Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20200182
Brazilian Journal of Pain
Review Article

Prevention and control of chronic post-amputation pain of extremities: systematic review

Prevenção e controle da dor crônica pós-amputação de extremidades: revisão sistemática

Nycole Filincowsky Ribeiro Xavier; Jéssica Cristina Farias de Almeida; Priscilla Roberta Silva Rocha; Mani Indiana Funez

http://dx.doi.org/10.5935/2595-0118.20200182 BrJP, vol.3, n4, p.359-365, 2020
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Abstract

BACKGROUND AND OBJECTIVES: Post-amputation pain is very frequent and can become chronic in almost 85% of the cases. The objective of this study was to conduct a systematic review concerning the evidence about the measures for the control or remission of chronic pain in the stump or phantom limb in adults and the elderly after extremity amputation.

CONTENTS: The search was conducted in the databases Pubmed, Mendeley, Livivo, and Science Direct. Additional searches were performed at ClinicalTrial.gov, Google Scholar, and in the references of the selected articles. Two independent reviewers performed the screening of the studies as well as the data extraction and synthesis. The Cochrane Collaboration Risk of Bias Tool was used to analyze the risk of bias, and four articles were identified. Two articles on pharmacological prevention strategies and two articles on non-pharmacological treatment. The risk of bias was low for the pharmacological approach, and uncertain or high for the non-pharmacological.

CONCLUSION: The findings suggest a protective effect of preventive pharmacological therapies, epidurally, in combination with bupivacaine and fentanyl or added to calcitonin, in the perioperative period. Promising data are also presented for non-pharmacological therapies for pain control, phantom motor execution and gradual motor images. However, caution is necessary due to the risk of bias and considering the number of studies that answer the research question. Additional studies are suggested to strengthen the evidence, especially with quantitative analysis.

Keywords

Amputation, Perioperative period, Phantom limb, Postoperative pain, Therapeutics

Resumo

JUSTIFICATIVA E OBJETIVOS: A dor pós-amputação tem alta prevalência, podendo tornar-se crônica em até 85% dos casos. O objetivo deste estudo foi analisar as evidências acerca de medidas para o controle ou remissão da dor crônica no coto ou membro fantasma em adultos e idosos com amputação de extremidades.

CONTEÚDO: Realizaram-se buscas nas bases Pubmed, Mendeley, Livivo e Science Direct. Buscas adicionais foram realizadas na página eletrônica ClinicalTrial.gov, Google Scholar e listas de referências dos artigos selecionados. A triagem dos estudos, bem como a extração e síntese dos dados, foi realizada por dois revisores independentes. A análise do risco de viés foi feita pela Cochrane Collaboration Risk of Bias Tool, sendo identificados quatro estudos. Dois sobre estratégias de prevenção farmacológica, e dois sobre estratégias de tratamento não farmacológico. O risco de viés foi baixo para as abordagens farmacológicas, e incerto ou alto para as abordagens não farmacológicas.

CONCLUSÃO: Os achados sugerem efeito protetor das terapias farmacológicas preventivas, por via peridural, em combinação de bupivacaína e fentanil ou somados à calcitonina, no período perioperatório. Dados promissores também são apresentados para as terapias não farmacológicas de controle da dor, execução motora fantasma e imagens motoras gradativas. Porém, é necessário prudência devido ao risco de viés e considerando a quantidade de estudos que respondem a pergunta de pesquisa. Sugerem-se estudos adicionais para fortalecer as evidências, especialmente com análise quantitativa.

Palavras-chave

Amputação, Dor pós-operatória, Membro fantasma, Período perioperatório, Terapêutica

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Submitted date:
02/03/2020

Accepted date:
07/21/2020

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