Disease relevance of Phantom Limb

• For phantom limb pain and postherpetic neuralgia, level II and level II studies provided objective evidence of reduced hyperpathia and pain relief was usually substantial either after parenteral or oral ketamine [1].
• CASE SUMMARY: We describe an 83-year-old dialysis-dependent white man who became comatose after a single dose of gabapentin for phantom limb pain [2].
• BACKGROUND: Silas Weir Mitchell (1829 to 1914), one of the most important neurologists in American Medicine, was known for his seminal work on the phantom limb syndrome, causalgia, and nerve injuries [3].
• CONCLUSIONS: The combination of long-term regional analgesia with prolonged block of NMDA receptors might be effective for treatment and prevention of phantom limb pain following traumatic amputations [4].

High impact information on Phantom Limb

• The patient reported here complained of a supernumerary phantom limb during an exacerbation of MS [5].
• Efficacy of the NMDA-receptor antagonist memantine in patients with chronic phantom limb pain--results of a randomized double-blinded, placebo-controlled trial [6].
• Ketamine (bolus at 0.1 mg/kg/5 min followed by an infusion of 7 micrograms/kg/min) was administered intravenously to 11 patients with established stump and phantom limb pain in a double-blind saline-controlled study [7].
• Hyperactivity of N-methyl D-aspartate (NMDA) receptors may be one of the factors in the maintenance of persistent stump and phantom limb pain [7].
• Fluoxetine in phantom limb pain [8].

Chemical compound and disease context of Phantom Limb

• Relief of persistent postamputation stump and phantom limb pain with intrathecal fentanyl [9].
• Preoperative lumbar epidural blockade with bupivacaine and morphine reduces the incidence of phantom limb pain in the first year after operation [10].
• Ketamine hydrochloride in the treatment of phantom limb pain [11].
• Three of 4 patients with accompanying phantom limb pain noted an increase in pain after the injection of gallamine [12].
• CONCLUSIONS: In treatment-naive patients, both amitriptyline and tramadol provided excellent and stable phantom limb and stump pain control with no major adverse events [13].

Anatomical context of Phantom Limb

• These results suggest both a modulatory role for spinal cord serotonin in the events occurring shortly after neurectomy and new therapeutic approaches for the prevention of certain pain syndromes, such as phantom limb pain [14].
• Continuous brachial plexus analgesia and NMDA-receptor blockade in early phantom limb pain: a report of two cases [4].

Gene context of Phantom Limb

• Both pain report and psychological distress were found to be related to use of strategies within factor 2 (Helplessness), the number of different drugs patients used, and the time they had experienced phantom limb pain [15].
• CONCLUSION: The extent to which the subjective experience of perceived stiffness could be dissociated from the assumed original peripheral source was strikingly illustrated in RA patients with phantom limbs [16].
• 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 [17].
• The approach has recently been extended to focal hand dystonia of musicians and possibly phantom limb pain [18].
• BACKGROUND AND OBJECTIVES: Severe phantom limb pain after surgical amputation affects 50% to 67% of patients and is difficult to treat [19].

Analytical, diagnostic and therapeutic context of Phantom Limb

• To test this hypothesis, patients with a phantom limb (PL) who had experienced characteristic RA stiffness prior to amputation were systematically investigated [16].
• Thiopental for phantom limb pain during spinal anesthesia [20].
• RESULTS AND CONCLUSIONS: Administration of oral methadone may be of value in the treatment of phantom limb pain; controlled clinical trials would be appropriate to verify this observation [21].
• This will be illustrated in examples of motor and language rehabilitation after stroke, the treatment of focal hand dystonia, and concomitants of injury-related reorganization such as phantom limb pain [22].

References