Flor Herta
Department of Clinical and Cognitive Neuroscience, University of Heidelberg, Central Institute of Mental Health, Mannheim, Germany.
Lancet Neurol. 2002 Jul;1(3):182-9. doi: 10.1016/s1474-4422(02)00074-1.
Phantom-limb pain is a common sequela of amputation, occurring in up to 80% of people who undergo the procedure. It must be differentiated from non-painful phantom phenomena, residual-limb pain, and non-painful residual-limb phenomena. Central changes seem to be a major determinant of phantom-limb pain; however, peripheral and psychological factors may contribute to it. A comprehensive model of phantom-limb pain is presented that assigns major roles to pain occurring before the amputation and to central as well as peripheral changes related to it. So far, few mechanism-based treatments for phantom-limb pain have been proposed. Most published reports are based on anecdotal evidence. Interventions targeting central changes seem promising. The prevention of phantom-limb pain by peripheral analgesia has not yielded consistent results. Additional measures that reverse or prevent the formation of central memory processes might be more effective.
幻肢痛是截肢术后常见的后遗症，在接受该手术的患者中发生率高达80%。必须将其与无痛性幻肢现象、残肢痛以及无痛性残肢现象相区分。中枢神经系统的变化似乎是幻肢痛的主要决定因素；然而，外周和心理因素也可能对其产生影响。本文提出了一个幻肢痛的综合模型，该模型认为截肢前出现的疼痛以及与之相关的中枢和外周变化起着主要作用。到目前为止，很少有基于机制的幻肢痛治疗方法被提出。大多数已发表的报告都是基于轶事证据。针对中枢变化的干预措施似乎很有前景。通过外周镇痛预防幻肢痛尚未取得一致的结果。逆转或预防中枢记忆过程形成的其他措施可能更有效。
