Summary
Phantom limb pain is an often severe and debilitating phenomenon that has been reported
in up to 85% of amputees. Its pathophysiology is poorly understood. Peripheral and
spinal mechanisms are thought to play a role in pain modulation in affected individuals;
however central mechanisms are also likely to be of importance. The neuromatrix theory
postulates a genetically determined representation of body image, which is modified
by sensory input to create a neurosignature. Persistence of the neurosignature may
be responsible for painless phantom limb sensations, whereas phantom limb pain may be due to abnormal reorganisation within the neuromatrix. This study assessed
the clinical outcome of deep brain stimulation of the periventricular grey matter
and somatosensory thalamus for the relief of chronic neuropathic pain associated with
phantom limb in three patients. These patients were assessed preoperatively and at
3 month intervals postoperatively. Self-rated visual analogue scale pain scores assessed
pain intensity, and the McGill Pain Questionnaire assessed the quality of the pain.
Quality of life was assessed using the EUROQOL EQ-5D scale. Periventricular gray stimulation
alone was optimal in two patients, whilst a combination of periventricular gray and
thalamic stimulation produced the greatest degree of relief in one patient. At follow-up
(mean 13.3 months) the intensity of pain was reduced by 62% (range 55–70%). In all
three patients, the burning component of the pain was completely alleviated. Opiate
intake was reduced in the two patients requiring morphine sulphate pre-operatively.
Quality of life measures indicated a statistically significant improvement. This data
supports the role for deep brain stimulation in patients with phantom limb pain. The
medical literature relating to the epidemiology, pathogenesis, and treatment of this
clinical entity is reviewed in detail.
Keywords
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Article info
Publication history
Accepted:
July 26,
2004
Received:
May 28,
2004
Identification
Copyright
© 2005 Published by Elsevier Inc.
