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Lone Nikolajsen - One of the best experts on this subject based on the ideXlab platform.
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Long term effect of spinal cord stimulation in a patient with complex regional Pain syndrome and Phantom Pain syndrome type 1 after amputation
Ugeskrift for laeger, 2008Co-Authors: Thomas Peter Enggaard, Lone Nikolajsen, Christian Scherer, Claus AndersenAbstract:The development of stump and Phantom Pain after limb amputation in patients with complex regional Pain syndrome (CRPS) is very frequent. Stump Pain is typically recurred CRPS and the possibilities for effective pharmacological Pain relief are often limited. Spinal cord stimulation (SCS) has a well-documented Pain relieving effect in patients with CRPS. This case story summarises the long term effect of SCS in a patient with CRPS after two amputations of the right leg. Pharmacological Pain therapies as well as Guanethidine blockade were found to be ineffective.
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randomised trial of epidural bupivacaine and morphine in prevention of stump and Phantom Pain in lower limb amputation
The Lancet, 1997Co-Authors: Lone Nikolajsen, Susanne Ilkjær, Karsten Krøner, Jørgen H Christensen, Troels S. JensenAbstract:BACKGROUND: Epidural analgesia before limb amputation is commonly used to reduce postamputation Pain. But there have been no controlled studies with large numbers of patients to prove such a pre-emptive effect. We investigated whether postamputation stump and Phantom Pain in the first year is reduced by preoperative epidural blockade with bupivacaine and morphine. METHODS: In a randomised, double-blind trial, 60 patients scheduled for lower-limb amputation were randomly assigned epidural bupivacaine (0.25% 4-7 mL/h) and morphine (0.16-0.28 mg/h) for 18 h before and during the operation (29 patients; blockade group) or epidural saline (4-7 mL/h) and oral or intramuscular morphine (31 patients; control group). All patients had general anaesthesia for the amputation and were asked about stump and Phantom Pain after 1 week and then after 3, 6, and 12 months by two independent examiners. Study endpoints were rate of stump and Phantom Pain, intensity of stump and Phantom Pain, and consumption of opioids. FINDINGS: Two patients in each group were withdrawn before amputation. The groups were well matched in baseline characteristics. Median duration of preoperative saline treatment was 18.5 h (IQR 17-20). Median duration of preoperative epidural blockade in the blockade group was 18 h (15-20.3). The combined median duration of postoperative epidural Pain treatment in both groups was 166 h (89.3-308.3). After 1 week, 14 (52%) patients in the blockade group and 15 (56%) in the control group had Phantom Pain (95% CI - 30.6 to 22.7, p = 0.9). The figures for blockade versus control group were: 14 (82%) vs ten (50%; 4.0 to 60.8, p = 0.09) at 3 months; 13 (81%) vs 11 (55%; -2.7 to 55.3, p = 0.2) at 6 months; and nine (75%) vs 11 (69%; -27.0 to 39.6, p = 1.0) at 12 months. Intensity of stump and Phantom Pain and consumption of opioids were similar in both groups at all four postoperative interviews. INTERPRETATION: Perioperative epidural blockade started a median of 18 h (15-20.3) before the amputation and continued into the postoperative period does not prevent Phantom or stump Pain.
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The influence of preamputation Pain on postamputation stump and Phantom Pain.
Pain, 1997Co-Authors: Lone Nikolajsen, Susanne Ilkjær, Karsten Krøner, Jørgen H Christensen, Troels S. JensenAbstract:The significance of preamputation Pain for the development of postamputation stump and Phantom Pain has been discussed over the years and is still a matter of dispute. It has been argued that preamputation Pain increases the risk of Phantom Pain and that Phantom Pain is a revivification of Pain experienced before the amputation. The purpose of this prospective study was to clarify the relation between preamputation Pain and Phantom Pain. Fifty-six patients scheduled for amputation of a lower limb were interviewed the day before the amputation about preamputation Pain and about stump and Phantom Pain 1 week, 3 and 6 months after the amputation. Pain was quantitated and described using a visual analogue scale (VAS), 10 different word descriptors, the McGill Pain Questionnaire (MPQ) and the patients' own words. If Phantom Pain was present patients were asked if the Pain was similar to any Pain experienced before the amputation. At each postoperative interview patients were asked to recall preamputation Pain intensity. Location of Pain and analgesic requirements were registered. Preamputation Pain significantly increased the incidence of stump Pain (P = 0.04) and Phantom Pain (P = 0.04) after 1 week and the incidence of Phantom Pain after 3 months (P = 0.03). About 42% of the patients reported that their Phantom Pain resembled the Pain they had experienced at the time of the amputation. However, there was no relation between the patients' own opinion about similarity between preamputation Pain and Phantom Pain and the actual similarity found when comparing pre- and postoperative recordings of Pain. Patients significantly overestimated preamputation Pain intensity after 6 months.
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The effect of ketamine on Phantom Pain: a central neuropathic disorder maintained by peripheral input
Pain, 1996Co-Authors: Lone Nikolajsen, Carsten L. Hansen, Jesper Ellerbæk Nielsen, Johnny Keller, Lars Arendt-nielsen, Troels S. JensenAbstract:Hyperactivity of N-methyl D-aspartate (NMDA) receptors may be one of the factors in the maintenance of persistent stump and Phantom limb Pain. 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. All 11 patients responded with a decrease in the rating of stump and Phantom limb Pain assessed by visual analogue scale (VAS) and McGill Pain Questionnaire (MPQ). Ketamine increased pressure-Pain thresholds significantly. Wind-up like Pain (Pain evoked by repeatedly tapping the dysaesthetic skin area) was reduced significantly by ketamine. In contrast, no effect was seen on Pain evoked by repeated thermal stimuli. Side effects were observed in nine patients. The results support the notion that stump and Phantom Pain are generated by activity in afferent fibres activated by mechanical but not by thermal stimuli and that the NMDA receptor is involved in the maintenance of postamputation Pain states. NMDA receptor antagonists may have a potential in the treatment of stump and Phantom limb Pain.
Pieter U. Dijkstra - One of the best experts on this subject based on the ideXlab platform.
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Amputation, Phantom Pain and subjective well-being
International Journal of Rehabilitation Research, 2007Co-Authors: Joline C. Bosmans, Jan H. B. Geertzen, Cees P. Van Der Schans, Theo P.b.m. Suurmeijer, Marieke Hulsink, Pieter U. DijkstraAbstract:The purpose of this qualitative study was to explore the impact of an amputation and of Phantom Pain on the subjective well-being of amputees. Sixteen lower-limb amputees were interviewed. A semi-structured interview and two Visual Analogue Scales were used. To interpret the results, a new socio-medical model joining two models, 'The Disablement Process model' and the 'Social Production Function theory', was used. Questions were asked concerning the factors influencing patients' subjective well-being prior to, at the time of and after an amputation. These factors were patients' medical history, their Phantom sensations and Phantom Pain, their daily activities, the social support they received, and the influence of an amputation and Phantom Pain on long-term behaviour and on their subjective well-being. All factors were found to have an influence on the individual's subjective well-being. All these factors, however, seemed to reinforce each other. Therefore, the greatest influence of factors on subjective well-being occurred when more than one factor was involved. Substituting certain activities by others then becomes less and less effective in inducing a sense of subjective well-being.
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Phantom Pain: a sensitivity analysis.
Disability and Rehabilitation, 2004Co-Authors: Susanne Borsje, Joline C. Bosmans, C. P. Van Der Schans, Joannes Geertzen, Pieter U. DijkstraAbstract:Purpose: To analyse how decisions to dichotomise the frequency and impediment of Phantom Pain into absent and present influence the outcome of studies by performing a sensitivity analysis on an existing database.Method: Five hundred and thirty-six subjects were recruited from the database of an orthopaedic workshop and filled out a questionnaire in which the following items were assessed: demographics, side, date, level and reason of amputation, presence and frequency of Phantom sensations, Phantom Pain and stump Pain, and impediment due to Phantom Pain.Results: The prevalence of Phantom Pain ranged from 7 – 72% when different cut off points for the frequency of Phantom Pain were applied. The significance of the various risk factors for the prevalence of Phantom Pain changed when different cut off points were applied. Only stump Pain and Phantom sensations were significant risk factors for all cut off points. Risk factors for the impediment of Phantom Pain changed when different cut off points were applie...
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Phantom Pain and health related quality of life in lower limb amputees
Journal of Pain and Symptom Management, 2002Co-Authors: Cees P Van Der Schans, Jan H. B. Geertzen, Tanneke Schoppen, Pieter U. DijkstraAbstract:Abstract Amputation of a limb may affect quality of life. However, little is known concerning health-related quality of life in amputees. The purposes of this study were to describe health-related quality of life in a population of lower limb amputees and to investigate potential determinants, including Phantom Pain. Data from 437 patients with a lower limb amputation were analyzed in this cross-sectional study. Amputation-related problems were investigated using a questionnaire. Health-related quality of life was investigated using the RAND-36 DLV. Amputees with Phantom Pain had a poorer health-related quality of life than amputees without Phantom Pain. In general, the most important amputation-specific determinants of health-related quality of life were ‘walking distance' and ‘stump Pain.'
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Phantom Pain and risk factors: a multivariate analysis.
Journal of Pain and Symptom Management, 2002Co-Authors: Pieter U. Dijkstra, Jan H. B. Geertzen, Roy E. Stewart, Cees P. Van Der SchansAbstract:Phantom Pain has been given considerable attention in literature. Phantom Pain reduces quality of life, and patients suffering from Phantom Pain make heavy use of the medical system. Many risk factors have been identified for Phantom Pain in univariate analyses, including Phantom sensations, stump Pain, Pain prior to the amputation, cause of amputation, prosthesis use, and years elapsed since amputation. Multivariate analyses are lacking in the literature and, therefore, no estimation of an overall risk for Phantom Pain can be made. The aim of this study was to analyze risk factors in a multivariate analysis in 536 subjects (19% upper limb amputees and 81% lower limb amputees). These subjects filled out a questionnaire in which the following items were assessed; side, date, level, and reason of amputation, pre-amputation Pain, presence or absence of Phantom Pain, Phantom sensations and or stump Pain, and prosthesis use. The prevalence of Phantom Pain was 72% (95% CI: 68 to 76%) for the total group, 41% (95% CI: 31 to 51%) in upper limb amputees and 80% (95% CI: 76 to 83%) in lower limb amputees. The most important risk factors for Phantom Pain were "bilateral amputation" and "lower limb amputation." The risk for Phantom Pain ranged from 0.33 for a 10-year-old patient with a distal upper limb amputation to 0.99 for a subject of 80 years with a bilateral lower limb amputation of which one side is an above knee amputation.
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Phantom Pain and Phantom sensations in upper limb amputees: an epidemiological study
Pain, 2000Co-Authors: C. M. Kooijman, Pieter U. Dijkstra, Joannes Geertzen, A. Elzinga, C. P. Van Der SchansAbstract:Phantom Pain in subjects with an amputated limb is a well-known problem. However, estimates of the prevalence of Phantom Pain differ considerably in the literature. Various factors associated with Phantom Pain have been described including Pain before the amputation, gender, dominance, and time elapsed since the amputation. The purposes of this study were to determine prevalence and factors associated with Phantom Pain and Phantom sensations in upper limb amputees in The Netherlands. Additionally, the relationship between Phantom Pain, Phantom sensations and prosthesis use in upper limb amputees was investigated. One hundred twenty-four upper limb amputees participated in this study. Subjects were asked to fill out a self-developed questionnaire scoring the following items: date, side, level, and reason of amputation, duration of experienced Pain before amputation, frequencies with which Phantom sensations, Phantom Pain, and stump Pain are experienced, amount of trouble and suffering experienced, respectively, related to these sensations, type of Phantom sensations, medical treatment received for Phantom Pain and/or stump Pain, and the effects of the treatment, self medication, and prosthesis use. The response rate was 80%. The prevalence of Phantom Pain was 51%, of Phantom sensations 76% and of stump Pain 49%; 48% of the subjects experienced Phantom Pain a few times per day or more; 64% experienced moderate to very much suffering from the Phantom Pain. A significant association was found between Phantom Pain and Phantom sensations (relative risk 11.3) and between Phantom Pain and stump Pain (relative risk 1.9). No other factors associated with Phantom Pain or Phantom sensations could be determined. Only four patients received medical treatment for their Phantom Pain. Phantom Pain is a common problem in upper limb amputees that causes considerable suffering for the subjects involved. Only a minority of subjects are treated for Phantom Pain. Further research is needed to determine factors associated with Phantom Pain.
Annemarie Bagnall - One of the best experts on this subject based on the ideXlab platform.
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transcutaneous electrical nerve stimulation tens for Phantom Pain and stump Pain following amputation in adults
Cochrane Database of Systematic Reviews, 2015Co-Authors: Mark I Johnson, Matthew R Mulvey, Annemarie BagnallAbstract:Background This is the first update of a Cochrane review published in Issue 5, 2010 on transcutaneous electrical nerve stimulation (TENS) for Phantom Pain and stump Pain following amputation in adults. Pain may present in a body part that has been amputated (Phantom Pain) or at the site of amputation (stump Pain), or both. Phantom Pain and stump Pain are complex and multidimensional and the underlying pathophysiology remains unclear. The condition remains a severe burden for those who are affected by it. The mainstay treatments are predominately pharmacological, with increasing acknowledgement of the need for non-drug interventions. TENS has been recommended as a treatment option but there has been no systematic review of available evidence. Hence, the effectiveness of TENS for Phantom Pain and stump Pain is currently unknown. Objectives To assess the analgesic effectiveness of TENS for the treatment of Phantom Pain and stump Pain following amputation in adults. Search methods For the original version of the review we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, AMED, CINAHL, PEDRO and SPORTDiscus (February 2010). For this update, we searched the same databases for relevant randomised controlled trials (RCTs) from 2010 to 25 March 2015. Selection criteria We only included RCTs investigating the use of TENS for the management of Phantom Pain and stump Pain following an amputation in adults. Data collection and analysis Two review authors independently assessed trial quality and extracted data. We planned that where available and appropriate, data from outcome measures were to be pooled and presented as an overall estimate of the effectiveness of TENS. Main results In the original review there were no RCTs that examined the effectiveness of TENS for the treatment of Phantom Pain and stump Pain in adults. For this update, we did not identify any additional RCTs for inclusion. Authors' conclusions There were no RCTs to judge the effectiveness of TENS for the management of Phantom Pain and stump Pain. The published literature on TENS for Phantom Pain and stump Pain lacks the methodological rigour and robust reporting needed to confidently assess its effectiveness. Further RCT evidence is required before an assessment can be made. Since publication of the original version of this review, we have found no new studies and our conclusions remain unchanged.
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The Cochrane Library - Transcutaneous electrical nerve stimulation (TENS) for Phantom Pain and stump Pain following amputation in adults.
Cochrane Database of Systematic Reviews, 2015Co-Authors: Mark I Johnson, Matthew R Mulvey, Annemarie BagnallAbstract:Background This is the first update of a Cochrane review published in Issue 5, 2010 on transcutaneous electrical nerve stimulation (TENS) for Phantom Pain and stump Pain following amputation in adults. Pain may present in a body part that has been amputated (Phantom Pain) or at the site of amputation (stump Pain), or both. Phantom Pain and stump Pain are complex and multidimensional and the underlying pathophysiology remains unclear. The condition remains a severe burden for those who are affected by it. The mainstay treatments are predominately pharmacological, with increasing acknowledgement of the need for non-drug interventions. TENS has been recommended as a treatment option but there has been no systematic review of available evidence. Hence, the effectiveness of TENS for Phantom Pain and stump Pain is currently unknown. Objectives To assess the analgesic effectiveness of TENS for the treatment of Phantom Pain and stump Pain following amputation in adults. Search methods For the original version of the review we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, AMED, CINAHL, PEDRO and SPORTDiscus (February 2010). For this update, we searched the same databases for relevant randomised controlled trials (RCTs) from 2010 to 25 March 2015. Selection criteria We only included RCTs investigating the use of TENS for the management of Phantom Pain and stump Pain following an amputation in adults. Data collection and analysis Two review authors independently assessed trial quality and extracted data. We planned that where available and appropriate, data from outcome measures were to be pooled and presented as an overall estimate of the effectiveness of TENS. Main results In the original review there were no RCTs that examined the effectiveness of TENS for the treatment of Phantom Pain and stump Pain in adults. For this update, we did not identify any additional RCTs for inclusion. Authors' conclusions There were no RCTs to judge the effectiveness of TENS for the management of Phantom Pain and stump Pain. The published literature on TENS for Phantom Pain and stump Pain lacks the methodological rigour and robust reporting needed to confidently assess its effectiveness. Further RCT evidence is required before an assessment can be made. Since publication of the original version of this review, we have found no new studies and our conclusions remain unchanged.
Troels S. Jensen - One of the best experts on this subject based on the ideXlab platform.
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randomised trial of epidural bupivacaine and morphine in prevention of stump and Phantom Pain in lower limb amputation
The Lancet, 1997Co-Authors: Lone Nikolajsen, Susanne Ilkjær, Karsten Krøner, Jørgen H Christensen, Troels S. JensenAbstract:BACKGROUND: Epidural analgesia before limb amputation is commonly used to reduce postamputation Pain. But there have been no controlled studies with large numbers of patients to prove such a pre-emptive effect. We investigated whether postamputation stump and Phantom Pain in the first year is reduced by preoperative epidural blockade with bupivacaine and morphine. METHODS: In a randomised, double-blind trial, 60 patients scheduled for lower-limb amputation were randomly assigned epidural bupivacaine (0.25% 4-7 mL/h) and morphine (0.16-0.28 mg/h) for 18 h before and during the operation (29 patients; blockade group) or epidural saline (4-7 mL/h) and oral or intramuscular morphine (31 patients; control group). All patients had general anaesthesia for the amputation and were asked about stump and Phantom Pain after 1 week and then after 3, 6, and 12 months by two independent examiners. Study endpoints were rate of stump and Phantom Pain, intensity of stump and Phantom Pain, and consumption of opioids. FINDINGS: Two patients in each group were withdrawn before amputation. The groups were well matched in baseline characteristics. Median duration of preoperative saline treatment was 18.5 h (IQR 17-20). Median duration of preoperative epidural blockade in the blockade group was 18 h (15-20.3). The combined median duration of postoperative epidural Pain treatment in both groups was 166 h (89.3-308.3). After 1 week, 14 (52%) patients in the blockade group and 15 (56%) in the control group had Phantom Pain (95% CI - 30.6 to 22.7, p = 0.9). The figures for blockade versus control group were: 14 (82%) vs ten (50%; 4.0 to 60.8, p = 0.09) at 3 months; 13 (81%) vs 11 (55%; -2.7 to 55.3, p = 0.2) at 6 months; and nine (75%) vs 11 (69%; -27.0 to 39.6, p = 1.0) at 12 months. Intensity of stump and Phantom Pain and consumption of opioids were similar in both groups at all four postoperative interviews. INTERPRETATION: Perioperative epidural blockade started a median of 18 h (15-20.3) before the amputation and continued into the postoperative period does not prevent Phantom or stump Pain.
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The influence of preamputation Pain on postamputation stump and Phantom Pain.
Pain, 1997Co-Authors: Lone Nikolajsen, Susanne Ilkjær, Karsten Krøner, Jørgen H Christensen, Troels S. JensenAbstract:The significance of preamputation Pain for the development of postamputation stump and Phantom Pain has been discussed over the years and is still a matter of dispute. It has been argued that preamputation Pain increases the risk of Phantom Pain and that Phantom Pain is a revivification of Pain experienced before the amputation. The purpose of this prospective study was to clarify the relation between preamputation Pain and Phantom Pain. Fifty-six patients scheduled for amputation of a lower limb were interviewed the day before the amputation about preamputation Pain and about stump and Phantom Pain 1 week, 3 and 6 months after the amputation. Pain was quantitated and described using a visual analogue scale (VAS), 10 different word descriptors, the McGill Pain Questionnaire (MPQ) and the patients' own words. If Phantom Pain was present patients were asked if the Pain was similar to any Pain experienced before the amputation. At each postoperative interview patients were asked to recall preamputation Pain intensity. Location of Pain and analgesic requirements were registered. Preamputation Pain significantly increased the incidence of stump Pain (P = 0.04) and Phantom Pain (P = 0.04) after 1 week and the incidence of Phantom Pain after 3 months (P = 0.03). About 42% of the patients reported that their Phantom Pain resembled the Pain they had experienced at the time of the amputation. However, there was no relation between the patients' own opinion about similarity between preamputation Pain and Phantom Pain and the actual similarity found when comparing pre- and postoperative recordings of Pain. Patients significantly overestimated preamputation Pain intensity after 6 months.
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The effect of ketamine on Phantom Pain: a central neuropathic disorder maintained by peripheral input
Pain, 1996Co-Authors: Lone Nikolajsen, Carsten L. Hansen, Jesper Ellerbæk Nielsen, Johnny Keller, Lars Arendt-nielsen, Troels S. JensenAbstract:Hyperactivity of N-methyl D-aspartate (NMDA) receptors may be one of the factors in the maintenance of persistent stump and Phantom limb Pain. 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. All 11 patients responded with a decrease in the rating of stump and Phantom limb Pain assessed by visual analogue scale (VAS) and McGill Pain Questionnaire (MPQ). Ketamine increased pressure-Pain thresholds significantly. Wind-up like Pain (Pain evoked by repeatedly tapping the dysaesthetic skin area) was reduced significantly by ketamine. In contrast, no effect was seen on Pain evoked by repeated thermal stimuli. Side effects were observed in nine patients. The results support the notion that stump and Phantom Pain are generated by activity in afferent fibres activated by mechanical but not by thermal stimuli and that the NMDA receptor is involved in the maintenance of postamputation Pain states. NMDA receptor antagonists may have a potential in the treatment of stump and Phantom limb Pain.
Mark I Johnson - One of the best experts on this subject based on the ideXlab platform.
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transcutaneous electrical nerve stimulation tens for Phantom Pain and stump Pain following amputation in adults
Cochrane Database of Systematic Reviews, 2015Co-Authors: Mark I Johnson, Matthew R Mulvey, Annemarie BagnallAbstract:Background This is the first update of a Cochrane review published in Issue 5, 2010 on transcutaneous electrical nerve stimulation (TENS) for Phantom Pain and stump Pain following amputation in adults. Pain may present in a body part that has been amputated (Phantom Pain) or at the site of amputation (stump Pain), or both. Phantom Pain and stump Pain are complex and multidimensional and the underlying pathophysiology remains unclear. The condition remains a severe burden for those who are affected by it. The mainstay treatments are predominately pharmacological, with increasing acknowledgement of the need for non-drug interventions. TENS has been recommended as a treatment option but there has been no systematic review of available evidence. Hence, the effectiveness of TENS for Phantom Pain and stump Pain is currently unknown. Objectives To assess the analgesic effectiveness of TENS for the treatment of Phantom Pain and stump Pain following amputation in adults. Search methods For the original version of the review we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, AMED, CINAHL, PEDRO and SPORTDiscus (February 2010). For this update, we searched the same databases for relevant randomised controlled trials (RCTs) from 2010 to 25 March 2015. Selection criteria We only included RCTs investigating the use of TENS for the management of Phantom Pain and stump Pain following an amputation in adults. Data collection and analysis Two review authors independently assessed trial quality and extracted data. We planned that where available and appropriate, data from outcome measures were to be pooled and presented as an overall estimate of the effectiveness of TENS. Main results In the original review there were no RCTs that examined the effectiveness of TENS for the treatment of Phantom Pain and stump Pain in adults. For this update, we did not identify any additional RCTs for inclusion. Authors' conclusions There were no RCTs to judge the effectiveness of TENS for the management of Phantom Pain and stump Pain. The published literature on TENS for Phantom Pain and stump Pain lacks the methodological rigour and robust reporting needed to confidently assess its effectiveness. Further RCT evidence is required before an assessment can be made. Since publication of the original version of this review, we have found no new studies and our conclusions remain unchanged.
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The Cochrane Library - Transcutaneous electrical nerve stimulation (TENS) for Phantom Pain and stump Pain following amputation in adults.
Cochrane Database of Systematic Reviews, 2015Co-Authors: Mark I Johnson, Matthew R Mulvey, Annemarie BagnallAbstract:Background This is the first update of a Cochrane review published in Issue 5, 2010 on transcutaneous electrical nerve stimulation (TENS) for Phantom Pain and stump Pain following amputation in adults. Pain may present in a body part that has been amputated (Phantom Pain) or at the site of amputation (stump Pain), or both. Phantom Pain and stump Pain are complex and multidimensional and the underlying pathophysiology remains unclear. The condition remains a severe burden for those who are affected by it. The mainstay treatments are predominately pharmacological, with increasing acknowledgement of the need for non-drug interventions. TENS has been recommended as a treatment option but there has been no systematic review of available evidence. Hence, the effectiveness of TENS for Phantom Pain and stump Pain is currently unknown. Objectives To assess the analgesic effectiveness of TENS for the treatment of Phantom Pain and stump Pain following amputation in adults. Search methods For the original version of the review we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, AMED, CINAHL, PEDRO and SPORTDiscus (February 2010). For this update, we searched the same databases for relevant randomised controlled trials (RCTs) from 2010 to 25 March 2015. Selection criteria We only included RCTs investigating the use of TENS for the management of Phantom Pain and stump Pain following an amputation in adults. Data collection and analysis Two review authors independently assessed trial quality and extracted data. We planned that where available and appropriate, data from outcome measures were to be pooled and presented as an overall estimate of the effectiveness of TENS. Main results In the original review there were no RCTs that examined the effectiveness of TENS for the treatment of Phantom Pain and stump Pain in adults. For this update, we did not identify any additional RCTs for inclusion. Authors' conclusions There were no RCTs to judge the effectiveness of TENS for the management of Phantom Pain and stump Pain. The published literature on TENS for Phantom Pain and stump Pain lacks the methodological rigour and robust reporting needed to confidently assess its effectiveness. Further RCT evidence is required before an assessment can be made. Since publication of the original version of this review, we have found no new studies and our conclusions remain unchanged.
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Transcutaneous electrical nerve stimulation for Phantom Pain and stump Pain in adult amputees.
Pain Practice, 2012Co-Authors: Matthew R Mulvey, Helen Radford, Helen J. Fawkner, Lynn Hirst, Vera Neumann, Mark I JohnsonAbstract:Following amputation, 50% to 90% of individuals experience Phantom and/or stump Pain. Transcutaneous electrical nerve stimulation (TENS) may prove to be a useful adjunct analgesic intervention, although a recent systematic review was unable to judge effectiveness owing to lack of quality evidence. The aim of this pilot study was to gather data on the effect of TENS on Phantom Pain and stump Pain at rest and on movement. Ten individuals with a transtibial amputation and persistent moderate-to-severe Phantom and/or stump Pain were recruited. Inclusion criteria was a baseline Pain score of ≥3 using 0 to 10 numerical rating scale (NRS). TENS was applied for 60 minutes to generate a strong but comfortable TENS sensation at the site of stump Pain or projected into the site of Phantom Pain. Outcomes at rest and on movement before and during TENS at 30 minutes and 60 minutes were changes in the intensities of Pain, nonPainful Phantom sensation, and prosthesis embodiment. Mean (SD) Pain intensity scores were reduced by 1.8 (1.6) at rest (P < 0.05) and 3.9 (1.9) on movement (P < 0.05) after 60 minutes of TENS. For five participants, it was possible to project TENS sensation into the Phantom limb by placing the electrodes over transected afferent nerves. NonPainful Phantom sensations and prosthesis embodiment remained unchanged. This study has demonstrated that TENS has potential for reducing Phantom Pain and stump Pain at rest and on movement. Projecting TENS sensation into the Phantom limb might facilitate perceptual embodiment of prosthetic limbs. The findings support the delivery of a feasibility trial.