title: Phantom limb pain: a report of two cases.
abstract: The efficacy of pre-emptive analgesia for phantom limb pain is still unclear. It is generally accepted that pre hyphen;amputation pain increases the incidence of phantom and stump pain, even if pre-emptive analgesia is performed before and during surgery and in the postoperative period. Two cases of traumatic upper limb amputations are described here with no pre-existing pain. Both received similar antinociceptive treatment by continuous block of the brachial plexus through infusion of ropivacaine 0.375% at 5 ml/h for 10 days. Treatment of case 1 was initiated immediately after surgery; however, this amputee developed intensive phantom limb pain which persisted at 6 months. Early use of the prosthesis after surgery was not possible for this patient. The intensity of phantom limb pain in case 2 decreased significantly after 6 months, even though brachial plexus blockade was not started until 5 weeks post-trauma. This patient used a functional prosthesis intensively beginning early after amputation. Serial magnetoencephalographic recordings were performed in both patients. Only case 2 showed significant changes of cortical reorganization. In case 1 markedly less cortical plasticity was found. A combination of relevant risk factors such as a painful neuroma, behavioural and cognitive coping strategies and the early functional use of prostheses are discussed as important mechanisms contributing to the development of phantom pain and cortical reorganization.
authors.affiliation: Department of Anaesthesiology, University of Tübingen, Hoppe-Seylerstr. 3, Tübingen, 72076, Germany. stephanie.toepfner@med.uni-tuebingen.de
authors.forename: S
authors.initials: S
authors.lastname: Töpfner
authors.forename: K
authors.initials: K
authors.lastname: Wiech
authors.forename: R T
authors.initials: RT
authors.lastname: Kiefer
authors.forename: K
authors.initials: K
authors.lastname: Unertl
authors.forename: N
authors.initials: N
authors.lastname: Birbaumer
mesh_terms: D000328:Adult; D000577:Amides / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D001186:Artificial Limbs; D002540:Cerebral Cortex / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009473:Neuronal Plasticity / Q000502:physiology*; D010146:Pain / Q000188:drug therapy / Q000503:physiopathology* / Q000523:psychology; D010591:Phantom Limb / Q000503:physiopathology* / Q000523:psychology / Q000534:rehabilitation; D000077212:Ropivacaine
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine