• The Korean Journal of Pain
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• 제25권4호
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• pp.272-274
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• 2012

Phantom limb pain is a painful sensation that is perceived in a body part that no longer exists. To control this pain, many methods have been used such as medication, physical treatment, nerve block, neuromodulation, surgical treatment and mirror therapy. However, until now, there effects have been uncertain. We report the successful reduction of phantom limb pain using mirror therapy when other treatments initially failed to control the pain.

• The Korean Journal of Pain
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• 제32권4호
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• pp.271-279
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• 2019

Background: We utilized diffusion tensor imaging (DTI) to evaluate the cerebral white matter changes that are associated with phantom limb pain in patients with unilateral arm amputation. It was anticipated that this would complement previous research in which we had shown that changes in cerebral blood volume were associated with the cerebral pain network. Methods: Ten patients with phantom limb pain due to unilateral arm amputation and sixteen healthy age-matched controls were enrolled. The intensity of phantom limb pain was measured by the visual analogue scale (VAS) and depressive mood was assessed by the Hamilton depression rating scale. Diffusion tensor-derived parameters, including fractional anisotropy, mean diffusivity, axial diffusivity (AD), and radial diffusivity (RD), were computed from the DTI. Results: Compared with controls, the cases had alterations in the cerebral white matter as a consequence of phantom limb pain, manifesting a higher AD of white matter in both hemispheres symmetrically after adjusting for individual depressive moods. In addition, there were associations between the RD of white matter and VAS scores primarily in the hemispheres related to the missing hand and in the corpus callosum. Conclusions: The phantom limb pain after unilateral arm amputation induced plasticity in the white matter. We conclude that loss of white matter integrity, particularly in the hemisphere connected with the missing hand, is significantly correlated with phantom limb pain.

• The Korean Journal of Pain
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• 제19권2호
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• pp.233-236
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• 2006

Phantom limb pain is a painful sensation from an absent limb. The onset of pain is generally early, with 75% of patients developing pain within the first few days after amputation. The frequency and duration of attacks tend to be reduced with time, although the prevalence and intensity remain constant. We report here a case of a 38-year-old man who exhibited the signs and symptoms of phantom limb pain due to the above-knee amputations of both legs. He was not responded to opioid therapy and a continuous intravenous infusion of ketamine, an N-methyl-D-aspatate receptor antagonist, reduced his severe pain.

• The Korean Journal of Pain
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• 제29권2호
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• pp.123-128
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• 2016

Phantom limb pain is a phenomenon in which patients experience pain in a part of the body that no longer exists. In several treatment modalities, spinal cord stimulation (SCS) has been introduced for the management of intractable post-amputation pain. A 46-year-old male patient complained of severe ankle and foot pain, following above-the-knee amputation surgery on the right side amputation surgery three years earlier. Despite undergoing treatment with multiple modalities for pain management involving numerous oral and intravenous medications, nerve blocks, and pulsed radiofrequency (RF) treatment, the effect duration was temporary and the decreases in the patient's pain score were not acceptable. Even the use of SCS did not provide completely satisfactory pain management. However, the trial lead positioning in the cauda equina was able to stimulate the site of the severe pain, and the patient's pain score was dramatically decreased. We report a case of successful pain management with spinal cauda equina stimulation following the failure of SCS in the treatment of intractable phantom limb pain.

• Archives of Plastic Surgery
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• 제48권3호
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• pp.310-322
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• 2021

The incidence of extremity amputation is estimated at about 200,000 cases annually. Over 25% of patients suffer from terminal neuroma or phantom limb pain (TNPLP), resulting in pain, inability to wear a prosthetic device, and lost work. Once TNPLP develops, there is no definitive cure. Therefore, there has been an emerging focus on TNPLP prevention. We examined the current literature on TNPLP prevention in patients undergoing extremity amputation. A literature review was performed using Ovid Medline, Cochrane Collaboration Library, and Google Scholar to identify all original studies that addressed surgical prophylaxis against TNPLP. The search was conducted using both Medical Subject Headings and free-text using the terms "phantom limb pain," "amputation neuroma," and "surgical prevention of amputation neuroma." Fifteen studies met the inclusion criteria, including six prospective trials, two comprehensive literature reviews, four retrospective chart reviews, and three case series/technique reviews. Five techniques were identified, and each was incorporated into a targetbased classification system. A small but growing body of literature exists regarding the surgical prevention of TNPLP. Targeted muscle reinnervation (TMR), a form of physiologic target reassignment, has the greatest momentum in the academic surgical community, with multiple recent prospective studies demonstrating superior prevention of TNPLP. Neurorrhaphy and transposition with implantation are supported by less robust evidence, but merit future study as alternatives to TMR.

• The Korean Journal of Pain
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• 제33권3호
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• pp.267-274
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• 2020

Background: General anesthesia (GA) has been considered the anesthetic technique which most frequent leads to phantom limb pain (PLP) after a limb amputation. However, these prior reports were limited by small sample sizes. The aims of this study were to evaluate the incidence of PLP according to the various anesthetic techniques used for limb amputation and also to compare the occurrence of PLP according to amputation etiology using the Korean Health Insurance Review and Assessment Service for large-scale demographic information. Methods: The claims of patients who underwent limb amputation were reviewed by analyzing the codes used to classify standardized medical behaviors. The patients were categorized into three groups-GA, neuraxial anesthesia (NA), and peripheral nerve block (PNB)-in accordance with the anesthetic technique. The recorded diagnosis was confirmed using the diagnostic codes for PLP registered within one year after the limb amputation. Results: Finally, 7,613 individuals were analyzed. According to the recorded diagnoses, 362 patients (4.8%) developed PLP after amputation. Among the 2,992 patients exposed to GA, 191 (6.4%) were diagnosed with PLP, whereas 121 (4.3%) of the 2,840 patients anesthetized with NA, and 50 (2.8%) of the 1,781 patients anesthetized under PNB developed PLP. The relative risks were 0.67 (95% confidence interval [CI], 0.53-0.84; P < 0.001) for NA and 0.43 (95% CI, 0.32-0.59; P < 0.001) for PNB. Conclusions: In this retrospective cohort study, using large-scale population-based databases, the incidence rates of PLP after limb amputations were, in the order of frequency, GA, NA, and PNB.

• Journal of Acupuncture Research
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• 제34권3호
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• pp.101-107
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• 2017

Objectives : We report a case of Phantom Limb Pain (PLP) and propose the possibility of integrative Korean and Western medicine in PLP treatment. Methods : For 42 days, a patient who complained of pain and insomnia with PLP (December 20, 2016 to January 20, 2017) received Korean and Western medical treatment. The patient was treated with analgesic injection, a neuropathic pain inhibitor, the combined herbal formula powders Bojungikgitang, and acupuncture. Symptom improvement was assessed using the numerical rating scale (NRS) and continuous sleep time. Results : The patient's NRS scores decreased, and continuous sleep time increased after treatment. The NRS scores decreased from 10 to 0, and the continuous sleep time increased from 2 hours to 7 to 8 hours. Conclusion : According to the results, this report suggests that integrative Korean and Western medicine could be effective in the treatment of PLP patients.

• 대한한방내과학회지
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• 제39권6호
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• pp.1306-1312
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• 2018

Objectives: This study presented the case of a 49-year-old Korean female with phantom limb pain after below right knee amputation and aimed to assess the effectiveness of Korean medicine treatment. Methods: The patient was treated with scalp acupuncture, electroacupuncture and herbal medicine. We executed a numerical rating scale (NRS), conducted a global assessment (G/A), administrated a Short-Form McGill Pain Questionnaire 2 (SF-MPQ-2) and measured total daily sleep time to evaluate symptom improvement. Results: The patient's G/A scores decreased from 10 to 2 and SF-MPQ-2 points decreased from 20 to 6 after treatment. The total daily sleep time did not changed due to anxiety. Conclusions: This study suggests that Korean medicine treatment could be effective in treating phantom limb pain after amputation. Further studies are needed.

• 대한방사선기술학회지:방사선기술과학
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• 제40권4호
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• pp.567-573
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• 2017

본 연구의 목적은 흉 복부 다중검출기전산화단층촬영(multi-detector computed tomography; MDCT)에서 상지를 머리 위로 위치 잡이 할 수 없는 경우 흉 복부에서 거리에 따른 인공유무를 평가하고자 하였다. 128-채널 MDCT로 흉 복부 CT를 위한 인체대상과 흉부 팬텀을 현재 임상에서 검사하고 있는 조건(120 kVp, 110 mAs, standard algorithm)으로 검사하였다. 인체 검사 시 한번은 팔을 머리 쪽으로 올리고 검사하고, 팔을 내린 후 동일한 조건으로 한 번 더 검사하였다. 흉부 팬텀 실험은 환자와 동일한 조건으로 검사를 하고, 상지팬텀을 흉 복부에서 일정한 거리(0, 3, 7 cm)를 두고 검사하였다. 목적하는 부위에 관심영역을 설정하여 CT 값, 노이즈, 신호 대 잡음비, 대조도 대 잡음비를 측정하여 평가하였다. 인체를 대상으로 획득한 영상에서 노이즈는 팔을 올렸을 때와 비교하여 팔을 내렸을 때 지방, 갈비뼈, 근육 모두에서 증가하였다(0.79, 47.8, 27%). 팬텀 영상에서도 상지를 아래로 내렸을 경우 근육, 폐 실질에서 노이즈가 증가하였다(31.2, 9.4%). 또한 상지의 위치가 흉 복부에서 멀어질수록(0, 3, 7 cm) 노이즈가 감소하였다. 근육에서 노이즈는 상지가 흉부와 붙어있을 경우(0 cm)를 기준으로 3 cm, 7cm 떨어졌을 때 5, 25.12% 감소하였고, 폐실질에서 5.6, 15.35% 감소하였다. 흉 복부 CT 촬영 시 갠트리 내 검사 이외의 부위(상지 등)가 위치할 경우 흉 복부로부터 약 3 cm 이상 거리를 유지시킨 후 검사를 진행하면 발생할 수 있는 인공음영을 최소화시킬 수 있을 것으로 사료된다.

• 대한물리치료과학회지
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• 제12권4호
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• pp.89-97
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• 2005

Objective: The purpose of this study was to access quality of life and evaluate pre and post surgery management for persons with lower limb amputations. Method: This study was designed as a telephone survey. The subjects were patients who underwent their lower limb amputation between January 1994, and February 2005 at Asan Medical Center in seoul. sixty one of 203 subjects had granted consent and were studied. Results: The major cause of below knee amputations was vascular disease. Traumatic injuries were more common among subjects with above knee amputations. 93.4% of subjects were in use of prosthesis and 70.1 days were required to fit the prosthesis. 68.4% of subjects were able to ambulate with single point cane or without assistive devices. 80.3% of subjects complained phantom pain. Most subjects expressed the unsatisfactory result regarding the functional usage of prosthesis and education from hospital. Conclusion: Pre and post surgery rehabilitation program will benefit to promote better functional status and quality of life for persons with lower limb amputations.