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Peripheral neuropathy and post-amputation pain syndromes 

Peripheral neuropathy and post-amputation pain syndromes
Chapter:
Peripheral neuropathy and post-amputation pain syndromes
Author(s):

Stefan Lauer

and Stephan A. Schug

DOI:
10.1093/med/9780199658220.003.0010
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date: 18 October 2019

Neuropathic pain has been recently redefined as ‘pain caused by a lesion or disease of the somatosensory system’. It poses a major clinical challenge as it is difficult to diagnose and to treat. Neuropathic pain is caused by a range of different diseases and lesions with multiple underlying mechanisms. Pharmacotherapy is the mainstay of treatment. Current guidelines recommend antidepressants, as well as calcium channel α‎2-δ‎ ligands and topical lignocaine as first-line treatment options. Tramadol and, in particular, opioids are regarded as second-line treatments. For optimal results, integration of pharmacotherapy into a multidisciplinary approach is required to address psychosocial factors and disability. Post-amputation pain includes stump and phantom limb pain, which both pose common clinical problems. Pre-amputation and severe acute pain seem to be predictors of chronic phantom limb pain. The pathophysiological basis of phantom limb pain is probably a combination of peripheral, spinal, and cortical phenomena. Many treatment strategies have been developed on the basis of these concepts. Limited evidence exists for the prevention of phantom limb pain by peri-operative epidural analgesia and for calcitonin to treat the acute manifestation. Sensory discrimination and motor imagery, laterality recognition and mirror therapy are interesting new approaches.

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