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截肢后疼痛管理的靶向介入疗法:综述

Targeted Interventional Therapies for the Management of Postamputation Pain: A Comprehensive Review.

作者信息

Savicevic Dunja, Grupkovic Jovana, Dabetic Uros, Aleksandric Dejan, Bogosavljevic Nikola, Novakovic Uros, Spasic Ljubica, Zagorac Slavisa

机构信息

Special Hospital for Rehabilitation and Orthopedic Prosthetics, 11000 Belgrade, Serbia.

Clinic for Orthopedic Surgery and Traumatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia.

出版信息

Biomedicines. 2025 Jun 27;13(7):1575. doi: 10.3390/biomedicines13071575.

Abstract

Postamputation pain (PAP), including residual limb pain (RLP) and phantom limb pain (PLP), remains a significant and debilitating complication after limb loss. Despite advances in pharmacological management, many patients experience inadequate pain relief, underscoring the need for alternative therapeutic strategies. This narrative review critically synthesizes current interventional therapies for PAP, focusing on mechanisms, clinical efficacy and practical application. A literature search was conducted in PubMed, EMBASE, Scopus and Web of Science databases for studies published between 2015 and 2025. Relevant articles on peripheral nerve interventions as well as different neuromodulation techniques were included. Peripheral interventions (such as alcohol neurolysis, radiofrequency ablation (RFA) and cryoneurolysis (CNL)) and neuromodulation techniques (including spinal cord stimulation (SCS), dorsal root ganglion (DRG) stimulation and cauda equina stimulation (CES)) demonstrate promising outcomes for PAP. Peripheral nerve stimulation (PNS) shows favorable safety and efficacy profiles and may help prevent the chronification of pain. Contemporary interventional therapies represent valuable options in the multidisciplinary management of PAP. Nevertheless, further research is required to standardize clinical algorithms, optimize therapeutic decision-making and improve long-term outcomes and quality of life for individuals with PAP.

摘要

截肢后疼痛(PAP),包括残肢痛(RLP)和幻肢痛(PLP),仍然是肢体缺失后一种严重且使人衰弱的并发症。尽管药物治疗取得了进展,但许多患者的疼痛缓解不充分,这突出表明需要替代治疗策略。本叙述性综述批判性地综合了目前针对PAP的介入治疗方法,重点关注其机制、临床疗效和实际应用。在PubMed、EMBASE、Scopus和Web of Science数据库中进行了文献检索,以查找2015年至2025年发表的研究。纳入了有关周围神经干预以及不同神经调节技术的相关文章。周围神经干预(如酒精神经溶解术、射频消融术(RFA)和冷冻神经溶解术(CNL))和神经调节技术(包括脊髓刺激(SCS)、背根神经节(DRG)刺激和马尾神经刺激(CES))对PAP显示出有前景的结果。周围神经刺激(PNS)显示出良好的安全性和疗效,可能有助于预防疼痛慢性化。当代介入治疗是PAP多学科管理中有价值的选择。然而,需要进一步研究以规范临床算法、优化治疗决策,并改善PAP患者的长期结局和生活质量。

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本文引用的文献

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A scoping review of spinal cord stimulation for phantom limb pain.脊髓刺激治疗幻肢痛的范围综述。
Interv Pain Med. 2025 Mar 12;4(1):100571. doi: 10.1016/j.inpm.2025.100571. eCollection 2025 Mar.
3
Postamputation Pain Management.截肢后疼痛管理。
Phys Med Rehabil Clin N Am. 2024 Nov;35(4):757-768. doi: 10.1016/j.pmr.2024.06.003. Epub 2024 Jul 16.
10
Burst Spinal Cord Stimulation in the Management of Chronic Pain: Current Perspectives.脊髓电刺激治疗慢性疼痛:当前观点
Anesth Pain Med. 2022 May 9;12(2):e126416. doi: 10.5812/aapm-126416. eCollection 2022 Apr.

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