Introduction: The management of phantom limb pain following amputation proves to be one of the major obstacles from the clinical point of view. Three main syndromes are often associated following this type of surgery: stump pain (pain felt in the residual limb region), phantom limb sensation (vivid and articulated image and sensation of the lost part), and finally phantom limb pain (pain felt in the missing body part). Underlying these syndromes appear to be mechanisms related to cortical reorganization. Specific treatment techniques to manage symptoms related to phantom limb include both pharmacological therapy and rehabilitative treatment: the most widely used nonpharmacological interventions for which there is evidence in the literature are implicit and explicit Graded Motor Imagery, Transcutaneous Electrical Nerve Stimulation (TENS), Transcranial Transcranial Stimulation (tDCS), and Mirror Therapy (MT). The latter treatment appears to have its efficacy for pain management and numerous studies are available on it, most of them focused on the chronic phase of phantom limb pain. Aims: To investigate the efficacy of mirror therapy for the management of phantom limb pain in amputee patients, with no limitations on the time elapsed since amputation surgery and the duration of phantom limb pain. Materials and methods: the review follows the PRISMA statement guidelines. A literature search was conducted from March until August 2022 from the following data-bases: Pubmed, PEDro and Cochrane Library. The keywords "Mirror therapy" and "Phantom Limb Pain" were used. The The Cochrane's ROB tool was used to assess the methodological quality of the studies. Criteria for risk assignment were made explicit. Results: The search yielded 187 articles. Following the selection process, 10 articles published between 2007 and 2021 were included. Methodological quality assessment found high risk for blinding of staff and participants, low risk for mode of randomization, incomplete outcomes and attrition bias, medium for the remaining domains. Conclusions: mirror therapy, in the short term, appears to be a cost-effective and effective therapy for the management of phantom limb pain in amputee patients by decreasing intensity, frequency and duration of individual episodes. Further studies with larger and more homogeneous samples are needed Clinical cases Aims: To study the effectiveness of mirror therapy in the patient with acute phantom limb pain, detecting quantitative and qualitative aspects related to pain, but also critical issues related to the setting and the psychological and emotional component of patients. Conclusions: Two patients admitted to the Orthopedic Operating Unit of the Hospital of Padua recently amputated one upper limb and the other lower limb were included and analyzed. Both were given inpatient mirror therapy, one of them continued with self-treatment at home. At follow-up, a decrease in both the number of unpleasant perceptions of the phantom limb experienced by the patient and the intensity of these was observed. This decrease probably occurred due to a spontaneous remission of symptoms. One change that was thought to be therapy-related was that related to the symptoms reported before and after treatment in one of the two patients. Some of the perceptions reported at the beginning of treatment, after about 15 minutes of mirror therapy, were often less intense, even to the point of disappearing. Critical issues related to setting, patient motivation and psychological impact were identified.
Introduzione: La gestione del dolore da arto fantasma a seguito di amputazione risulta uno degli ostacoli principali dal punto di vista clinico. A seguito di questo tipo di intervento sono spesso associate tre sindromi principali: moncone doloroso (dolore percepito nella regione di arto residuo), sensazione da arto fantasma (immagine e sensazione vivida e articolata della parte perduta) e infine il dolore da arto fantasma (dolore percepito nella parte del corpo mancante). Alla base di queste sindromi sembrano esserci i meccanismi legati alla riorganizzazione corticale. Tra le tecniche di trattamento specifiche per gestire i sintomi relativi all’arto fantasma si può ricorrere sia alla terapia farmacologica che al trattamento riabilitativo: gli interventi non farmacologici più utilizzati, per le quali sono presenti evidenze in letteratura sono la Graded Motor Imagery implicita ed esplicita, la Stimolazione Elettrica Nervosa Transcutanea (TENS), la stimolazione transcranica (tDCS) e la Mirror Therapy (MT). Quest’ultimo trattamento risulta avere la sua efficacia per la gestione del dolore e sono presenti numerosi studi a riguardo, la maggior parte dei quali focalizzati sulla fase cronica del dolore da arto fantasma. Obiettivi: indagare l’efficacia della mirror therapy per la gestione del dolore da arto fantasma nei pazienti amputati, senza limiti relativi al tempo trascorso dall’intervento di amputazione e alla durata del dolore da arto fantasma. Materiali e metodi: la revisione segue le linee guida PRISMA Statement. Da Marzo fino ad Agosto 2022 è stata condotta una ricerca della letteratura a partire dai seguenti data-base: Pubmed, PEDro e Cochrane Library. Sono state utilizzate le parole chiave “Mirror Therapy” e “Phantom Limb Pain”. Per la valutazione della qualità metodologica degli studi è stato utilizzato il ROB tool della Cochrane Library. Sono stati esplicitati i criteri per l’assegnazione del rischio. Risultati: La ricerca ha prodotto 187 articoli. In seguito al processo di selezione sono stati inclusi 10 articoli pubblicati tra il 2007 e il 2021. La valutazione della qualità metodologica ha rilevato un alto rischio per quanto riguarda l’accecamento del personale e dei partecipanti, basso rischio per le modalità di randomizzazione, completezza degli outcome e attrition bias, medio per i restanti domini. Conclusioni: la mirror therapy sembra essere, nel breve termine, una terapia economica ed efficace per la gestione del dolore da arto fantasma nei pazienti amputati, diminuendo intensità, frequenza e durata dei singoli episodi. Sono necessari ulteriori studi con campioni più ampi ed omogenei Casi clinici Obiettivi: studiare l’effetto della mirror therapy sul dolore acuto da arto fantasma in pazienti amputati, rilevando aspetti quantitativi e qualitativi relativi al dolore, ma anche criticità legate al setting e alla componente psicologica ed emotiva dei pazienti. Conclusioni: Sono stati inclusi ed analizzati due pazienti ricoverati presso l’unità operativa di Ortopedia dell’Azienda Ospedaliera di Padova amputati uno di arto superiore e l’altro di arto inferiore. Ad entrambi è stata somministrata la mirror therapy in regime di ricovero, uno dei due ha proseguito con l’autotrattamento a domicilio. Al follow-up è stata rilevata una diminuzione sia del numero di percezioni spiacevoli dell’arto fantasma riferite dal paziente, che dell’intensità di queste. Questa diminuzione è avvenuta probabilmente grazie ad una remissione spontanea dei sintomi. Un cambiamento che è stato ritenuto legato alla terapia era quello legato ai sintomi riferiti prima e dopo il trattamento in uno dei due pazienti. Alcune delle percezioni riferite ad inizio trattamento, dopo circa 15 minuti di mirror therapy, erano spesso meno intense, anche fino a scomparire. Sono state individuate criticità legate a setting, motivazione del paziente e all’impatto psicologico.
La Mirror Therapy per la gestione del dolore da arto fantasma: revisione sistematica della letteratura e analisi di due casi clinici.
PIROI, SOFIA
2021/2022
Abstract
Introduction: The management of phantom limb pain following amputation proves to be one of the major obstacles from the clinical point of view. Three main syndromes are often associated following this type of surgery: stump pain (pain felt in the residual limb region), phantom limb sensation (vivid and articulated image and sensation of the lost part), and finally phantom limb pain (pain felt in the missing body part). Underlying these syndromes appear to be mechanisms related to cortical reorganization. Specific treatment techniques to manage symptoms related to phantom limb include both pharmacological therapy and rehabilitative treatment: the most widely used nonpharmacological interventions for which there is evidence in the literature are implicit and explicit Graded Motor Imagery, Transcutaneous Electrical Nerve Stimulation (TENS), Transcranial Transcranial Stimulation (tDCS), and Mirror Therapy (MT). The latter treatment appears to have its efficacy for pain management and numerous studies are available on it, most of them focused on the chronic phase of phantom limb pain. Aims: To investigate the efficacy of mirror therapy for the management of phantom limb pain in amputee patients, with no limitations on the time elapsed since amputation surgery and the duration of phantom limb pain. Materials and methods: the review follows the PRISMA statement guidelines. A literature search was conducted from March until August 2022 from the following data-bases: Pubmed, PEDro and Cochrane Library. The keywords "Mirror therapy" and "Phantom Limb Pain" were used. The The Cochrane's ROB tool was used to assess the methodological quality of the studies. Criteria for risk assignment were made explicit. Results: The search yielded 187 articles. Following the selection process, 10 articles published between 2007 and 2021 were included. Methodological quality assessment found high risk for blinding of staff and participants, low risk for mode of randomization, incomplete outcomes and attrition bias, medium for the remaining domains. Conclusions: mirror therapy, in the short term, appears to be a cost-effective and effective therapy for the management of phantom limb pain in amputee patients by decreasing intensity, frequency and duration of individual episodes. Further studies with larger and more homogeneous samples are needed Clinical cases Aims: To study the effectiveness of mirror therapy in the patient with acute phantom limb pain, detecting quantitative and qualitative aspects related to pain, but also critical issues related to the setting and the psychological and emotional component of patients. Conclusions: Two patients admitted to the Orthopedic Operating Unit of the Hospital of Padua recently amputated one upper limb and the other lower limb were included and analyzed. Both were given inpatient mirror therapy, one of them continued with self-treatment at home. At follow-up, a decrease in both the number of unpleasant perceptions of the phantom limb experienced by the patient and the intensity of these was observed. This decrease probably occurred due to a spontaneous remission of symptoms. One change that was thought to be therapy-related was that related to the symptoms reported before and after treatment in one of the two patients. Some of the perceptions reported at the beginning of treatment, after about 15 minutes of mirror therapy, were often less intense, even to the point of disappearing. Critical issues related to setting, patient motivation and psychological impact were identified.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/38691