McGovern Medical School at the University of Texas Health Science Center (UTHealth), Houston, TX.
Department of Pain Medicine, Division of Anesthesiology, Critical Care, Medicine, and Pain Medicine, University of Texas MD Anderson Cancer Center, Houston, TX.
Pain Physician. 2022 Oct;25(7):E941-E957.
Phantom limb pain (PLP), defined as a painful sensation in a portion of the body that has been amputated, occurs in upwards of 80% of limb amputees and can significantly impact a patient's quality of life. First hypothesized in 1551, the disease has been poorly understood for much of this time. Still today, the exact etiology of the condition is yet to be elucidated. In the periphery, PLP resembles the neuronal changes seen in other neuropathic pain conditions. However, in the central nervous system (CNS), imaging studies suggest changes unique to PLP, such as cortical reorganization. Despite a growing understanding of its underpinnings, a mechanism-based treatment is not yet available. Rather, a plethora of treatment methodologies are available with varying levels of supporting evidence and many treatments being utilized based on efficacy seen in non-PLP patients.
In this review, we provide a thorough summary of the current literature regarding PLP's etiology, diagnosis, treatment, and attempts to prevent the development of PLP following amputation.
A narrative review.
This was a narrative review conducted after an extensive and thorough review of available literature on the topic from a variety of sources.
Current evidence supports a central reorganization process with potential amplification of aberrant peripheral inputs as the etiology of PLP. This conclusion is supported by functional neuroimaging as well as the failure of peripherally focused treatments. Treatment of PLP remains difficult due to varying response rates to therapies. Nonetheless, there are several treatment modalities that have proven effective in the majority of patients tested, ranging from noninvasive systemic pharmacotherapy to more invasive neuromodulation, such as spinal cord stimulation. While opioid therapy remains the most evidence-based treatment, the newer neuromodulation techniques appear to be superior in symptom reduction with minimal side effects.
Evidence for the treatment of PLP is largely restricted to uncontrolled case reports and/or small single-site uncontrolled case series. Some research is further hampered by the presence of confounding factors such as concurrent treatment regimens.
While PLP remains a difficult-to-treat condition, practitioners can greatly improve the quality of life of patients suffering from the condition with a wide range of developing treatments. For pain intractable to traditional pharmacologic treatment, neuromodulation therapies have proven to be highly effective with minimal side effect profiles.
幻肢痛（PLP）定义为已截肢部位的疼痛感觉，发生在 80%以上的肢体截肢患者中，并可显著影响患者的生活质量。这种疾病最早于 1551 年被假设，在很长一段时间内人们对它的了解都很差。直到今天，这种疾病的确切病因仍未被阐明。在周围神经系统中，PLP 类似于其他神经性疼痛疾病中所见的神经元变化。然而，在中枢神经系统（CNS）中，影像学研究表明存在 PLP 所特有的变化，例如皮质重组。尽管人们对其潜在机制的理解日益加深，但仍没有基于机制的治疗方法。相反，有大量的治疗方法，其疗效证据水平各不相同，许多治疗方法是根据非 PLP 患者的疗效来应用的。
在这篇综述中，我们提供了关于 PLP 的病因、诊断、治疗以及预防截肢后 PLP 发展的现有文献的全面总结。
叙述性综述。
这是在从各种来源对该主题的现有文献进行广泛而彻底的回顾后进行的叙述性综述。
目前的证据支持中枢神经系统重新组织的过程，以及潜在的异常外周输入的放大作为 PLP 的病因。这一结论得到了功能神经影像学以及外周聚焦治疗失败的支持。由于对治疗的反应率不同，PLP 的治疗仍然很困难。尽管如此，仍有几种治疗方式已被证明对大多数接受测试的患者有效，从非侵入性全身药物治疗到更具侵入性的神经调节，如脊髓刺激。虽然阿片类药物治疗仍然是最有证据的治疗方法，但新型神经调节技术在减轻症状方面似乎优于最小副作用。
PLP 治疗的证据主要限于未经对照的病例报告和/或小型单站点非对照病例系列。一些研究进一步受到并发治疗方案等混杂因素的影响。
虽然 PLP 仍然是一种难以治疗的疾病，但随着治疗方法的不断发展，医生可以极大地提高患有这种疾病的患者的生活质量。对于传统药物治疗无法缓解的疼痛，神经调节疗法已被证明具有高度疗效，副作用最小。
