Introduction: phantom limb pain is a phenomenon which consists in the presence of painful sensations that seem to originate from the removed limb following amputation. Its incidence is estimated to vary between 40% and 90% (Kooijman et al., 2000; Shukla et al., 1982) and, because of the intrusive and often intense symptomatology, it considerably reduces life quality and autonomy of the ones affected. Objectives: this paper’s objective is to analyze the main theories aiming to explain the etiology of phantom limb pain, based both on the involvement of the peripheral and central nervous system. Afterwards, the effectiveness and application mode of the main treatments currently employed were examined, divided into different categories: pharmacological therapies, treatments based on non-invasive neuromodulation techniques, therapies resulting from the mirror mechanism and approaches based on mental imagery. Finally, how some of these treatment categories can be implemented into a home-based context will be investigated, with the aim of making these therapies easier to access for those who suffer from this disorder. Materials e methods: to explore these themes, a search into the currently available literature was performed, using PubMed as a database and keywords like “phantom limb pain”, “treatment”, “home”. Results: the research highlighted studies that try to explain the origin of phantom limb pain both concerning the involvement of the peripheral and central nervous system. Among these, the “Neuromatrix” (Melzack, 2001), the “Cortical remapping theory” (Merzenich & Jenkins, 1993) or the “persistent representation model” (Makin et al., 2013) are particularly relevant. Concerning the examined treatments, the studies currently available in the literature show conflicting findings, not allowing the possibility to clearly define their effectiveness. Finally, only for some of the treatment strategies examined, including mirror therapy and treatments based on virtual and augmented reality, the effectiveness into a home-based context has been tested, with pilot studies or with a way too limited sample of patients. Overall, it can be highlighted how there currently is a lack of a therapy of choice to treat phantom limb pain, and the need to further the research in this field is emphasized, to better define the possibility of implementing the most effective treatments into a home-based context.
Introduzione: il dolore da arto fantasma è un fenomeno che consiste nella presenza di sensazioni dolorose che sembrano originare dall’arto rimosso in seguito alla sua amputazione. Ha un’incidenza che secondo le stime varia dal 40% al 90% (Kooijman et al., 2000; Shukla et al., 1982) e, a causa della sintomatologia invadente e spesso intensa, riduce nettamente la qualità della vita e l’autonomia di chi ne soffre. Obiettivi: l’obiettivo dell’elaborato è di analizzare le principali teorie che si propongono di spiegare l’eziologia del dolore da arto fantasma, basate sia sul coinvolgimento del sistema nervoso periferico, sia centrale. Successivamente vengono esaminate efficacia e modalità di applicazione dei principali trattamenti attualmente utilizzati, suddivisi in categorie: terapie farmacologiche, trattamenti di neuromodulazione non invasiva, terapie derivanti dal meccanismo mirror e approcci basati sull’immaginazione mentale. Infine, si passerà ad approfondire come alcuni di questi trattamenti possano essere sfruttati in un contesto home-based, con l’effetto di rendere le terapie maggiormente accessibili da parte di chi soffre di questo disturbo. Materiali e metodi: per esplorare questi argomenti è stata svolta una ricerca nella letteratura attualmente disponibile, utilizzando PubMed come database e parole chiave come “phantom limb pain”, “treatment”, “home”. Risultati: la ricerca ha evidenziato studi che tentano di spiegare l’origine del dolore da arto fantasma sia attraverso un coinvolgimento del sistema nervoso centrale che periferico. Tra queste, assumono particolare rilievo il “Neuromatrix” (Melzack, 2001), la “Cortical remapping theory” (Merzenich e Jenkins, 1993) o il “persistent representation model” (Makin et al., 2013). Per quanto riguarda i trattamenti analizzati, la letteratura attualmente disponibile riporta risultati contrastanti, non permettendo di definirne con chiarezza l’efficacia. Infine, solo per alcune di queste tipologie di trattamento, tra cui la mirror therapy e la realtà virtuale o aumentata, sono stati condotti studi pilota o con campioni troppo ridotti per valutare l’efficacia in un contesto home-based. Nel complesso si evidenzia la mancanza di una terapia di elezione per trattare il dolore da arto fantasma, e si sottolinea la necessità di ulteriore ricerca per definire la possibilità di applicazione dei trattamenti più efficaci a un contesto home-based.
Approcci di trattamento per la sindrome dell’arto fantasma e loro applicazione ad un contesto home-based.
GIACONE, ANNALISA
2023/2024
Abstract
Introduction: phantom limb pain is a phenomenon which consists in the presence of painful sensations that seem to originate from the removed limb following amputation. Its incidence is estimated to vary between 40% and 90% (Kooijman et al., 2000; Shukla et al., 1982) and, because of the intrusive and often intense symptomatology, it considerably reduces life quality and autonomy of the ones affected. Objectives: this paper’s objective is to analyze the main theories aiming to explain the etiology of phantom limb pain, based both on the involvement of the peripheral and central nervous system. Afterwards, the effectiveness and application mode of the main treatments currently employed were examined, divided into different categories: pharmacological therapies, treatments based on non-invasive neuromodulation techniques, therapies resulting from the mirror mechanism and approaches based on mental imagery. Finally, how some of these treatment categories can be implemented into a home-based context will be investigated, with the aim of making these therapies easier to access for those who suffer from this disorder. Materials e methods: to explore these themes, a search into the currently available literature was performed, using PubMed as a database and keywords like “phantom limb pain”, “treatment”, “home”. Results: the research highlighted studies that try to explain the origin of phantom limb pain both concerning the involvement of the peripheral and central nervous system. Among these, the “Neuromatrix” (Melzack, 2001), the “Cortical remapping theory” (Merzenich & Jenkins, 1993) or the “persistent representation model” (Makin et al., 2013) are particularly relevant. Concerning the examined treatments, the studies currently available in the literature show conflicting findings, not allowing the possibility to clearly define their effectiveness. Finally, only for some of the treatment strategies examined, including mirror therapy and treatments based on virtual and augmented reality, the effectiveness into a home-based context has been tested, with pilot studies or with a way too limited sample of patients. Overall, it can be highlighted how there currently is a lack of a therapy of choice to treat phantom limb pain, and the need to further the research in this field is emphasized, to better define the possibility of implementing the most effective treatments into a home-based context.File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/66202