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Prävalenz und Risikofaktoren von Phantomschmerzen und Phantomwahrnehmungen in Deutschland

Eine bundesweite Befragung

Prevalence and risk factors of phantom limb pain and phantom limb sensations in Germany

A nationwide field survey

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Zusammenfassung

Hintergrund

Die Häufigkeit und Qualität von Phantomschmerzen (PSz) und Phantomgefühlen (PG) sollten in einer bundesweiten Befragung erhoben werden.

Material und Methoden

Mit Hilfe der Infrastruktur einer Prothesen produzierenden Firma und Presseaufrufen wurden 537 Amputierte erreicht und mittels Fragebogen befragt.

Ergebnisse

Den Fragebogen (62 Fragen) beantworteten 537 von 1088 Amputierten; 14,8% waren schmerzfrei; 74,5% hatten PSz, 45,2% Stumpfschmerz (SSz) und 35,5% eine Kombination davon. Schlafstörungen hatten 62,4% aller Amputierten, mit PSz sogar 77,3%, 66,8% der PSz-Patienten mit Durchschlafstörungen erwachten mehrfach. Überwiegende PSz-Qualitäten waren Brennen 13,6%, Krämpfe 15,3%, Stechen 23,4%; Elektrisieren 21%, Kribbeln 20,4%. Bei 73,4% war das Phantom spürbar, PG hierbei waren 66,8% beweglich, normal temperiert 64%, warm 19,5%, kalt 16,5%, nackt 35,9%, bekleidet 13,6%, nicht unangenehm 31,7%‚ gepresst 29,6%, verdreht 7,5%, aufgeblasen 5,8%. 35,7% der Patienten mit PG hatten diese betont ventral, 26,7% betont dorsal. Signifikant häufiger PSz bestand bei Anwesenheit von PG gegenüber deren Fehlen (p <0,0001), nicht jedoch in Abhängigkeit von der Art des PG oder demographischen Faktoren bzw. Amputationshöhe oder -seite. Die Wahrnehmung einer Prothese „als Fremdkörper“ war hochsignifikant öfter mit PSz assoziiert als beim Gefühl der „Verschmelzung mit dem Körper“ (p <0,0001).

Schlussfolgerung

Die vorliegende Untersuchung ist unseres Wissens die größte Phantomschmerzbefragung in Europa und belegt eine hohe Prävalenz und Ausprägung von PSz, ungewöhnlichen PG und amputationsbedingten Schlafstörungen. Bedeutung und Beeinflussbarkeit der oben genannten PG und Risikofaktoren müssen weiter erforscht werden.

Abstract

Background

Data on the incidence and intensity of phantom limb pain (PLP) and phantom limb sensations (PLS) were collected in a nationwide survey.

Materials and methods

Supported by a manufacturer of artificial limbs and press notices a total of 537 amputees were contacted and interviewed by questionnaire.

Results

The questionnaire containing 62 questions was filled in by 537 out of 1,088 amputees. Of the amputees 14.8% were pain free, 74.5% had PLP, 45.2% stump pain (SP) and 35.5% a combination of both. In addition 62.4% of the amputees reported disturbed sleep, of those with PLP it was even higher at 77.3% and 66.8% of patients with PLP woke up several times during the night.

The prevailing features of PLP included burning sensation (13.6%), cramp (15.3%), prickling (23.4%), electrification (21%) and tingling (20.4%). Phantom sensations were felt by 73.4% and were described as being mobile (66.8%), of normal temperature (64%), warm (19.5%), cold (16.5%), bare (35.9%), clothed (13.6%), not unpleasant (31.7%), pressed (29.6%), contorted (7.5%) and blown up (5.8%). Of the patients with PLP, 35.7% described the location as mostly ventral, 26.7% as mostly dorsal. Significantly more PLP was found in the presence of PLS than in its absence (p <0.0001), but unrelated to the type of PLS, to demographic factors, or to the level or side of amputation. Perception of the artificial limb being “a foreign body” was highly significantly more often associated with PLP than with a sensation of “fusing with the body” (p <0.0001).

Conclusion

To our knowledge the present study constitutes the largest field survey on phantom limb pain carried out in Europe and corroborates the high prevalence and intensity of PLP, unusual PLS and amputation-related sleep disturbances. The significance and manageability of phantom feelings and its risk factors need further research.

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Literatur

  1. Baron R, Maier C (1995) Phantom limb pain: are cutaneous nociceptors and spinothalamic neurons involved in the signaling and maintenance of spontaneous and touch-evoked pain? A case report. Pain 60(2):223–228

    Article  PubMed  CAS  Google Scholar 

  2. Belleggia G, Birbaumer N (2001) Treatment of phantom limb pain with combined EMG and thermal biofeedback: a case report. Appl Psychophysiol Biofeedback 26(2):141–146

    Article  PubMed  CAS  Google Scholar 

  3. Bone M, Critchley P, Buggy DJ (2002) Gabapentin in postamputation phantom limb pain: a randomized, double-blind, placebo-controlled, cross-over study. Reg Anesth Pain Med 27(5):481–486

    PubMed  CAS  Google Scholar 

  4. Brodie EE, Whyte A, Niven CA (2007) Analgesia through the looking-glass? A randomized controlled trial investigating the effect of viewing a ‚virtual‘ limb upon phantom limb pain, sensation and movement. Eur J Pain 11(4):428–436

    Article  PubMed  Google Scholar 

  5. Dijkstra PU, Geertzen JH, Stewart R, van der Schans CP (2002) Phantom pain and risk factors: a multivariate analysis. J Pain Symptom Manage 24(6):578–585

    Article  PubMed  Google Scholar 

  6. Ephraim PL, Wegener ST, MacKenzie EJ et al (2005) Phantom pain, residual limb pain and back pain in amputees: results of a national survey. Arch Phys Med Rehabil 86(10):1910–1919

    Article  PubMed  Google Scholar 

  7. Flor H, Elbert T, Muhlnickel W et al (1998) Cortical reorganization and phantom phenomena in congenital and traumatic upper-extremity amputees. Exp Brain Res 119(2):205–212

    Article  PubMed  CAS  Google Scholar 

  8. Flor H, Bierbaumer N (2000) Phantom limb pain: cortical plasticity and novel therapeutic approaches. Curr Opin Anaesthesiol 13:561–564

    Article  PubMed  CAS  Google Scholar 

  9. Flor H (2002) Phantom-limb pain: characteristics, causes and treatment. Lancet Neurol 1(3):182–189

    Article  PubMed  Google Scholar 

  10. Flor H (2008) Maladaptive plasticity, memory for pain and phantom limb pain: review and suggestions for new therapies. Expert Rev Neurother 8(5):809–818

    Article  PubMed  Google Scholar 

  11. Gustorff B, Dorner T, Likar R et al (2008) Prevalence of self-reported neuropathic pain and impact on quality of life: a prospective representative survey. Acta Anaesthesiol Scand 52(1):132–136

    PubMed  CAS  Google Scholar 

  12. Hanley MA, Ehde DM, Campbell KM et al (2006) Self-reported treatments used for lower-limb phantom pain: descriptive findings. Arch Phys Med Rehabil 87(2):270–277

    Article  PubMed  Google Scholar 

  13. Hill A (1999) Phantom limb pain: a review of the literature on attributes and potential mechanisms. J Pain Symptom Manage 17(2):125–142

    Article  PubMed  CAS  Google Scholar 

  14. Holm S (1979) A simple sequentially rejective multiple test procedure. Scand J Stat 6:65–70

    Google Scholar 

  15. Huse E, Larbig W, Birbaumer N, Flor H (2001) Cortical reorganization and pain. Empirical findings and therapeutic implication using the example of phantom pain. Schmerz 15(2):131–137

    Article  PubMed  CAS  Google Scholar 

  16. Jankovic J, Glass JP (1985) Metoclopramide-induced phantom dyskinesia. Neurology 35(3):432–435

    PubMed  CAS  Google Scholar 

  17. Kern U, Martin C, Scheicher S, Müller H (2003) Botulinum-Toxin-A in der Behandlung von Phantomschmerzen – Eine Pilotstudie. Schmerz 17(2):117–124

    Article  PubMed  CAS  Google Scholar 

  18. Kern U, Scheicher S, Martin C, Müller H (2003) Botulinumtoxin Typ A und B beeinflusst Phantombewegungen und -gefühle bei amputierten Schmerzpatienten. Schmerz 17 [suppl 1]:97

  19. Kern U (2004) Influence of botulinum toxin on postamputation pain and phantom limbs. J Neurol 251 [suppl 1]:I/42

  20. Kulisevsky J, Martí-Fàbregas J, Grau JM (1992) Spasms of amputation stumps. J Neurol Neurosurg Psychiatry 55(7):626–627

    Article  PubMed  CAS  Google Scholar 

  21. Kundermann B, Krieg JC, Schreiber W, Lautenbacher S (2004) The effect of sleep deprivation on pain. Pain Res Manag Spring 9(1):25–32

    Google Scholar 

  22. Manchikanti L, Singh V (2004) Managing phantom pain. Pain Physician 7(3):365–375

    PubMed  Google Scholar 

  23. Montoya P, Ritter K, Huse E et al (1998) The cortical somatotopic map and phantom phenomena in subjects with congenital limb atrophy and traumatic amputees with phantom limb pain. Eur J Neurosci 10(3):1095–1102

    Article  PubMed  CAS  Google Scholar 

  24. Moseley GL (2006) Graded motor imagery for pathologic pain: a randomized controlled trial. Neurology 67(12):2129–2134

    Article  PubMed  Google Scholar 

  25. Pascual-Leone A, Peris M, Tormos JM (1996) Reorganization of human cortical motor output maps following traumatic forearm amputation. Neuroreport 2068–2070

  26. Ramachandran VS, Rogers-Ramachandran D (1996) Synaesthesia in phantom limbs induced with mirrors. Proc Biol Sci 263(1369):377–386

    Article  PubMed  CAS  Google Scholar 

  27. R Development Core Team (2008) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. ISBN 3-900051-07-0

  28. Richardson C, Glenn S, Nurmikko T, Horgan M (2006) Incidence of phantom phenomena including phantom limb pain 6 months after major lower limb amputation in patients with peripheral vascular disease. Clin J Pain 22(4):353–358

    Article  PubMed  Google Scholar 

  29. Richardson C, Glenn S, Horgan M, Nurmikko T (2007) A prospective study of factors associated with the presence of phantom limb pain six months after major lower limb amputation in patients with peripheral vascular disease. J Pain 8(10):793–801

    Article  PubMed  Google Scholar 

  30. Schwoebel J, Coslett HB, Bradt J et al (2002) Pain and the body schema: effects of pain severity on mental representations of movement. Neurology 59(5):775–777

    PubMed  CAS  Google Scholar 

  31. Sherman RA, Arena JG (1992) Phantom limb pain: mechanisms, incidence and treatment. Critical Rev Phys Rehabil Med 4:1–26

    Google Scholar 

  32. Uğur F, Akin A, Esmaoğlu A et al (2007) Comparison of phantom limb pain or phantom extremity sensation of upper and lower extremity amputations. Agri 19(1):50–56

    PubMed  Google Scholar 

  33. Winter C, Fritsche K, Karl A et al (2001) The phantom and stump phenomena interview PSPI. Schmerz 15(3):172–178

    Article  PubMed  CAS  Google Scholar 

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Interessenkonflikt

Der Erstautor ist Berater der Fa. medi, Bayreuth, und wurde bei der Durchführung der Untersuchung von dieser organisatorisch unterstützt. Frank Birklein ist von der DFG und dem BMBF (DFNS) unterstützt.

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Authors and Affiliations

  1. Schmerz- und Palliativzentrum, Facharztzentrum medicum Wiesbaden, Langenbeckplatz 2, 65189, Wiesbaden, Deutschland

    U. Kern & M. Rockland

  2. Klink und Poliklinik für Neurologie, Universität Regensburg, Regensburg, Deutschland

    V. Busch

  3. Lehrstuhl für Stochastik, Universität Bayreuth, Bayreuth, Deutschland

    M. Kohl

  4. Neurologische Klinik, Universitätsklinikum Mainz, Mainz, Deutschland

    F. Birklein

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  1. U. Kern
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  2. V. Busch
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  3. M. Rockland
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  4. M. Kohl
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  5. F. Birklein
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Corresponding author

Correspondence to U. Kern.

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Kern, U., Busch, V., Rockland, M. et al. Prävalenz und Risikofaktoren von Phantomschmerzen und Phantomwahrnehmungen in Deutschland. Schmerz 23, 479–488 (2009). https://doi.org/10.1007/s00482-009-0786-5

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  • DOI: https://doi.org/10.1007/s00482-009-0786-5

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