Multimodal intrathecal therapy for phantom limb pain: a report of 2 cases
Keywords:
Pain Management, Phantom Limb, Infusion Pumps, Infusions, Spinal, Case Reports
Abstract
Introduction:
Phantom limb pain (PLP) is a chronic debilitating condition, frequently observed in amputees. At present, there is no standard treatment, and its optimal management requires a multidisciplinary approach in which minimally invasive treatment should be considered in more complex cases.
Objective:
To report successful treatment of 2 cases of PLP treated with ziconotide as part of multimodal intrathecal management.
Materials and methods:
Descriptive, retrospective case report developed in a multimodal pain treatment unit.
Results:
A total of 2 cases of patients with diagnosis of PLP refractory to medical therapy, treated with intrathecal multimodal therapy, are presented. Their favorable course, with 50% pain reduction, is described.
Conclusion:
Implantation of infusion systems for administration of intrathecal analgesia with ziconotide at the cervical and supraspinal level proved to be effective in the described cases; this technique should be evaluated in specific trials for the treatment of PLP refractory to other therapies.
References
1. Cadavid Puentes AM, Castañeda Marin EM. Very early phantom limb pain following amputation of a lower extremity. Case report. Colombian Journal of Anesthesiology 2013;1:236-239.
2. Malavera Angarita MA, Carrillo Villa S, Gomezese Ribero OF, García RG, Silva Sieger FA. Pathophysiology and treatment of phantom limb pain. Colombian Journal of Anesthesiology 2014;42:40-46.
3. Richardson C, Kulkarni J. A review of the management of phantom limb pain: challenges and solutions. J Pain Res 2017;10:1861-1870.
4. Luo Y, Anderson TA. Phantom limb pain: a review. Int Anesthesiol Clin 2016;54:121-139.
5. Kuffler DP. Origins of phantom limb pain. Mol Neurobiol 2018;55:60-69.
6. Melzack R, Coderre TJ, Katz J, et al. Central neuroplasticity and pathological pain. Ann N Y Acad Sci 2001;933:157-174.
7. Batsford S, Ryan CG, Martin DJ. Non-pharmacological conservative therapy for phantom 7. limb pain: a systematic review of randomized controlled trials. Physiother Theory Pract 2017; 33:173-183.
8. Herrador Colmenero L, Perez Mármol JM, Martí-García C, Querol Zaldivar MLÁ, Tapia Haro RM, Castro Sánchez AM, et al. Effectiveness of mirror therapy, motor imagery, and virtual feedback on phantom limb pain following amputation: a systematic review. Prosthet Orthot Int 2018;42:288-298.
9. Ferraro F, Jacopetti M, Spallone V, et al. Diagnosis and treatment of pain in plexopathy, radiculopathy, peripheral neuropathy and phantom limb pain. Evidence and recommendations from the Italian Consensus Conference on Pain on Neuro-rehabilitation. Eur J Phys Rehabil Med 2016;52:855-866.
10. Alviar MJM, Hale T, Dungca M. Pharmacologic interventions for treating phantom limb pain. Cochrane Database Syst Rev 2016; 10:CD006380.
11. Deer TR, Pope JE, Hayek SM, et al. The Polyanalgesic Consensus Conference (PACC): recommendations on Intrathecal Drug Infusion Systems Best Practices and Guidelines. Neuromodulation 2017;20:96-132.
12. Falco FJE, Patel VB, Hayek SM, et al. Intrathecal infusion systems for long-term management of chronic non-cancer pain: an update of assessment of evidence. Pain Physician 2013;16 (2 suppl): SE185-SE216.
13. Wie CS, Derian A. Ziconotide. Treasure Island, FL: StatPearls Publishing; 2017.
14. Williams JA, Day M, Heavner JE. Ziconotide: an update and review. Expert Opin Pharmacother 2008;9:1575-1583.
15. Dupoiron D, Bore F, Lefebvre-Kuntz D, et al. Ziconotide adverse events in patients with cancer pain: a multicenter observational study of a slow titration, multidrug protocol. Pain Physician 2012;15:395-403.
16. Brose WG, Gutlove DP, Luther RR, et al. Use of intrathecal SNX-111, a novel, N-type, voltage-sensitive, calcium channel blocker, in the management of intractable brachial plexus avulsion pain. Clin J Pain 1997;13:256-259.
17. Wallace MS, Rauck R, Fisher R, et al. Intrathecal ziconotide for severe chronic pain: safety and tolerability results of an open-label, long-term trial. Anesth Analg 2008;106:628-637. table of contents.
18. Wermeling DP, Berger JR. Ziconotide infusion for severe chronic pain: case series of patients with neuropathic pain. Pharmacotherapy 2006;26:395-402.
19. Staats PS, Yearwood T, Charapata SG, et al. Intrathecal ziconotide in the treatment of refractory pain in patients with cancer or AIDS: a randomized controlled trial. JAMA 2004;291:63-70.
20. Staquet H, Dupoiron D, Nader E, et al. Intracerebroventricular pain treatment with analgesic mixtures including ziconotide for intractable pain. Pain Physician 2016;19:E905-E915.
21. Talu GK, Erdine S. Intrathecal morphine and bupivacaine for phantom limb pain: a case report. Pain Pract 2005;5:55-57.
22. Dahm PO, Nitescu PV, Appelgren LK, et al. Long-term intrathecal infusion of opioid and/or bupivacaine in the prophylaxis and treatment of phantom limb pain. Neuromodulation 1998;1:111-128.
2. Malavera Angarita MA, Carrillo Villa S, Gomezese Ribero OF, García RG, Silva Sieger FA. Pathophysiology and treatment of phantom limb pain. Colombian Journal of Anesthesiology 2014;42:40-46.
3. Richardson C, Kulkarni J. A review of the management of phantom limb pain: challenges and solutions. J Pain Res 2017;10:1861-1870.
4. Luo Y, Anderson TA. Phantom limb pain: a review. Int Anesthesiol Clin 2016;54:121-139.
5. Kuffler DP. Origins of phantom limb pain. Mol Neurobiol 2018;55:60-69.
6. Melzack R, Coderre TJ, Katz J, et al. Central neuroplasticity and pathological pain. Ann N Y Acad Sci 2001;933:157-174.
7. Batsford S, Ryan CG, Martin DJ. Non-pharmacological conservative therapy for phantom 7. limb pain: a systematic review of randomized controlled trials. Physiother Theory Pract 2017; 33:173-183.
8. Herrador Colmenero L, Perez Mármol JM, Martí-García C, Querol Zaldivar MLÁ, Tapia Haro RM, Castro Sánchez AM, et al. Effectiveness of mirror therapy, motor imagery, and virtual feedback on phantom limb pain following amputation: a systematic review. Prosthet Orthot Int 2018;42:288-298.
9. Ferraro F, Jacopetti M, Spallone V, et al. Diagnosis and treatment of pain in plexopathy, radiculopathy, peripheral neuropathy and phantom limb pain. Evidence and recommendations from the Italian Consensus Conference on Pain on Neuro-rehabilitation. Eur J Phys Rehabil Med 2016;52:855-866.
10. Alviar MJM, Hale T, Dungca M. Pharmacologic interventions for treating phantom limb pain. Cochrane Database Syst Rev 2016; 10:CD006380.
11. Deer TR, Pope JE, Hayek SM, et al. The Polyanalgesic Consensus Conference (PACC): recommendations on Intrathecal Drug Infusion Systems Best Practices and Guidelines. Neuromodulation 2017;20:96-132.
12. Falco FJE, Patel VB, Hayek SM, et al. Intrathecal infusion systems for long-term management of chronic non-cancer pain: an update of assessment of evidence. Pain Physician 2013;16 (2 suppl): SE185-SE216.
13. Wie CS, Derian A. Ziconotide. Treasure Island, FL: StatPearls Publishing; 2017.
14. Williams JA, Day M, Heavner JE. Ziconotide: an update and review. Expert Opin Pharmacother 2008;9:1575-1583.
15. Dupoiron D, Bore F, Lefebvre-Kuntz D, et al. Ziconotide adverse events in patients with cancer pain: a multicenter observational study of a slow titration, multidrug protocol. Pain Physician 2012;15:395-403.
16. Brose WG, Gutlove DP, Luther RR, et al. Use of intrathecal SNX-111, a novel, N-type, voltage-sensitive, calcium channel blocker, in the management of intractable brachial plexus avulsion pain. Clin J Pain 1997;13:256-259.
17. Wallace MS, Rauck R, Fisher R, et al. Intrathecal ziconotide for severe chronic pain: safety and tolerability results of an open-label, long-term trial. Anesth Analg 2008;106:628-637. table of contents.
18. Wermeling DP, Berger JR. Ziconotide infusion for severe chronic pain: case series of patients with neuropathic pain. Pharmacotherapy 2006;26:395-402.
19. Staats PS, Yearwood T, Charapata SG, et al. Intrathecal ziconotide in the treatment of refractory pain in patients with cancer or AIDS: a randomized controlled trial. JAMA 2004;291:63-70.
20. Staquet H, Dupoiron D, Nader E, et al. Intracerebroventricular pain treatment with analgesic mixtures including ziconotide for intractable pain. Pain Physician 2016;19:E905-E915.
21. Talu GK, Erdine S. Intrathecal morphine and bupivacaine for phantom limb pain: a case report. Pain Pract 2005;5:55-57.
22. Dahm PO, Nitescu PV, Appelgren LK, et al. Long-term intrathecal infusion of opioid and/or bupivacaine in the prophylaxis and treatment of phantom limb pain. Neuromodulation 1998;1:111-128.
How to Cite
1.
Carvajal G, Rocha A, Dupoiron D. Multimodal intrathecal therapy for phantom limb pain: a report of 2 cases. Colomb. J. Anesthesiol. [Internet]. 2019 Jul. 1 [cited 2024 Apr. 25];47(3):198-201. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/85
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Published
2019-07-01
How to Cite
1.
Carvajal G, Rocha A, Dupoiron D. Multimodal intrathecal therapy for phantom limb pain: a report of 2 cases. Colomb. J. Anesthesiol. [Internet]. 2019 Jul. 1 [cited 2024 Apr. 25];47(3):198-201. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/85
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Section
Case Report / Case Series
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