After an 截肢, some patients may feel pain in their residual limbs. Post-截肢 pain—categorized as 幻肢疼痛 or stump pain—can be a challenging condition to treat.
Phantom pain is different from stump pain, but they often occur together. Describing your post-截肢 pain can help your doctor accurately diagnose and treat these two conditions.
幻肢痛
Phantom limb pain feels like it's coming from a body part that's no longer there. Doctors once believed this post-截肢 phenomenon was a psychological problem, but experts now recognize that this is a real sensation originating in the 脊髓 and brain. "Many layers are involved in determining the causes of phantom limb pain," says 科尔比·汉森，医学博士, an associate professor in the Department of Physical Medicine and Rehabilitation at University of Utah Health. "A combination of both central (brain and 脊髓) and peripheral (nerves in the affected extremity) nervous system can contribute to phantom limb pain."
症状
Characteristics of phantom limb pain can start within the first week, be delayed months after 截肢, 可以来去自如, 或者连续. 被截肢者s describe phantom limb pain as shooting, stabbing, cramping, crushing, 悸动的, or 燃烧. For many, it may resemble the type of pain they may have experienced in their limb before 截肢.
诊断
Although there's no medical test to diagnose 幻肢疼痛, doctors identify the condition based on your symptoms and the knowledge that 幻肢疼痛 could be caused by a miscommunication between your brain, 脊髓, and nerves that continues after your 截肢. Your physician will ask you about other causes that can worsen your pain, 包括压力, 焦虑, 抑郁症, and pain in the limb before 截肢.
治疗
For some people, 幻肢疼痛 gets better over time without treatment. For others, managing 幻肢疼痛 can be challenging. Hansen says a team effort by health care professionals including physical therapists, 心理学家, 外科医生, and prosthetists results in alleviating 幻肢疼痛 effectively through:
- Over-the-counter pain relievers and some stronger medications
- 抗抑郁药
- Physical and occupational therapy
- 注射
- Surgery on the residual limb and nerve
- 电刺激
- 穿着一件 假体 更频繁地
- 镜治疗
- Standard relaxation techniques such as mindfulness, 引导图像, 温柔的按摩, 听音乐
树桩疼痛
树桩疼痛, also called residual limb pain, is a type of pain felt in the part of a limb that remains after an 截肢. It occurs in about half of people within the first week following an 截肢 but also may last beyond healing.
症状
Residual limb pain varies in severity, but you may feel uncomfortable sensations such as pressing, 悸动的, 燃烧, 挤压, 或刺.
诊断
Tests and procedures used to diagnose stump pain include:
- 物理考试: Checks for skin breakdown, pressure sores, bone problems, signs of infection, and masses. Your doctor may detect a neuroma—a tangle of nerve endings that can form after 截肢—and complications with the fit or use of a prosthesis.
- 成像测试: 核磁共振成像, CT扫描, x射线, or ultrasound help rule out other causes for your pain and identify fractures, 骨骼畸形, 肿瘤, 和感染.
- 血液测试: Detect other medical conditions that could result in pain.
治疗
治疗 for stump pain focuses on treating the underlying cause of the pain. 树桩疼痛 eventually improves without treatment in about half of the patients. Pain relief options include medications (pain relievers, 抗抑郁药, 和抗惊厥药物), physical and occupational therapy, 按摩, 催眠, 神经阻断, 和神经调节.
在犹他大学, Hansen and other physicians use the most advanced techniques to restore strength, 函数, 控制, 避免疼痛. 其中一种方法是 targeted muscle reinnervation (TMR) surgery to split the ends of the nerves and place them into muscles where they will grow into new muscles. TMR surgery can prevent pain and allow 假体 limbs to read signals from the muscles.
An amputee whom Hansen cared for did not have residual pain for about eight years following a leg 截肢 due to a traumatic injury. 然而, 在诊所就诊期间, the amputee reported 燃烧 and tingling pain that may have been caused by a neuroma forming off his sciatic nerve. He was treated for delayed stump pain using therapies of medicine, 注射, and ultrasonography-guided radiofrequency ablation to relieve post-截肢 pain. Hansen found that a combination of strategies such as these has worked to relieve the amputee’s occasional residual pain when it reoccurs.
"The sorting out of the causes of pain can be tricky, but with the patient’s and health care providers’ perseverance, many amputees can be pain-free through psychological and therapeutic strategies,汉森说。.