Moesker Albert A, Karl Helen W, Trescot Andrea M
Diaconessenhuis Meppel Hospital, Meppel, The Netherlands.
Pain Pract. 2014 Jan;14(1):52-6. doi: 10.1111/papr.12020. Epub 2012 Dec 19.
The pathophysiology of phantom limb pain (PLP) is multifactorial. It probably starts in the periphery and is amplified and modified in the central nervous system. A small group of patients with PLP were questioned as to the portion of the phantom limb affected by pain (e.g., "great toe," "thumb"). In the stump, the corresponding amputated nerve was located with a nerve stimulator. With correct placement and stimulation, the PLP could then be reproduced or exacerbated. A small dose of local anesthesia was then injected, resulting in the disappearance of the PLP. If a peripheral nerve injection gave temporary relief, our final treatment was cryoanalgesia at this location. Evaluation of 5 patients, followed for at least 2.5 years, yielded the following results: 3 patients had excellent results (100%, 95%, and 90% decrease in complaints, respectively), 1 patient had an acceptable result (40% decrease), and 1 patient had only a 20% decrease in pain. Although both central and peripheral components are likely involved in PLP, treatment of a peripheral pain locus with cryoanalgesia should be considered. We propose the identification of a peripheral etiology may help match patients to an appropriate therapy, and cryoanalgesia may result in long-term relief of PLP.
幻肢痛（PLP）的病理生理学是多因素的。它可能始于外周，并在中枢神经系统中被放大和改变。一小群患有PLP的患者被询问幻肢受疼痛影响的部位（例如，“大脚趾”、“拇指”）。在残端，用神经刺激器定位相应的被切断神经。通过正确的放置和刺激，然后可以重现或加剧PLP。然后注射小剂量局部麻醉剂，导致PLP消失。如果外周神经注射能带来暂时缓解，我们最后的治疗方法是在该部位进行冷冻镇痛。对5例患者进行了至少2.5年的随访，结果如下：3例患者效果极佳（主诉分别减少100%、95%和90%），1例患者效果尚可（减少40%），1例患者疼痛仅减少20%。虽然中枢和外周因素可能都与PLP有关，但应考虑用冷冻镇痛治疗外周疼痛部位。我们认为，确定外周病因可能有助于为患者匹配合适的治疗方法，并且冷冻镇痛可能会使PLP得到长期缓解。
