截肢后幻肢痛的治疗推荐：专家共识德尔菲研究。
Treatment Recommendations for Phantom Limb Pain in People with Amputations: An Expert Consensus Delphi Study.
机构信息
Department of Anaesthesia and Perioperative Medicine, Pain Management Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
出版信息
PM R. 2021 Nov;13(11):1216-1226. doi: 10.1002/pmrj.12556. Epub 2021 Feb 26.
BACKGROUND
Phantom limb pain (PLP) is common and often accompanied by serious suffering. Current systematic-review evidence suggests that recommended treatments are no more effective than placebo for reducing PLP. Given the difficulty in conducting a meta-analysis for nonpharmacological treatments and the weak evidence for pharmacological treatments for PLP, consensus on the first-line management of PLP needs to be reached using alternative methods.
OBJECTIVE
To reach expert consensus and make recommendations on the effective management of PLP.
DESIGN
A three-round Delphi design was used.
SETTING
The study was conducted using e-mail and Google survey tool as the main methods of communication and providing feedback.
PARTICIPANTS
The study included 27 clinicians and researchers from various health disciplines who are experts in PLP management.
METHOD
Data were collected using three sequential rounds of anonymous online questionnaires where experts proposed and ranked the treatments for PLP. A consensus was reached on the treatments that were endorsed by 50% or more of the experts.
RESULTS
Thirty-seven treatments were proposed for the management of PLP at the beginning of the study. Consensus was reached on seven treatments that were considered effective for managing PLP and on two treatments that were considered ineffective. Graded motor imagery, mirror therapy, amitriptyline, sensory discrimination training, and use of a functional prosthesis were endorsed by most experts because of the available backing scientific evidence and their reported efficacy in clinical practice. Cognitive behavioral therapy and virtual reality training were endorsed by most experts because of their reported efficacy in clinical practice despite indicating a dearth of scientific evidence to support their ranking. Citalopram and dorsal root ganglion pulsed radiofrequency were rejected owing to a lack of relevant scientific evidence.
CONCLUSION
The results of this study suggest that the nonpharmacological treatments endorsed in this study may have an important role in the management of PLP.
背景
幻肢痛（PLP）很常见，常伴有严重的痛苦。目前的系统评价证据表明，推荐的治疗方法在减轻 PLP 方面并不比安慰剂更有效。鉴于非药物治疗进行荟萃分析的困难以及药物治疗 PLP 的证据较弱，需要使用替代方法就 PLP 的一线管理达成共识。
目的
达成专家共识并提出 PLP 有效管理的建议。
设计
使用三轮 Delphi 设计。
设置
该研究使用电子邮件和 Google 调查工具作为主要的沟通和提供反馈方式。
参与者
研究包括来自不同健康学科的 27 名临床医生和研究人员，他们是 PLP 管理方面的专家。
方法
使用三轮匿名在线问卷收集数据，专家在问卷中提出并对 PLP 的治疗方法进行排名。达成了 50%或以上专家认可的治疗方法的共识。
结果
在研究开始时，提出了 37 种治疗 PLP 的方法。达成了七种被认为对管理 PLP 有效的治疗方法和两种被认为无效的治疗方法的共识。由于有可用的科学证据支持和在临床实践中的疗效报告，大多数专家认可运动想象疗法、镜像疗法、阿米替林、感觉辨别训练和功能性假体的使用。由于报告的疗效在临床实践中，大多数专家认可认知行为疗法和虚拟现实训练，尽管表明缺乏支持其排名的科学证据。由于缺乏相关科学证据，西酞普兰和背根神经节脉冲射频治疗被拒绝。
结论
本研究结果表明，本研究中支持的非药物治疗方法可能在 PLP 的管理中发挥重要作用。
Zotero 插件