Chapter 4 Diagnostic and Treatment Issues in Postamputation Pain After Landmine Injury
2006; Oxford University Press; Volume: 7; Issue: suppl 2 Linguagem: Inglês
10.1111/j.1526-4637.2006.00234_6.x
ISSN1526-4637
AutoresPhilip J Wiffen, J. Meynadier, Michel Y. Dubois, Calude Thurel, Johan DeSmet, R. Norman Harden,
Tópico(s)Pain Management and Treatment
ResumoTreating postamputation pain is challenging because it probably comprises nociceptive and neuropathic components, and the neuropathic part probably has both peripheral and central elements. Nociceptive pain usually responds to traditional analgesics, but neuropathic pain is less responsive to most medications and is therefore more difficult to treat. Phantom limb pain (PLP) is by definition neuropathic. Satisfactory management of the pain is often difficult to achieve, although a systematic and empathic approach often improves outcomes. Controlled studies on the efficacy of treatments for postamputation pain are generally lacking, and even less evidence is available for postamputation pain resulting specifically from landmine injuries. In this chapter we will often extrapolate from evidence from other related diagnoses. Diagnostic imprecision in which PLP is not distinguished from stump pain or neuroma pain adds to the problems for both victim and caregiver. A proper diagnostic work-up can help establish the general cause of pain, provide hints as to mechanism, and thereby guide treatment decisions. To match the putative mechanism of pain with presumed mechanism of drug action is the ideal. Douleur Sans Frontieres developed a simple questionnaire to distinguish stump pain from PLP: 1. Do you have a sensation of the limb being present? 2. Do you sometimes fall down when you rise, thinking that your limb is still present? 3. Do you have pain in your missing limb? 4. Do you have stump pain (pain in the residual limb): 5. Does pain prevent you from using your prosthesis? Simply asking this series of questions will help the practitioner to distinguish between PLP and residual limb pain (RLP). The distinction of neuroma pain requires physical examination to detect a “Tinnel's sign” (an electrical/painful sensation elicited from the neuroma by a digital or reflex hammer percussion). Eliciting as many verbal descriptors of the pain …
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