Departments of Neurologic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
Departments of Neurology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
Acta Neurochir (Wien). 2019 May;161(5):925-934. doi: 10.1007/s00701-019-03828-1. Epub 2019 Feb 21.
Phantom limb pain is a complex, incompletely understood pain syndrome that is characterized by chronic painful paresthesias in a previous amputated body part. Limited treatment modalities exist that provide meaningful relief, including pharmacological treatments and spinal cord stimulation that are rarely successful for refractory cases. Here, we describe our two-patient cohort with recalcitrant upper extremity phantom limb pain treated with chronic subdural cortical stimulation. The patient with evidence of cortical reorganization and almost 60 years of debilitating phantom limb pain experienced sustained analgesic relief at a follow-up period of 6 months. The second patient became tolerant to the stimulation and his pain returned to baseline at a 1-month follow-up. Our unique case series report adds to the growing body of literature suggesting critical appraisal before widespread implementation of cortical stimulation for phantom limb pain can be considered.
幻肢痛是一种复杂且尚未完全被理解的疼痛综合征，其特征是先前截肢的身体部位出现慢性疼痛性感觉异常。目前存在有限的治疗方法，这些方法可以提供有意义的缓解，包括药物治疗和脊髓刺激，但对于难治性病例很少成功。在这里，我们描述了我们的两名顽固性上肢幻肢痛患者的队列，他们接受了慢性硬膜下皮质刺激治疗。一名患者有皮质重组的证据，并且有近 60 年的致残性幻肢痛，在 6 个月的随访期间经历了持续的镇痛缓解。第二名患者对刺激产生耐受，并且他的疼痛在 1 个月的随访时回到基线。我们的独特病例系列报告增加了越来越多的文献，表明在广泛应用皮质刺激治疗幻肢痛之前，需要进行批判性评估。
