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

Downloads: 0
Views: 381

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

References

Peixoto AM, Zimpel SA, Oliveira ACA, Monteiro RLS, Carneiro TKG. Prevalence of upper and lower limb amputations of SUS patients in the state of Alagoas between 2008 and 2015. Fisioter Pesqui. 2017;24(4):378-84.

Ahuja V, Thapa D, Ghai B. Strategies for prevention of lower limb post-amputation pain: a clinical narrative review. J Anaesthesiol Clin Pharmacol. 2018;34(4):439-49.

Kumar GK, Souza CD, Diaz EA. Incidence and causes of lower-limb amputations in a tertiary care center: evaluation of the medical records in a period of 2 years. Int J Surg Sci. 2018;2(3):16-9.

Postamputation Pain. Global Year Against Neuropathic Pain. 2015.

Nikolajsen L. Phantom limb. Wall and Melzack's Textbook of Pain, SB. 2013.

Taylan A, Derya Ö. Chronic post-surgical pain. Agri. 2009;21(1):1-9.

Posso IP, Romanek RM, Posso JP, Carvalho M. Dor Crônica Pós-Operatória. Tratado de Dor: Publicação da Sociedade Brasileira para Estudo da Dor. 2017.

Yaputra F, Widyadharma IPE. Management of phantom limb pain: a review. Int J Med Rev Case Rep. 2018;2(2):29-32.

Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1):1-9.

Campbell M, McKenzie JE, Sowden A, Katikireddi SV, Brennan SE, Ellis S. Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline. BMJ. 2020;368:l6890.

da Costa Santos CM, de Mattos Pimenta CA, Nobre MR. The PICO strategy for the research question construction and evidence search. Rev Lat Am Enfermagem. 2007;15(3):508-11.

Sterne JAC, Savovic J, Page MJ, Elbers RG, Blencowe NS, Boutron I. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898.

Carvalho APV, SilvaII V, Grande AJ. Avaliação do risco de viés de ensaios clínicos randomizados pela ferramenta da colaboração Cochrane. Diagn Tratamento. 2013;18(1):38-44.

Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. 2011.

Karanikolas M, Aretha D, Tsolakis I, Monantera G, Kiekkas P, Papadoulas S. Optimized perioperative analgesia reduces chronic phantom limb pain intensity, prevalence, and frequency: a prospective, randomized, clinical trial. Anesthesiology. 2011;114(5):1144-54.

Yousef AA, Aborahama AM. The preventive value of epidural calcitonin in patients with lower limb amputation. Pain Med. 2017;18(9):1745-51.

Ortiz-Catalan M, Guðmundsdóttir RA, Kristoffersen MB, Zepeda-Echavarria A, Caine-Winterberger K, Kulbacka-Ortiz K. Phantom motor execution facilitated by machine learning and augmented reality as treatment for phantom limb pain: a single group, clinical trial in patients with chronic intractable phantom limb pain. Lancet. 2016;388(10062):2885-94.

Limakatso K, Madden VJ, Manie S, Parker R. The effectiveness of graded motor imagery for reducing phantom limb pain in amputees: a randomised controlled trial. Physiotherapy. 2019;28:S0031-9406(18)30188-3.

Subedi B, Grossberg GT. Phantom limb pain: mechanisms and treatment approaches. Pain Res Treat. 2011;2011:864605.

Flor H. Maladaptive plasticity, memory for pain and phantom limb pain: review and suggestions for new therapies. Expert Rev Neurother. 2008;8(5):809-18.

Collins KL, Russell HG, Schumacher PJ, Robinson-Freeman KE, O'Connor EC, Gibney KD. A review of current theories and treatments for phantom limb pain. J Clin Invest. 2018;128(6):2168-76.

Bach S, Noreng MF, Tjhllden NU. Phantom limb pain in amputees during the first 12 months following limb amputation, after preoperative lumbar epidural blockade. Pain. 1988;33(3):297-301.

Duarte LT, Fernandes Mdo C, Fernandes MJ, Saraiva RA. Continuous epidural analgesia: analysis of efficacy, side effects and risk factors. Rev Bras Anestesiol. 2004;54(3):371-90.

Deer TR, Serafini M, Buchser E, Ferrante FM, Hassenbusch SJ. Intrathecal bupivacaine for chronic pain: a review of current knowledge. neuromodulation: technology at the neural interface. Neurom Techonol Neural Interface. 2002;5(4):196-207.

Ito A, Yoshimura M. Mechanisms of the analgesic effect of calcitonin on chronic pain by alteration of receptor or channel expression. Mol Pain. 2017;13:1744806917720316.

McCormick Z, Chang-Chien G, Marshall B, Huang M, Harden RN. Phantom limb pain: a systematic neuroanatomical-based review of pharmacologic treatment. Pain Med. 2014;15(2):292-305.

Jaeger H, Maier C. Calcitonin in phantom limb pain: a double-blind study. Pain. 1992;48(1):21-7.

Coderre T, Katz J, Vaccarino A, Melzack R. Contribution of central neuroplasticity to pathological pain: review of clinical and experimental evidence. Pain. 1993;52(3):259-85.

Flor H, Elbert T, Knecht S, Wienbruch C, Pantev C, Birbaumer N. Phantom-limb pain as a perceptual correlate of cortical reorganization following arm amputation. Nature. 1995;375(6531):482-4.

Flor H, Nikolajsen L, Staehelin Jensen T. Phantom limb pain: a case of maladaptive CNS plasticity?. Nat Rev Neurosci. 2006;7(11):873-81.

Diers M, Christmann C, Koeppe C, Flor H. Mirrored, imagined and executed movements differentially activate sensorimotor cortex in amputees with and without phantom limb pain. Pain. 2010;149(2):296-304.

Nikolajsen L, Jensen TS. Phantom limb pain. Br J Anaesth. 2001;87(1):107-16.

Yaputra F, Widyadharma E. Management of phantom limb pain: a review. Int J Med Rev Case Reports. 2018;5:29-32.


Submitted date:
02/03/2020

Accepted date:
07/21/2020

60873279a953956479074643 brjp Articles

BrJP

Share this page
Page Sections