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Search List Of Advanced Clinical Trial Solutions for Amputees! : Treatments
Resources and Related Organizations:
Amputee Coalition
Amputees In Motion
Amputee Resources
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Post-Amputation Pain and Phantom Limb Pain:
What is post-amputation pain?
Post-amputation pain is a poorly understood, yet common, condition that causes significant disability and can be difficult to treat. Amputation pain occurs in approximately 60 to 70% of patients, often arising weeks or months after a limb has been removed due to accident, injury, or disease. Pain following an amputation may develop as either residual limb pain, phantom limb pain, or phantom limb sensation.
• Residual limb pain – pain or discomfort experienced in or at the stump of the amputated limb
• Phantom limb pain – pain or discomfort felt to be coming from the missing limb or body part
• Phantom limb sensation – sensation or perception of movement coming from the missing limb or body part
Post-amputation pain is a broad “catch-all” term, often used to refer to any of the aforementioned (without distinction) or even simply the general pain from the trauma of the amputation itself. The pain is often described as aching, throbbing, shooting, cramping, or burning. Non-painful sensations may include feelings of numbness, itching, paresthesias, twisting, pressure or even the perception of involuntary muscle movements in the residual limb at the amputation site. These sensations may be generalized to the entire missing limb or localized to specific anatomical regions such as the fingers or toes.
What is phantom limb pain?
Phantom limb pain is a type of post-amputation pain that can occur in any part of the body that no longer exists. Phantom pain has been described after mastectomy (phantom breast syndrome), eye removal and even after teeth extraction.
Phantom sensations may be mild at first and decline over time, yet remain to some degree indefinitely. Occasionally the discomfort will progress to severe pain that includes intermittent tremors and muscle spasms.
With time the sensation of a phantom body part can fade away. However in 50% of cases, especially upper limb phantoms, the missing arm seems to get progressively shorter until the patient is left with a sensation of the phantom hand alone, dangling from the stump. This symptom change is referred to as telescoping.
What causes post-amputation pain?
This type of pain is believed to stem from mixed signals that arise from the residual limb or brain. At the end of the stump, nerve fibers may grow a mass, or neuroma, that sends disordered signals to the brain. Meanwhile, in the brain, as other functions gradually take over the part of the brain that had been linked to the limb, painful sensations may arise.
What are the risk factors for post-amputation pain?
Relative risks are indicated as: greater risks > lesser risks
• Pre-amputation pain
• Traumatic amputation > surgical amputation
• Upper extremities > lower extremities
• Amputation on both sides > amputation on only one side
• Area of limb amputation closer to the body > area of limb amputation farther from the body
• Older > younger (e.g. children have lower incidence than adults)
• Female sex
• Poor stump condition and stump pains
• Phantom sensations
• Catastrophizing and certain pain coping-strategies and beliefs
What is stump pain?
Stump pain is common in the early post-amputation period but diminishes as healing occurs. In 5% to 10% of patients, stump pain persists and can even get worse over time.
Stump pain and phantom pain are interconnected. For instance, lingering stump problems such as scars, neuromas (a post-amputation growth containing nervous-system tissue), or bone spurs can directly influence the intensity and duration of phantom pain. A significant association has been found between stump pain and phantom limb pain.
What treatments exist for post-amputation pain?
Treatment can be challenging and should entail a multimodal and multidisciplinary approach that includes oral pain medications combined with rehabilitation therapy (i.e. biofeedback, mirror therapy, etc.).
Providers should remember to look for causes of stump pain and treat these since addressing the cause may reduce the incidence or severity of phantom pain.
Medications:
• Acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs)
• Opioids (narcotic pain medications)
• Antidepressants
• Anticonvulsants
• Beta-blockers
• Muscle relaxants
Physical therapy and behavioral interventions:
• Modalities (i.e. moist heat)
• Ultrasound
• Biofeedback
• Relaxation techniques
• Massage of the amputation area
• TENS (transcutaneous electrical nerve stimulation) of the stump
Interventional pain management treatments:
• Nerve blocks
• Sympathetic nerve blocks
• Neurolysis (i.e. pulsed radiofrequency ablation)
• Intravenous infusion therapy (i.e. ketamine)
What is neurostimulation?
Neurostimulation is the purposeful modulation of the nervous system’s activity. Spinal cord and peripheral nerve stimulation have been performed with varying results. For selected patients who have not obtained adequate relief with medical management, i.e. those who have intractable pain, spinal cord stimulation (SCS) can prove an effective intervention and should be considered.
In 2015, dorsal root ganglion (DRG) stimulation in eight patients with amputation pain was reported to reduce phantom limb and residual limb pain by 53%; one individual reported a complete resolution of pain at 9 months.
Potential newer neurostimulation treatments have been studied in recent years. For example, in 2015, pilot-study results were reported for high-frequency electrical nerve block in post-amputation pain. A randomized clinical trial of repetitive transcranial magnetic stimulation in phantom limb pain was reported in 2016.
• Massage of the amputation area
• TENS (transcutaneous electrical nerve stimulation) of the stump
Interventional pain management treatments:
• Nerve blocks
• Sympathetic nerve blocks
• Neurolysis (i.e. pulsed radiofrequency ablation)
• Intravenous infusion therapy (i.e. ketamine)
Information provided by the International Neuromodulation Society.
WeHeal and Aloha Health Network Partnership:
WeHeal has partnered with Aloha Health Network to publish the above list of currently recruiting amputee clinical trials and host the free access Amputee Advocate Network where you can ask questions and find valuable resources.
Aloha and WeHeal are also launching similar trial and advocate community offerings for a variety of diseases and therapeutic areas, including a list of new treatment technologies for COVID-19.
Read more about this partnership and the process of clinical trial matching on Aloha Health’s blog.
WeHeal is very grateful to our valued sources of information which include Wikipedia, WebMD, ClinicalTrials.gov, Cancer.gov, Infoplease, and the US CDC (Center for Disease Control).