Pre-emptive analgesia in postamputation pain: an update

Abstract

This chapter examines the experimental and clinical evidence for a pre-emptive analgesic effect on nerve injury pain with emphasis on phantom and stump pains as consequences of limb amputation. The importance of sensitization for chronic pain syndromes and the possible role of pre-injury pain for late post-injury pain have raised the issue whether phantom pain can be prevented. Early studies have shown that such prevention is possible by a preemptive analgesic treatment. However, subsequent randomized and controlled trials have failed to find evidence for such a pre-emptive effect. In fact it is not surprising that a short-lasting pre-injury treatment should prevent various aspects central sensitization induced by an intense and long-lasting noxious input before, during, and after the amputation. A future challenge lies in determining whether a long-lasting and intense pre-, peri-, and postoperative analgesic treatment can in fact reduce the subsequent development of nerve injury pain including phantom pain. Moreover, it will be important to identify those patients that are likely to benefit from such a procedure.