Potential of Physical Analgesia in the Complex Rehabilitation of Patients with Stump Pain and Phantom Pain After Lower Limb Amputation (A Double-blind Randomised Controlled Trial of Efficacy of Deep Oscillation, Laser Therapy and Paravertebral Infiltrations) | Chapter 09 | Current Trends in Medicine and Medical Research Vol. 3
Introduction:
Most of amputees feel residual limb (stump) pain, phantom sensations and
phantom pain. Our purpose was to remind the wide public of the impact of
rehabilitation (including the modern physical
modalities Deep Oscillation – DO and
Laser therapy –L Th) in
the pain management
of amputees. According the medical definitions the amputation is ‘’the
intentional surgical removal of a limb
or body part;
performed for the
following reasons: to
remove malignant tumors,
after severe trauma, and to remove
tissues without adequate blood supply, because of injury to the blood vessel,
hardening of the arteries, arterial embolism, impaired circulation, repeated
severe infection that leads to gangrene, severe frostbite, Raynaud's disease,
or Buerger's disease’’.
Aims:
Comparative evaluation of drug, physical (including DO and LTh) and combined
analgesia in the complex rehabilitation of patients after trans-femoral
amputation suffering from stump pain and phantom pain. In the current chapter,
we tested the hypothesis that some modern
preformed modalities (Deep Oscillation and Laser therapy) in combination
with paravertebral infiltrations have the capacity to provide an analgesic
effect, to relieve reactive depression and to ameliorate the quality of life of
amputees.
Materials and Methods: During last
years a total of 105 amputees with stump pain and phantom pain were observed
and investigated. The
investigation was conducted
with consideration for
the protection of patients, as outlined in the Declaration of Helsinki,
and was approved by the appropriate institutional review boards and ethic
commissions. All patients gave written informed consent before undergoing any
examination or study procedure. A
simple randomization was
used. Patients were
sequentially numbered and
randomized into five treatment groups of 21 each one.
All patients received
a complex rehabilitation programme
including physical therapy
and patients’ education. In group
1 we applied too drug therapy – paravertebral infiltrations with steroids,
lidocaine and B vitamins. Patients of group 2 received a complex rehabilitation
programme, including DO. In group 3 we applied drug and physical analgesia
techniques (infiltrations and DO). Patients of group 4 received a
complex rehabilitation programme,
including LaserTh. In
group 5 we
applied drug and physical analgesia techniques (infiltrations
and LTh). For statistical evaluation we used t-test (ANOVA) and Wilcoxon rank
test (non-parametrical correlation analysis), performed using SPSS package. The
treatment difference was considered as statistically significant if the P
valuewas < 0.05.
Results:
The comparative analysis of results shows a significant improvement of the
symptoms of the patients, concerning:
pain relief (visualized
by the analysis
of results of
Visual analogue scale, evaluation of
stump tenderness), and
depression (scales of
Zung and McGill
Quality of life questionnaire). In all cases we detected
reduction of pain sensation and depression; amelioration of the independence in
ADL. The
drug analgesia in
group 1 was fast,
but short; the
efficacy in physiotherapy groups 2 & 4 was slow, but stable, and
durable. We received best results in combined groups 3 & 5.
Discussion:
The drug therapy is efficient but with short duration. The physical analgesia
with DO and L Th initiates its effect
slowly, but the
results are stable.
Best efficacy was
observed in case
of combination of medication with physical
modalities – in the beginning
due to the steroid
injection, toward the moment of effective «input» of the physical
modalities. Current paper proposes
personal opinions on
some contemporaneous theories
of pain and therapeutic concepts of analgesia,
including physical analgesia. We mentioned principal natural and preformed
physical modalities, with effectiveness in clinical practice. Authors suggest a
conception of mechanisms of physical
analgesia, especially in case of
application of Deep oscillation and
Laser therapy.
Conclusion:
We consider most
effective the combination
of drug and
non-drug analgesia in all
patients after lower limb amputation. We could recommend the complex program
for treatment of the pain in amputees. Pain management is an important part of
the rehabilitation algorithms in amputated patients with stump and phantom limb
pain. The efficacy of Deep Oscillation is probably due to a block of nociceptors. The application of
Laser therapy is
most effective in
cases with trophic alterations.
Author(s) Details
Prof. Ivet Borissova Koleva
Medical University of Sofia,
Sofia, Bulgaria.
Borislav Radoslavov
Yoshinov
Medical Faculty of Sofia
University, Sofia, Bulgaria.
Prof. Radoslav Yoshinov
Bulgarian Academy of
Sciences, Laboratory of Telematics, Sofia, Bulgaria.
Comments
Post a Comment