Q: Gabapentin is considered a standard of care treatment for phantom limb pain after upper or lower extremity amputation due to its high effectiveness.
A) True
B) False
Answer: B
Unfortunately, despite being well-known in the literature after limb amputations, the etiology of phantom limb pain is poorly understood, and so far, no standard of treatment has been agreed upon. Various modalities can be tried, and treatment should be case-by-case, depending on each patient's responsiveness. There is weak evidence that the use of preemptive epidural anesthesia may reduce the incidence and severity of phantom pain.
Other modalities which can be tried are:
- ketamine
- calcitonin
- gabapentin
- amitriptyline
- mexiletine
- botulinum neurotoxin A,
- mirror therapy
- virtual reality
- peripheral nerve stimulation
- incorporating sensory feedback from a specialized prosthetic
- target muscle reinnervation (TMR)
Phantom limb pain is a diagnosis of exclusion. It is a complex process, and patients describe various sensations like burning, aching, or electric-type pain in the amputated limb. Before labelling as phantom limb pain, ischemia, infection, neuroma, and pressure-related wounds should be ruled out.
#surgical-critical-care
#pain
References:
1. Karanikolas M, Aretha D, Tsolakis I, et al. Optimized perioperative analgesia reduces chronic phantom limb pain intensity, prevalence, and frequency: a prospective, randomized, clinical trial. Anesthesiology 2011; 114:1144.
2. Limakatso K, Bedwell GJ, Madden VJ, Parker R. The prevalence and risk factors for phantom limb pain in people with amputations: A systematic review and meta-analysis. PLoS One 2020; 15:e0240431.
3. Rutledge T, Velez D, Depp C, et al. A Virtual Reality Intervention for the Treatment of Phantom Limb Pain: Development and Feasibility Results. Pain Med 2019; 20:2051.
4. Bowen JB, Ruter D, Wee C, et al. Targeted Muscle Reinnervation Technique in Below-Knee Amputation. Plast Reconstr Surg 2019; 143:309.
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