加速将研究成果转化为临床实践:来自幻肢痛临床试验的见解。

K. Pacheco-Barrios, Paulo S de Melo, Karen Vásquez-Ávila, A. Cardenas-Rojas, Paola Gonzalez-Mego, A. Marduy, Joao Parente, Ingrid Rebello Sanchez, P. Cortêz, Meghan Whalen, L. Castelo-Branco, F. Fregni
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引用次数: 1

摘要

幻肢痛(PLP)被定义为截肢肢体的疼痛感觉或部分或完全脱神经后的疼痛。它属于一组神经性疼痛综合征,它的治疗是具有挑战性的,往往是难治性的许多方式,造成巨大的负担和痛苦。截肢后PLP的患病率在60-80%之间(Limakatso et al., 2020)。在某些情况下,疼痛可能会随着时间的推移而减轻甚至消失,但研究表明,即使在两年后,大多数患者仍然存在疼痛,只有一小部分患者报告疼痛强度减轻(Erlenwein et al., 2021)。到目前为止,还没有关于PLP治疗的指南,而且大多数治疗方法的证据水平很低。可能的治疗方法包括使用药物治疗,包括阿片类药物、抗抑郁药、神经抑制剂、肌肉松弛剂和抗惊厥药(Flor, 2002)、各种外科手术(Nikolajsen & Christensen, 2015)、神经阻滞、局部麻醉、经皮神经电刺激(TENS) (Kern et al., 2012)、针灸、心理干预、物理治疗和催眠等身心技术(Bamford, 2006;Moura et al., 2012)。用于PLP的常规治疗,如药物治疗,有相应的局限性。使用药物来控制疼痛与几种副作用有关,并且从长期来看可能不可持续(Els等人)。
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Accelerating the translation of research findings to clinical practice: insights from phantom limb pain clinical trials.
Phantom limb pain (PLP) is defined as a painful sensation in an amputated limb or pain that follows partial or complete deafferentation. It belongs to a group of neuropathic pain syndromes, and its treatment is challenging and often refractory to many modalities, causing significant burden and suffering. The prevalence of PLP after amputation ranges between 60–80% (Limakatso et al., 2020). In some cases, the pain might decrease with time and even fade away, but studies have shown that even after two years, a majority of the patients still present pain, and only a small percentage have reported a decrease in intensity of pain (Erlenwein et al., 2021). To date, there is no guidelines for the treatment of PLP and most therapies have low levels of evidence. Possible treatments include the use of pharmacotherapy including opioids, antidepressants, neuroleptics, muscle relaxants and anticonvulsants (Flor, 2002), a variety of surgical procedures (Nikolajsen & Christensen, 2015), nerve blocks, local anesthesia, transcutaneous electrical nerve stimulation (TENS) (Kern et al., 2012), acupuncture, psychological interventions, physiotherapy, and mind-body techniques such as hypnosis(Bamford, 2006; Moura et al., 2012). Conventional treatments used for PLP, such as pharmacologic agents, have pertinent limitations. The use of pharmacologic agents for controlling pain is associated with several side effects and can become unsustainable in the long term (Els et al.,
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Developing transcranial direct current stimulation as a treatment for phantom limb pain: from pilot mechanistic studies to large clinical studies. Enhancing Dissemination and Understanding in Clinical Research Protocols: Optimizing Visual Communication in a Phantom Limb Pain Clinical Trial. Physical Conditioning, Obesity and Fibromyalgia: Causal Relationship or Confounding? Editorial - Seeking Brain Homeostatic Compensatory Mechanisms for Pain Control. XIV International Symposium of Neuromodulation: Conference Abstracts
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