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病例报告:镜像疗法与骶丛磁刺激相结合缓解了一名患者的幻肢痛。

Case report: A combination of mirror therapy and magnetic stimulation to the sacral plexus relieved phantom limb pain in a patient.

作者信息

Deng Chunchu, Li Qian

机构信息

Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

出版信息

Front Neurosci. 2023 May 26;17:1187486. doi: 10.3389/fnins.2023.1187486. eCollection 2023.

Abstract

Phantom limb pain (PLP) is a common sequela of amputation, experienced by 50-80% of amputees. Oral analgesics as the first-line therapy have limited effects. Since PLP usually affects activities of daily living and the psychological conditions of patients, effective treatments are imperatively needed. In this case study, a 49-year-old man was admitted to our hospital because of uncontrollable paroxysmal pain in his missing and residual leg. Due to severe injuries in a truck accident, the right lower limb of the patient was surgically amputated ~5 years ago. Around 1 month after amputation, he felt pain in his lost leg and PLP was diagnosed. Then, he started taking oral analgesics, but the pain still occurred. After admission on July 9, 2022, the patient received treatments of mirror therapy and magnetic stimulation to the sacral plexus. 1-month treatments reduced the frequency and intensity of pain in the phantom limb and the stump, without any adverse events. Analysis of high-resolution three-dimensional T1-weighted brain volume images at the end of 2-month treatments showed alterations in the thickness of cortex regions related to pain processing, compared to that before treatment. This case study gives us hints that one or both interventions of mirror therapy and sacral plexus magnetic stimulation effectively relieved PLP and stump limb pain. These non-invasive, low-cost and easily conducted treatments could be good options for PLP. But randomized controlled trials with a large number of cases are required to confirm their efficacy and safety.

摘要

幻肢痛(PLP)是截肢后的常见后遗症,50%-80%的截肢者会经历这种疼痛。口服镇痛药作为一线治疗方法效果有限。由于幻肢痛通常会影响患者的日常生活活动和心理状况,因此迫切需要有效的治疗方法。在本病例研究中,一名49岁男性因缺失腿和残肢出现无法控制的阵发性疼痛而入住我院。由于在一次卡车事故中受重伤,患者的右下肢于约5年前接受了手术截肢。截肢后约1个月,他感到已截肢的腿部疼痛,被诊断为幻肢痛。随后,他开始服用口服镇痛药,但疼痛仍会发作。2022年7月9日入院后,患者接受了镜像疗法和骶丛磁刺激治疗。1个月的治疗降低了幻肢和残端疼痛的频率和强度,且未出现任何不良事件。2个月治疗结束时对高分辨率三维T1加权脑容量图像的分析显示,与治疗前相比,与疼痛处理相关的皮质区域厚度发生了变化。本病例研究提示我们,镜像疗法和骶丛磁刺激这两种干预措施中的一种或两种可有效缓解幻肢痛和残端肢体疼痛。这些非侵入性、低成本且易于实施的治疗方法可能是治疗幻肢痛的良好选择。但需要大量病例的随机对照试验来证实其疗效和安全性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e5a7/10251437/8d7850a29245/fnins-17-1187486-g0001.jpg

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