Phantom limb pain: low frequency repetitive transcranial magnetic stimulation in unaffected hemisphere.

Department of Psychiatry, University of Florence, 50134 Florence, Italy.
Case Reports in Medicine 01/2011; 2011:130751. DOI: 10.1155/2011/130751
Source: PubMed

ABSTRACT Phantom limb pain is very common after limb amputation and is often difficult to treat. The motor cortex stimulation is a valid treatment for deafferentation pain that does not respond to conventional pain treatment, with relief for 50% to 70% of patients. This treatment is invasive as it uses implanted epidural electrodes. Cortical stimulation can be performed noninvasively by repetitive transcranial magnetic stimulation (rTMS). The stimulation of the hemisphere that isn't involved in phantom limb (unaffected hemisphere), remains unexplored. We report a case of phantom limb pain treated with 1 Hz rTMS stimulation over motor cortex in unaffected hemisphere. This stimulation produces a relevant clinical improvement of phantom limb pain; however, further studies are necessary to determine the efficacy of the method and the stimulation parameters.

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    ABSTRACT: Introducción El dolor de miembro fantasma puede ocurrir hasta en el 80% de los sujetos con amputación por trauma o enfermedad vascular periférica. Varios factores se han asociado a su generación, como el dolor preamputación, la etiología y el nivel de la amputación. Objetivo Revisar el estado actual de los mecanismos fisiopatológicos, las opciones de trata-miento y su eficacia en el dolor de miembro fantasma. Métodos Se realizó una revisión de la literatura no sistemática en las bases de datos PubMedy Cochrane sobre artículos que describieran la fisiopatología y el tratamiento del dolor de miembro fantasma. Resultados y conclusiones Los mecanismos fisiopatológicos propuestos aún se encuentran en investigación e incluyen factores periféricos, centrales y psicológicos. Las opciones de tratamiento continúan siendo limitadas, y menos del 10% reportan mejoría a largo plazo.
    01/2013; DOI:10.1016/j.rcae.2013.10.002
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    ABSTRACT: Background: Phantom limb pain (PLP) occurs in up to 85% of patients who have amputations and significantly worsens their quality of life. PLP is extremely difficult to treat, and common pain treatment is rarely effective. This case report describes the use of Yamamoto New Scalp Acupuncture (YNSA) to treat chronic severe PLP. Case: A 59-year-old man presented to an outpatient pain clinic with a chief complaint of chronic severe PLP after the left-femoral lower-third amputation that he had 21 years before. Intervention: YNSA was performed on the points representing the cranial nerves. Main Outcome Measures: PLP intensity, duration, and frequency were monitored to determine if the patient gained any pain relief from YNSA. Results: During the week after the thirteenth YNSA session, the patient reported a decrease in PLP intensity from 9 – 1 before the treatment to *1 or no PLP at all. Following the sixteenth YNSA session, the patient reported a decrease in the average duration of PLP (0.5 – 0.25 minutes) from * 13 – 11 hours to 30 seconds per incidence, with an intensity of *1. After the twenty-fourth session, the patient reported a sustained reduction of *50% in the frequency of PLP episodes. Conclusions: This is the first case report on the effective use of YNSA for the treatment of chronic severe PLP.
    Medical Acupuncture 06/2012; 24(2). DOI:10.1089/acu.2011.0854
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    ABSTRACT: Introduction Phantom limb pain may be present in up to 80% of patients subjected to amputation because of trauma or peripheral vascular disease. Several factors have been associated with its occurrence, including pre-amputation pain, the etiology, and the amputation level. Objective To review the current status of the pathophysiological mechanisms, treatment options and their efficacy for the management of phantom limb pain. Method Non-systematic review of the literature in PubMed and Cochrane, of articles describing the pathophysiology and treatment of phantom limb pain. Results and conclusions The proposed pathophysiological mechanisms are still in research and include peripheral, central and psychological factors. Treatment options are still limited, and less than 10% of patients report long-term improvement.
    Revista Colombiana de Anestesiologia 01/2013; DOI:10.1016/j.rca.2013.09.012

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