Fantomski bol i postraumatska bolna stanja

Abstract

After limb or body part amputation, three different types of perceptual sensitive phenomena can be recognized. They can be all named posttraumatic neuropathies: painless sensations in phantom limb, painful phantom limb and painful posttraumatic stump. Painless sensations in phantom limb can be seen in 90% of cases in resected body parts as soon as first postoperative day, less often during the first week, and its clinical characteristics are usually stabilized during the first year. Painful posttraumatic stump appears because of pain neuroma existing, that forms at the proximal end of amputational stump as a consequence of physiological nerve regeneration attempt. Frequency of pain significantly varies considering authors from 5-90%, depending on definition of this phenomena and criteria used. It is considered that 5-10% mast be under permanent medicament treatment. Phantom pain appears more often in elderly and people with specific affective personality construction. It can be permanent, burning, nettling, tearing (25%), or intermittent, lancerating, in the shape of electrical discharging (32%), but it can also have bizarre attributes. Phantom pain appearance usually announces its duration in the longer period. After two years it is present at 59% of patients, with decreasing intensity, and only 5-10% suffer severe pain. In our Institute in the period from 1980-2003, 48 patients have been treated, 36 patients with medicamentous treatment, local blockades and chronic stimulations, and 12 patients, who did not react at conservative treatment were operated. In operated group in 10 patients pain disappeared, one patient it was with decreasing intensity, and one patient was without change.