IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia.
Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia.
Eur J Pain. 2021 Jan;25(1):23-38. doi: 10.1002/ejp.1657. Epub 2020 Sep 28.
This systematic, rapid review aimed to critically appraise and synthesize the recent literature (2014-2019) evaluating the incidence and prevalence of post-amputation phantom limb pain (PLP) and sensation (PLS).
Five databases (Medline, Embase, Emcare, PsychInfo, Web of Science) and Google Scholar were searched, with two independent reviewers completing eligibility screening, risk of bias assessment and data extraction.
The search identified 1,350 studies with 12 cross-sectional and 3 prospective studies included. Studies evaluated traumatic (n = 5), atraumatic (n = 4), and combined traumatic/atraumatic (n = 6) amputee populations, ranging from 1 month to 33 years post-amputation. Study heterogeneity prevented data pooling. The majority of studies had a high risk of bias, primarily due to limited generalizability. Three studies evaluated PLP incidence, ranging from 2.2% (atraumatic; 1 month) to 41% (combined; 3 months) and 82% (combined; 12 months). Only one study evaluated PLS/telescoping incidence. Across contrasting populations, PLP point prevalence was between 6.7%-88.1%, 1 to 3-month period prevalence was between 49%-93.5%, and lifetime prevalence was high at 76%-87%. Point prevalence of PLS was 32.4%-90%, period prevalence was 65% (1 month) and 56.9% (3 months), and lifetime prevalence was 87%. Telescoping was less prevalent, highest among traumatic amputees (24.6%) within a 1-month prevalence period. Variations in population type (e.g. amputation characteristics) and incidence and prevalence measures likely influence the large variability seen here.
This review found that lifetime prevalence was the highest, with most individuals experiencing some type of phantom phenomena at some point post-amputation.
This systematic rapid review provides a reference for clinicians to make informed prognosis estimates of phantom phenomena for patients undergoing amputation. Results show that most amputees will experience phantom limb pain (PLP) and phantom limb sensations (PLS): high PLP incidence 1-year post-amputation (82%); high lifetime prevalence for PLP (76%-87%) and PLS (87%). Approximately 25% of amputees will experience telescoping. Consideration of individual patient characteristics (cause, amputation site, pre-amputation pain) is pertinent given their likely contribution to incidence/prevalence of phantom phenomena.
本系统、快速回顾旨在批判性评估和综合最近的文献（2014-2019 年），评估截肢后幻肢痛（PLP）和幻肢感觉（PLS）的发生率和流行率。
检索了五个数据库（Medline、Embase、Emcare、PsychInfo、Web of Science）和 Google Scholar，由两名独立的审查员进行资格筛选、偏倚风险评估和数据提取。
搜索共确定了 1350 项研究，其中包括 12 项横断面研究和 3 项前瞻性研究。研究评估了创伤性（n=5）、非创伤性（n=4）和混合创伤/非创伤性（n=6）截肢人群，截肢后时间从 1 个月到 33 年不等。由于研究的普遍性有限，研究的异质性阻止了数据的汇总。大多数研究的偏倚风险较高，主要是由于普遍性有限。三项研究评估了 PLP 的发生率，范围从 2.2%（非创伤性；1 个月）到 41%（混合性；3 个月）和 82%（混合性；12 个月）。只有一项研究评估了 PLS/伸缩的发生率。在不同的人群中，PLP 的时点患病率在 6.7%-88.1%之间，1-3 个月的期间患病率在 49%-93.5%之间，终生患病率为 76%-87%。PLS 的时点患病率为 32.4%-90%，期间患病率为 65%（1 个月）和 56.9%（3 个月），终生患病率为 87%。伸缩现象较少见，在创伤性截肢者中，1 个月的流行期内，最高患病率为 24.6%。人群类型（如截肢特征）的变化以及发病率和患病率的衡量标准可能会影响到这里看到的大的变异性。
本综述发现，终生患病率最高，大多数患者在截肢后某个时间点都会经历某种类型的幻肢现象。
本系统快速回顾为临床医生对接受截肢的患者的幻肢现象做出知情预后估计提供了参考。结果表明，大多数截肢者会经历幻肢痛（PLP）和幻肢感觉（PLS）：截肢后 1 年的 PLP 发生率高（82%）；PLP（76%-87%）和 PLS（87%）的终生患病率高。大约 25%的截肢者会经历伸缩现象。考虑到个体患者的特征（原因、截肢部位、术前疼痛）可能会影响幻肢现象的发病率/患病率，因此考虑这些特征是很重要的。
