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Neuropathy – phantom limb pain

from Chief complaints and diagnoses

Published online by Cambridge University Press:  18 December 2009

By
David Cline
Edited by
Stephen H. Thomas
Stephen H. Thomas
Affiliation:
Harvard Medical School
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Summary

Acute care providers need to be familiar with phantom limb pain (PLP) as the complaint occurs in up to 80% of patients after amputation and it is important to institute early and effective intervention. Opioids are commonly recommended for acute treatment of PLP. Oral opioids, usually in combination with another agent (e.g. calcitonin), form the mainstay of PLP therapy. The benzodiazepines, which potentiate the spinal neuronal inhibitory effects of gamma-aminobutyric acid (GABA), may ameliorate pain from acute PLP flares. In contradistinction to their utility in other forms of neuropathic pain, antidepressants have only a limited role for acute PLP. The anticonvulsants have been investigated for PLP, with mixed results. Carbamazepine is postulated to be of utility, but supporting evidence for its use in PLP is anecdotal. There is stronger evidence for gabapentin prescription in PLP.

Keywords

antiemeticsbeta-blockerscalcium channel blockersergot alkaloidsNSAIDsopioidsumatriptanmigraine headache
Type
Chapter
Information
Emergency Department Analgesia
An Evidence-Based Guide
 , pp. 301 - 305
Publisher: Cambridge University Press
Print publication year: 2008

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