4 Psychological Methods
5 Surgical
4
Q
- Perioperative analgesic techniques
A
- Evidence success is not of clear or of sufficient quality
Methods aim to prevent reprogramming
central nervous system
- Probably occurs during prolonged course preop pain
3. Techniques Central neuraxial block CSE Peripheral nerve block catheters sciatic nerve blocks
5
Q
- Pharmacological Methods
A
- Post op pain
WHO ladder - Neuropathic phantom pain
TCA
Anticonvulsants
Opioids in stepwise manner
either:
1 TCA or Anticonvulsants
2 then TCA + Anticonvulsant
3 then TCA + Anticonvulsant + Opioid
- Lidocaine patch on stump
6
Q
- Physical Methods
A
- Mirror box usage
reverse clenching sensation experienced in pain - Acupuncture
- Hot cold massage treatments
- TENS
- Stump manipulation
7
Q
- Psychological methods
A
- CBT
- Hypnotherapy
- Psychotherapy
- Education techniques
8
Q
- Surgical
A
- Neuroma excision
considered once only
2. MicroDREZotomy Dorsal root entry Destruction of sensory root fibres @ entry point spinal cord and superficial layers of dorsal horn of grey mater
Last resort
High risk of motor or sensory deficit
and significant pain post op
