Serotonin reuptake pumps, sodium channels, and the muscarinicĪcetylcholine, alpha 1, histamine 1, and GABA A receptors. TCAs produce theirĮffect by blocking several receptors, including the norepinephrine and (TCAs) are commonly prescribed to treat neuropathies. 14-16Īntidepressants: Tricyclic antidepressants 13 In preliminary studies, the anticonvulsant pregabalin has also shown promise at doses of 300 to 600 mg per day. Carbamazepineĭoses of 400 to 600 mg per day have been effective for treating Used to manage PLP, inhibits sodium-channel activity. Well tolerated however, it is important to monitor renal function and 11Īlthough studies have yielded mixed results, gabapentin is often usedĪs first-line treatment in clinical practice. Significant difference in pain intensity for gabapentin versus placebo. However, a recent study by the Department of Veterans Affairs found no 9 One study concluded that gabapentin effectively improved PLP at doses ranging from 300 to 2,400 mg per day. Mechanism involves high-affinity binding to the alpha 2/delta-1 subunit of voltage-gated calcium channels. That is structurally similar to gamma-aminobutyric acid (GABA). Medications-such as anticonvulsants, antidepressants, opioids,Īnesthetics, and NMDA receptor antagonists-that target multipleĪnticonvulsants: Gabapentin is an anticonvulsant Multifactorial, effective treatment often involves a combination of Overlaps in therapeutic options, it is important to select treatments Often treated with agents used for neuropathic pain. There are currently no guidelines for the management of PLP, which is 8 In this theory, PLP occurs because proprioceptive memory causes the neurons to remain in an active state after amputation. Visual-proprioceptive dissociation involves a disconnect between proprioceptive memory, which refers to the awareness of limb position, and visual perception. In N-methyl-D-aspartate (NMDA) receptor activity results in aĬhange in neuronal firing of the nociceptive neurons, exacerbating PLP. Another proposed mechanism is that the increase Sensitization occurs when neurons in the spinal cord that are notĪssociated with nociception sprout in areas that are responsible for the In these neuromas triggers the hyperexcitability. PNH involves the development of neuromas resulting from the severing 4 There is an association between the degree of cortical reorganization and the intensity of perceived PLP. The nociceptive neurons within the stump are stimulated, pain is Is amputated, the neighboring zones remap these areas in the brain. Reorganization is a phenomenon that involves the primary motor cortexĪnd somatosensory regions of the brain. Proposed mechanisms includeĬortical reorganization, peripheral-nerve hyperexcitability (PNH),Ĭentral sensitization, and visual-proprioceptive dissociation. Peripheral, and psychological components. The etiology of PLP is multifactorial and includes central, 3 An accurate diagnosis is important for appropriate management.
![phantom pain management algorithm phantom pain management algorithm](http://www.tihcij.com/images/chartsgraphs/Algorithm-Fig2-Large.jpg)
In residual limb pain, also known as stump pain, the pain is limited to the remaining stump. Phantom limb sensations are nonpainful feelings experienced inĪbsent limbs. PLP is a sensation of pain in an absent limb, often manifesting asīurning, throbbing, or lancinating pain or the feeling of pins and Other pain disorders, such as phantom limb sensation and residual limb 3Īlthough PLP is prevalent among amputees, it is often mistaken for 1,2 The risk factors for this condition are unknown, but some studies suggest that preamputation pain has an association.
![phantom pain management algorithm phantom pain management algorithm](https://www.researchgate.net/profile/Dominic-Aldington/publication/257599912/figure/fig1/AS:463791071731718@1487587816879/A-pathway-for-management-of-phantom-limb-pain.png)
Undergone limb amputation, and 60% to 80% of these patients develop In the United States, an estimated 1.7 million patients have The United States increases, it is important to become familiar with Novel therapies have shown promise as well. Studied the use of anticonvulsants, antidepressants, anesthetics, N-methyl-D-aspartate While no clear-cut guidelines have beenĭeveloped for the management and treatment of PLP, researchers have Approximately 60% to 80% of amputeesĭevelop this debilitating condition, which is often misdiagnosed.Īlthough the exact cause of PLP is poorly understood, theories suggest a Limb, often experienced as burning, throbbing, or lancinating pain or ABSTRACT: Phantom limb pain (PLP) is a sensation of pain in an absent