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Physiotherapy Theory and Practice May 2024Phantom limb pain affects 64% of amputees. Graded Motor Imagery comprises three consecutive application techniques designed to reorganize maladaptive changes that have...
INTRODUCTION
Phantom limb pain affects 64% of amputees. Graded Motor Imagery comprises three consecutive application techniques designed to reorganize maladaptive changes that have occurred after the amputation.
OBJECTIVE
To assess the feasibility of a home-based Graded Motor Imagery intervention, the GraMI protocol, for amputee people with phantom limb pain.
METHODS
Twenty individuals over 18 years of age with upper or lower limb amputation, experiencing phantom limb pain, who were pharmacologically stable, and had been discharged from the hospital were recruited. The experimental group followed the GraMI protocol. Primary outcomes included study processes, such as recruitment time and rate, adherence, compliance, and the acceptability of digital technologies as a treatment tool. Secondary outcomes assessed the impact on phantom limb pain, quality of life, functionality, and depressive symptoms.
RESULTS
On average, seven participants were recruited monthly over a three-month period. No losses were recorded throughout the nine weeks of intervention. Treatment adherence averaged 89.32%, and all participants demonstrated familiarity with the usability of digital technologies. No significant differences were observed between groups ( = .054). However, within the experimental group, intragroup analysis revealed a significant ( = .005) and clinically relevant reduction (>2 points) with a large effect size (0.89) in phantom limb pain.
CONCLUSION
Conducting a multicenter study with a home-based intervention using the GraMI protocol is feasible. Future clinical trials are needed to verify its effectiveness in managing phantom limb pain.
PubMed: 38708842
DOI: 10.1080/09593985.2024.2349759 -
Cureus Apr 2024Cryoneurolysis has been utilized for numerous persistent and intractable painful conditions, including phantom limb pain and postsurgical pain. Although there are...
Cryoneurolysis has been utilized for numerous persistent and intractable painful conditions, including phantom limb pain and postsurgical pain. Although there are reports on the effectiveness of cryoneurolysis in various regions, including the intercostal nerves, the subcostal nerve remains a common culprit of chronic pain for which the literature is scarce. Different modalities are commonly utilized to address subcostal neuropathic pain, such as non-opioid pharmacotherapy, including nonsteroidal anti-inflammatory drugs (NSAIDs) and anticonvulsants, site-specific regional anesthesia, and radiofrequency ablation.However, the analgesia provided by these modalities is often inadequate or short-lived. Cryoneurolysis of the subcostal nerve remains largely unexplored and may provide a promising solution.Here, we present the first technical description of ultrasound and fluoroscopic guided percutaneous cryoneurolysis of the subcostal nerve and the case of a patient with 14 years of lower thoracic rib pain who failed multiple interventions but achieved complete pain resolution at the three-month follow-up through this procedure.
PubMed: 38706996
DOI: 10.7759/cureus.57521 -
Rehabilitacion May 2024The presence of different complications whilst follow-up amputee patients reaches 10-80%. The main objective of this research is to assess the impact of these in the...
INTRODUCTION
The presence of different complications whilst follow-up amputee patients reaches 10-80%. The main objective of this research is to assess the impact of these in the return-to-work of lower-limb traumatic amputation cases.
MATERIALS AND METHODS
A retrospective cohort research was carried out. Clinic-demographic variables information was recollected in order to assess its linkage to different medical-surgical complications and functional outcomes. Survival curves were created to evaluate the return-to-work of patients with and without complications.
RESULTS
A total of 46 patients, on average aged 45.7 years old (91.3% men, 71.7% without comorbidities), were included on this research. The most frequent level of amputation was transtibial (65.2%). Residual limb pain, phantom pain, dermatological-infectious complications and painful neuroma were registered in 80.4%, 58.7%, 50% y 30.4% of the cases respectively. Half of the patients had returned to their workplace after 2years of post-surgical follow-up. The return-to-work rates were significantly lower in patients suffering from residual limb pain (p=0.0083) and from painful neuroma (p=0.0051).
CONCLUSION
Complications are frequent during traumatic-amputee patients' follow-up and, some of them, may impact on the return-to-work rate.
PubMed: 38705100
DOI: 10.1016/j.rh.2024.100850 -
Nigerian Journal of Physiological... Dec 2023The concept of referred pain is an integral part of the anatomy didactic content taught and discussed in all medical school curricula. However, this discussion has...
The concept of referred pain is an integral part of the anatomy didactic content taught and discussed in all medical school curricula. However, this discussion has excluded the topic of phantom limb pain, despite the existence of parallels in neurophysiological explanations between these conditions. This brief viewpoint attempts to reason why phantom limb paresthesia or pain should be included in the fold of refereed pain discussions.
Topics: Humans; Phantom Limb; Neuronal Plasticity; Pain, Referred; Paresthesia
PubMed: 38696692
DOI: No ID Found -
JPRAS Open Jun 2024
PubMed: 38689635
DOI: 10.1016/j.jpra.2024.04.002 -
Plastic Surgery (Oakville, Ont.) May 2024Painful neuromas are a common postoperative complication of limb amputation often treated with secondary reinnervation. Surgical reinnervation include Targeted Muscle...
Targeted Muscle Reinnervation and Regenerative Peripheral Nerve Interfaces Versus Standard Management in the Treatment of Limb Amputation: A Systematic Review and Meta-Analysis.
Painful neuromas are a common postoperative complication of limb amputation often treated with secondary reinnervation. Surgical reinnervation include Targeted Muscle Reinnervation (TMR) and Regenerative Peripheral Nerve Interface (RPNI), and can be primary and secondary. The aim of this review is to assess the effects of primary TMR/RPNI at the time of limb amputation on the incidence and intensity of post-operative neuroma and pain. This review was registered on PROSPERO (CRD42021264360). A search of the following databases was performed in June 2021: Medline, EMBASE, and CENTRAL. Unpublished trials were searched using clinicaltrials.gov. All randomized and non-randomized studies assessing amputation with a reinnervation strategy (TMR, RPNI) were included. Outcomes evaluated included the incidences of painful neuroma, phantom limb pain (PLP), residual limb pain (RLP), as well as severity of pain, and Pain intensity, behavior, and interference (PROMIS). Eleven studies were included in this systematic review, and five observational studies for quantitative synthesis. Observational study evidence suggests that TMR/RPNI results in a statistically significant reduction in incidence, pain scores and PROMIS scores of PLP and RLP. Decreased incidence of neuromas favored primary TMR/RPNI, but this did not achieve statistical significance (p = 0.07). Included studies had moderate to critical risk of bias. The observational data suggests that primary TMR/RPNI reduces incidence, pain scores and PROMIS scores of PLP and RLP. Going forward, randomized trials are warranted to evaluate this research question, particularly to improve the certainty of evidence.
PubMed: 38681253
DOI: 10.1177/22925503221107462 -
Bioengineering (Basel, Switzerland) Apr 2024Dentists, including endodontists, frequently experience musculoskeletal disorders due to unfavourable working postures. Several measures are known to reduce the...
BACKGROUND
Dentists, including endodontists, frequently experience musculoskeletal disorders due to unfavourable working postures. Several measures are known to reduce the ergonomic risk; however, there are still gaps in the research, particularly in relation to dental work in the different oral regions (Quadrants 1-4).
METHODS
In this study (of a pilot character), a total of 15 dentists (8 male and 7 female) specialising in endodontics were measured while performing root canal treatments on a phantom head. These measurements took place in a laboratory setting using an inertial motion capture system. A slightly modified Rapid Upper Limb Assessment (RULA) coding system was employed for the analysis of kinematic data. The significance level was set at = 0.05.
RESULTS
The ergonomic risk for the entire body was higher in the fourth quadrant than in the first quadrant for 80% of the endodontists and higher than in the second quadrant for 87%. For 87% of the endodontists, the ergonomic risk for the right side of the body was significantly higher in the fourth quadrant compared to the first and second quadrant. The right arm was stressed more in the lower jaw than in the upper jaw, and the neck also showed a greater ergonomic risk in the fourth quadrant compared to the first quadrant.
CONCLUSION
In summary, both the total RULA score and scores for the right- and lefthand sides of the body ranged between 5 and 6 out of a possible 7 points. Considering this considerable burden, heightened attention, especially to the fourth quadrant with a significantly higher ergonomic risk compared to Quadrants 1 and 2, may be warranted.
PubMed: 38671821
DOI: 10.3390/bioengineering11040400 -
The Clinical Journal of Pain Apr 2024To quantify the test-retest reliability of three patient-reported outcome measures of pain for people living with phantom limb pain (PLP) and assess impact of...
OBJECTIVES
To quantify the test-retest reliability of three patient-reported outcome measures of pain for people living with phantom limb pain (PLP) and assess impact of test-retest errors on future research and clinical decisions.
METHODS
Thirty-nine participants (30 males), mean (SD) age: 55 (16), mean (SD) years post amputation: 6.8 (8.3), reported their PLP levels on a Visual Analogue Scale (VAS) for pain intensity, the revised Short Form McGill Pain Questionnaire (SF-MPQ-2), and a pain diary, on two occasions 7-14 days apart. Mean systematic change, within-subjects SD, limits of agreement (LOA), coefficient of variation and the intraclass correlation coefficient (ICC) were quantified alongside their respective 95% confidence intervals (95%CI).
RESULTS
Systematic learning effects (mean changes) were not clinically relevant across the VAS, SF-MPQ-2 and pain diary. Within-subjects SDs (95%CI) were 11.8 (9.6-15.3), 0.9 (0.7-1.2), and 8.6 (6.9-11.5), respectively. LOA (95%CI) were 32.6 (26.5-42.4), 2.5 (2-3.3), and 23.9 (19.2-31.8), respectively. ICCs (95%CI) were 0.8 (0.6-0.9), 0.8 (0.7-0.9), and 0.9 (0.8-0.9), respectively, but may have been inflated by sample heterogeneity. The test-retest errors allowed detection of clinically relevant effect sizes with feasible sample sizes in future studies, but individual errors were large.
DISCUSSION
For people with PLP, a pain intensity VAS, the SF-MPQ-2, and a pain diary show an acceptable level of inter-session reliability for use in future clinical trials with feasible sample sizes. Nevertheless, the random error observed for all three of the pain outcome measures suggests they should be interpreted with caution in case studies and when monitoring individuals' clinical status and progress.
PubMed: 38639472
DOI: 10.1097/AJP.0000000000001219 -
Journal of Neurosurgery. Case Lessons Apr 2024Phantom limb pain and traumatic neuromas are not commonly seen in neurosurgical practice. These conditions can present with similar symptoms; however, management of...
BACKGROUND
Phantom limb pain and traumatic neuromas are not commonly seen in neurosurgical practice. These conditions can present with similar symptoms; however, management of traumatic neuroma is often surgical, whereas phantom limb pain is treated with conservative measures.
OBSERVATIONS
A 77-year-old female patient with a long-standing history of an above-the-knee amputation experienced severe pain in her right posterior buttocks area for several years' duration, attributed to phantom limb pain, which radiated down the stump of her leg and was treated with a variety of conservative measures. A recent exacerbation of her pain led to a prolonged hospitalization with magnetic resonance imaging of her leg stump, revealing a mass in the sciatic notch, at a relative distance from the stump. The anatomical location of the mass on the sciatic nerve in the notch led to a presumed radiological diagnosis of nerve sheath tumor, for which she underwent excision. At surgery, a neuroma of the proximal portion of the transected sciatic nerve that had retracted from the amputated stump to the notch was diagnosed.
LESSONS
Traumatic neuromas of transected major nerves after limb amputation should be considered in the differential diagnosis of phantom limb pain.
PubMed: 38621303
DOI: 10.3171/CASE247 -
Journal of Plastic, Reconstructive &... May 2024Globally, over 1 million lower limb amputations are performed annually, with approximately 75% of patients experiencing significant pain, profoundly impacting their... (Review)
Review
BACKGROUND
Globally, over 1 million lower limb amputations are performed annually, with approximately 75% of patients experiencing significant pain, profoundly impacting their quality of life and functional capabilities. Targeted muscle reinnervation (TMR) has emerged as a surgical solution involving the rerouting of amputated nerves to specific muscle targets. Originally introduced to enhance signal amplification for myoelectric prosthesis control, TMR has expanded its applications to include neuroma management and pain relief. However, the literature assessing patient outcomes is lacking, specifically for lower limb amputees. This systematic review aims to assess the effectiveness of TMR in reducing pain and enhancing functional outcomes for patients who have undergone lower limb amputation.
METHODS
A systematic review was performed by examining relevant studies between 2010 and 2023, focusing on pain reduction, functional outcomes and patient-reported quality of life measures.
RESULTS
In total, 20 studies were eligible encompassing a total of 778 extremities, of which 75.06% (n = 584) were lower limb amputees. Average age was 46.66 years and patients were predominantly male (n = 70.67%). Seven studies (35%) reported functional outcomes. Patients who underwent primary TMR exhibited lower average patient-reported outcome measurement information system (PROMIS) scores for phantom limb pain (PLP) and residual limb pain (RLP). Secondary TMR led to improvements in PLP, RLP and general limb pain as indicated by average numeric rating scale and PROMIS scores.
CONCLUSION
The systematic review underscores TMR's potential benefits in alleviating pain, fostering post-amputation rehabilitation and enhancing overall well-being for lower limb amputees.
Topics: Humans; Quality of Life; Amputation, Surgical; Lower Extremity; Nerve Transfer; Muscle, Skeletal; Phantom Limb; Patient Reported Outcome Measures; Pain Management; Amputees
PubMed: 38599000
DOI: 10.1016/j.bjps.2024.03.013