Phantom Pain Research Articles

Supernumerary Phantom Pain: From Mechanisms To Treatment

The article is devoted to the supernumerary phantom pain. It is described as pain in a supernumerary phantom limb. This is a very rare phenomenon with only sporadic and brief descriptions in the literature. However, this syndrome brings great suffering to the patient not only due to the feeling of pain, but also due to the complexity of its description and the difficulty of understanding by the doctor. For simplicity, patients draw a supernumerary limb and mark the location of pain on it. The pathogenesis of supernumerary phantom pain is not completely clear. Therefore, the description of each case is important for clinical practice. The article attempts to summarize the available information about the etiology, pathogenesis, methods of diagnosis and therapy of this syndrome.

Phantom Pain

The paper introduces the oeuvre of Kurt Drawert and analyzes, by which means and with which aims the contemporary history of German Reunification is reflected critically in his essays, poems and prose. Drawert’s work circles around carefully recorded absences that the author himself has experienced and which are possibly reflected more extensively due to his relocation to federal West Germany in 1993. Such absences are shown to be ruinous for post-Soviet individuals in the unified society. But at the same time, they are constitutive for Drawert’s poetics, written from the passage through the non-places of his (former) country. Reading his oeuvre from this perspective means comprehending a meticulous measurement in his poetics of the absent: of Heimat, causing an atopian perception (including the increase of retrotopian nationalistic thinking); of speech that has been and still is ‘injured’ or even lost, causing a not only political aphasia (allegorized by the Kaspar-Hauser-figure); and absence of time, as past is lost with the belated and declined East—and the present suffers from a global acceleration, causing an asynchronia in transformation that further reduces the society’s ability to design the future. Drawert’s engagement does not cease with a melancholic exploration of a collective phantom pain, stating a persisting disintegration. Out of the analytical measurement of such ‘left-overs’ of the reunification process in Germany there evolves a harsh criticism of the contemporary situation surrounding the individual in the global digitized society. A related mission of literature reveals the (always fragmented) truth to the reader—prolonging a political kind of criticism whose methods trail back to GDR-opposition. Thus, any ‘valid’ political change would depend on the influence of a common language and maturity.

Features of diagnosis, treatment and curation of patients with neuropathic pain syndrome of traumatic genesis

BACKGROUND: The existing international and national clinical recommendations for the treatment of neuropathic pain syndrome are based mainly on the experience of providing care to patients with non-traumatic genesis of neuropathic pain. Approaches to the diagnosis, treatment and curation patients with neuropathic pain syndrome due damage of the nervous system as a result of wounds received during hostilities may differ from those in patients with somatic diseases.
 AIM: To systematize the features of medical care and improve the methodological approach of curation patients with traumatic neuropathic pain syndrome.
 MATERIALS AND METHODS: The practical experience of providing assistance to the wounded with traumatic lesions of the peripheral nervous system (including patients with phantom pain syndrome) accumulated by the staff of the Department and the Clinic of Nervous Diseases Military Medical Academy for 2022–2023 is summarized.
 RESULTS: The features of inpatient routing, diagnosis, treatment and organization of medical care for patients with traumatic neuropathic pain syndrome at the stage of a specialized medical institution are systematized. The practical aspects of the curation patients with neuropathic pain due to wounds received during hostilities, related to the appointment of medications (including narcotic analgesics), regional anesthesia and the provision of neurosurgical care are highlighted. A separate emphasis is placed on the importance of assessing the mental state and quality of sleep of the wounded with neuropathic pain syndrome, the features of drug correction identified disorders. Practical recommendations for the treatment of patients based on the results of assessing the severity neuropathic pain syndrome using a daily graphic pain diary are presented.
 CONCLUSION: The revealed differences in therapeutic and diagnostic approaches in providing medical care to the wounded with traumatic neuropathic pain syndrome, the importance of interdisciplinary interaction different specialties doctors (neurologists, surgeons, traumatologists, neurosurgeons, psychiatrists) at the early stages of treatment indicate the need to develop separate recommendations for the treatment of neuropathic pain in victims of armed conflicts.

The Effect of Distant Reiki Applied to Individuals with Extremity Amputation on Pain Level and Holistic Well-Being: A Quasi-experimental Study

BackgroundPain felt in an amputated limb is quite common. Phantom pain affects the lives of individuals in many ways and can negatively affect the holistic well-being of individuals. Distant Reiki can be used in the management of these problems. AimThis study was conducted to examine the effect of distant Reiki applied to individuals with extremity amputation on pain level and holistic well-being. MethodThis a quasi-experimental single group pre-test. Post-test design research was conducted between September 2022 and April 2023 and included 25 individuals with extremity amputation. Then, according to Classical Usui Reiki, distant Reiki application has been performed for 20 minutes every day for 10 days. Data were collected at the beginning of the study and at the end of the 10th day. The data were obtained using an Introductory Information Form, the Visual Analog Scale for Pain, and Holistic Well-Being Scale. ResultsThe mean age of the participants was 51.32 ± 16.65 years. There was a significant difference between pre-test and post-test pain levels of the participants (p < .05) and HWBS subscale scores (p < .05). Accordingly, it was determined that after 20-minute distant Reiki sessions for 10 consecutive days, the pain levels of the individuals were significantly reduced and their holistic well-being improved. ConclusionDistant Reiki has been found to be easy to administer, inexpensive, non-pharmacological, and appropriate for independent nursing practice to be effective in reducing phantom pain levels and increasing holistic well-being in people with limb amputation.

The Prevalence of Pain in Chronic Diseases: An Umbrella Review of Systematic Reviews

Since pain is common in many diseases, it is important to summarize the precise prevalence data on pain and high-impact pain, which frequently worsens the quality of life and work activities. This umbrella review aims to estimate the prevalence of pain among patients with different chronic diseases/conditions. We followed the PRISMA guidelines. We identified the following areas addressing the prevalence of pain: (1) pain in cancer patients; (2) neurodegenerative diseases; (3) chronic heart failure; (4) chronic obstructive pulmonary disease; (5) chronic kidney diseases; (6) liver diseases and failure; (7) nursing home seniors; and (8) postamputation (phantom) pain. We included systematic reviews and meta-analyses that reported pain in patients from the mentioned populations. The prevalence of pain in chronic diseases is high, in some cases even higher than the cardinal symptoms of these diseases/conditions. Most patients who suffer from any of these diseases/conditions can develop chronic pain at later stages. Pain in chronic diseases does not receive enough attention and is not properly managed. Future studies are warranted to establish a more precise prevalence of chronic pain and develop better methods of pain screening, detection, and management.

ПСИХОЛОГІЧНІ НАСЛІДКИ ПЕРЕНЕСЕНОЇ АМПУТАЦІЇ КІНЦІВОК: ОГЛЯД ЛІТЕРАТУРИ

This work contains a literary review, which systematizes the knowledge about psychological consequences of limb amputation, the pathopsychological characteristics of people who had limb amputations and comorbid symptoms of mental disorders. We conducted a literary analysis on the topic under study, which includes sources published in the last 5 years. PubMed, Google Scholar and Cochrane Library databases were analyzed. From 96 analyzed sources we included 28 that reached our inclusion criteria. Overall, psychological distress experienced by people after limb amputation is a very relevant and underestimated problem in the medical community. Significant criterion in the context of the research topic is also the clinical and psychological characteristics of individuals, which has a significant impact on the specifics of the psychological consequences of amputation. Thus, the emergence of negative psychological consequences and mental disorders after amputation is due to the characteristics of the premorbid personality, such as certain psychological personality traits, coping strategies, comorbid mental and somatic diseases. The age of the amputees, the availability of social support, as well as the reasons, type and level of amputation were also mentioned as important factors. Distorted perception of the body scheme, social stigma and negative emotional reactions are also the direct psychological consequences of amputation in the studied category of persons. The most common mental disorders include PTSD, anxiety, depression, and substance use disorder. Among the somatic symptoms of amputation, attention should be paid to the consequences of functional limitations, sexual dysfunctions and phantom pain.

Targeted Muscle Reinnervation and Regenerative Peripheral Nerve Interfaces for Prophylactic Pain Control in Neurofibromatosis Type 1 Amputees.

Neurofibromatosis type 1 (NF1) is an inherited multisystem disorder that affects one in 2500 to one in 5000 people. Neurofibromas are the second-most common benign peripheral nerve sheath tumors arising from Schwann cells and are associated with neurofibromatosis. Chronic pain and opioid use is elevated in patients with NF1 when neurofibromas are associated with sensory nerves. Surgical excision is the primary treatment of neurofibromas when they become large, malignant, or painful, but they are associated with high rates of recurrence. Targeted muscle reinnervation and regenerative peripheral nerve interfaces are two prophylactic surgical techniques that are used to prevent neuroma-associated residual limb and phantom pain in amputees. Both techniques stimulate physiologic regeneration of the nerve via trophic stimulus from denervated muscle. This case report describes two patients with NF1 who underwent targeted muscle reinnervation and/or regenerative peripheral nerve interfaces at the time of amputation. Despite the abnormality of the peripheral nerves involved, both patients had excellent postoperative outcomes with minimal pain. This experience advocates for the use of prophylactic nerve management techniques in neurofibromatosis patients despite baseline nerve pathology.

Rotationplasty outcomes assessed by gait analysis following resection of lower extremity bone neoplasms

AimsThe standard of surgical treatment for lower limb neoplasms had been characterized by highly interventional techniques, leading to severe kinetic impairment of the patients and incidences of phantom pain. Rotationplasty had arisen as a potent limb salvage treatment option for young cancer patients with lower limb bone tumours, but its impact on the gait through comparative studies still remains unclear several years after the introduction of the procedure. The aim of this study is to assess the effect of rotationplasty on gait parameters measured by gait analysis compared to healthy individuals.MethodsThe MEDLINE, Scopus, and Cochrane databases were systematically searched without time restriction until 10 January 2022 for eligible studies. Gait parameters measured by gait analysis were the outcomes of interest.ResultsThree studies were eligible for analyses. Compared to healthy individuals, rotationplasty significantly decreased gait velocity (-1.45 cm/sec; 95% confidence interval (CI) -1.98 to -0.93; p &lt; 0.001), stride length (-1.20 cm; 95% CI -2.31 to -0.09; p &lt; 0.001), cadence (-0.83 stride/min; 95% (CI -1.29 to -0.36; p &lt; 0.001), and non-significantly increased cycle time (0.54 sec; 95% CI -0.42 to 1.51; p = 0.184).ConclusionRotationplasty is a valid option for the management of lower limb bone tumours in young cancer patients. Larger studies, with high patient accrual, refined surgical techniques, and well planned rehabilitation strategies, are required to further improve the reported outcomes of this procedure.Cite this article: Bone Jt Open 2023;4(11):817–824.

Features of opioid analgesia s in patients with phantom limb pain after amputation due to gunshot wounds

Background. Since the beginning of the large-scale war on the territory of Ukraine, the incidence of limb injuries has reached 40 %: 15 % of them are upper limb injuries, 25 % are lower limb injuries, and the proportion of patients who have lost limbs due to trauma has increased significantly. In these patients, phantom pain occurs in more than 60 % of cases. Such pain is extremely difficult to treat with standard approaches. Usually, the prescription of opioid analgesics is required, but there is no data on their effectiveness in the comprehensive therapy of phantom pain, which appears as a result of limb amputation and is one of the most difficult clinical problems today. Materials and methods. Our study involved 57 patients. The diagnosis of phantom pain was made based on the clinical picture and patient description. The severity of pain was studied using the visual analog scale. To determine the neuropathic component of pain, Douleur Neuropathique 4 questions were used. The distribution of quantitative indicators for normality was checked with the Shapiro-Wilk test and Student’s test. Results. According to the visual analog scale data, no significant statistical difference was found between group 1 and 2 (p &gt; 0.05). The data of Douleur Neuropathique 4 questions indicate that group 1 has statistically better results than group 2 (p &lt; 0.05). Conclusions. The results of pain relief in patients with phantom limb pain after amputation due to gunshot wounds in comprehensive therapy shows a better result than tramadol.

Limitations and solutions of low cost virtual reality mirror therapy for post-stroke patients

Mirror therapy is applied to reduce phantom pain and as a rehabilitation technique in post-stroke patients. Using Virtual Reality and head-mounted displays this therapy can be performed in virtual scenarios. However, for its efficient use in clinical settings, some hardware limitations need to be solved. A new system to perform mirror therapy in virtual scenarios for post-stroke patients is proposed. The system requires the patient a standalone virtual reality headset with hand-tracking features and for the rehabilitator an external computer or tablet device. The system provides functionalities for the rehabilitator to prepare and follow-up rehabilitation sessions and a virtual scenario for the patient to perform rehabilitation. The system has been tested on a real scenario with the support of three experienced rehabilitators and considering ten post-stroke patients in individual sessions focused on upper limb motor rehabilitation. The development team observed all the sessions and took note of detected errors regarding technological aspects. Solutions to solve detected problems will be proposed and evaluated in terms of feasibility, performance cost, additional system cost, number of solved issues, new limitations, or advantages for the patient. Three types of errors were detected and solved. The first error is related to the position of the hands relative to the head-mounted display. To solve it the exercise area can be limited to avoid objectives that require turning the head too far. The second error is related to the interaction between the hands and the virtual objects. It can be solved making the main hand non-interactive. The last type of error is due to patient limitations and can be mitigated by having a virtual hand play out an example motion to bring the patient’s attention back to the exercise. Other solutions have been evaluated positively and can be used in addition or instead of the selected ones. For mirror therapy based on virtual reality to be efficient in post-stroke rehabilitation the current head-mounted display-based solutions need to be complemented with specific strategies that avoid or mitigate the limitations of the technology and the patient. Solutions that help with the most common issues have been proposed.

Outcomes Associated with Concomitant Lower-Limb Amputation in Persons with Major Upper-Limb Amputation: Results of a National Study

ABSTRACT Introduction The challenges faced by persons with amputations are amplified for those with multiple limb loss, compared with single limb loss. However, there is limited research describing the functional outcomes of mixed upper and lower limb loss or the long-term psychosocial and health-related quality of life (HRQoL) outcomes among this group. Materials and Methods A cross-sectional, national telephone survey of 808 US veterans with major upper-limb amputation (ULA) with and without concomitant lower-limb amputation (LLA) who received care at US Veterans Affairs Medical Centers between 2010 and 2015 was conducted. T-tests and χ2 tests identified any significant differences in characteristics and outcomes of groups with and without LLA. Linear regressions examined the association between amputation laterality and outcomes. Results In comparison to those with no LLA, respondents with concomitant LLA were slightly younger (60.0 vs. 63.7) and had similar mean time in years from initial amputation (31.5 vs. 31.4). Transfemoral was the most common level of LLA (67.7%), and there was no significant difference in the distribution of ULA levels between the 2 groups. Phantom pain was less common among those with concomitant LLA compared with ULA only (64.4% vs. 74.5%, P &lt; 0.05). No significant differences were found in prevalence of residual limb, neck, or back pain; measures of disability (QuickDASH); HRQoL; or need for activities of daily living help across the two groups. Conclusions In veterans with concomitant LLA and ULA, transfemoral amputation was the most common level of LLA. Those with concomitant LLA were less likely to report phantom limb pain. No statistically significant differences were found by group in need for ADL help, disability, or HRQoL. Clinical Relevance These results provide clinicians with a greater appreciation of the similarities and differences between the two groups in relation to amputation characteristics, pain, prosthesis utilization, prosthesis satisfaction, and functional outcomes.

Functional and structural synaptic remodeling mechanisms underlying somatotopic organization and reorganization in the thalamus

The somatosensory system organizes the topographic representation of body maps, termed somatotopy, at all levels of an ascending hierarchy. Postnatal maturation of somatotopy establishes optimal somatosensation, whereas deafferentation in adults reorganizes somatotopy, which underlies pathological somatosensation, such as phantom pain and complex regional pain syndrome. Here, we focus on the mouse whisker somatosensory thalamus to study how sensory experience shapes the fine topography of afferent connectivity during the critical period and what mechanisms remodel it and drive a large-scale somatotopic reorganization after peripheral nerve injury. We will review our findings that, following peripheral nerve injury in adults, lemniscal afferent synapses onto thalamic neurons are remodeled back to immature configuration, as if the critical period reopens. The remodeling process is initiated with local activation of microglia in the brainstem somatosensory nucleus downstream to injured nerves and heterosynaptically controlled by input from GABAergic and cortical neurons to thalamic neurons. These fruits of thalamic studies complement well-studied cortical mechanisms of somatotopic organization and reorganization and unveil potential intervention points in treating pathological somatosensation.

A case of phantom pain and stump pain that was effectively controlled by ultrasound‐guided ulnar and median peripheral nerve blocks

AbstractPhantom limb pain and stump pain are often intractable, and their incidences are relatively high. We report a case of a patient with phantom limb and stump pain of the finger, who was successfully treated by peripheral nerve blocks. The patient was a male truck driver in his fifties, who had his left annular finger amputated in an accident 2 years previously. Owing to poor pain control at the stump of his finger, he was referred to our department. The initial examination revealed pain about numerical rating scale (NRS) 6/10 in the left annular finger transection as well as allodynia. Although some pain relief had been observed with postoperative medication, he still had persistent resting pain of about NRS 4/10. Therefore, blocks of the ulnar nerve and median nerve were performed. After the blocks were performed, the pain improved to NRS 1 to 2/10, and pain upon movement also almost disappeared. Peripheral nerve blocks can be a useful treatment modality for phantom limb pain and stump pain in the fingers, as in this case.

A novel mixed reality system to manage phantom pain in-home: results of a pilot clinical trial.

Mirror therapy for phantom limb pain (PLP) is a well-accepted treatment method that allows participants to use a mirror to visually perceive the missing limb. Mixed reality options are now becoming increasingly available, but an in-home virtual mirror therapy option has yet to be adequately investigated. We had previously developed a mixed reality system for Managing Phantom Pain (Mr. MAPP) that registers the intact limb and mirrors it onto the amputated limb with the system's visual field, allowing the user to engage with interactive games targeting different large lower limb movements. Feasibility and pilot outcomes of treating patients with lower extremity PLP by using Mr. MAPP at home for 1 month were evaluated in this study. Pain intensity and interference were assessed using the McGill Pain Questionnaire, Brief Pain Inventory, and a daily exercise diary. Function was assessed using the Patient Specific Functional Scale (PSFS). The clinical trial registry number for this study is NCT04529083. This pilot study showed that it was feasible for patients with PLP to use Mr. MAPP at home. Among pilot clinical outcomes, statistically significant differences were noted in mean current pain intensity [1.75 (SD = 0.46) to 1.125 (SD = 0.35) out of 5, P = .011] and PSFS goal scores [4.28 (SD = 2.27) to 6.22 (SD = 2.58) out of 10, P = .006], with other outcome measures showing non-significant trends towards improvement. This pilot study revealed that in-home use of Mr. MAPP has potential to provide pain relief and improve function in patients with lower extremity PLP and is feasible. Each scale used provided unique perspective on the functional impact of PLP. Further expanded studies and investigation, including a fully powered clinical trial, with these scales are warranted. https://www.clinicaltrials.gov/ct2/show/NCT04529083, Identifier: NCT04529083.

X-reality for phantom limb management for amputees: A systematic review and meta-analysis

Phantom limb is a disabling neuropsychiatric condition among amputees resulting in pain and disturbance that impact their functions, quality of life, and autonomy. While pharmacological approaches appeared to be ineffective, the emergence and integration of X-reality, including virtual reality, augmented reality, and mixed reality, might elevate the effectiveness of mirror therapy in managing phantom limb. The objective of this study is to review X-reality for managing phantom pain. A systematic search was conducted on PubMed, Scopus, Web of Science, PsycINFO, Embase, and CINAHL. Sixteen (n = 16) studies containing 66 lower-limb and 53 upper-limb amputees were included for the review over the thematic framework of amputee characteristics and intervention designs, while thirteen (n = 13) studies were further proceeded for the meta-analysis. We found eleven studies on virtual reality (n = 11), four studies on marker-based augmented reality (n = 4) and one study on mixed reality (n = 1) with a total of 40 game/task themes involving, motor skills, motor control, and stimulus-sensing. Regardless, all these interventions adopted the movement representation strategies with different techniques. Overall, the X-reality interventions reduced the pain level of the amputees (mean difference: -2.30, 95% CI, -3.38 to -1.22), especially the virtual reality subgroup (mean difference: -2.83, 95% CI, -4.43 to -1.22). However, there were substantial heterogeneity and partially explained by the subgroup analysis on publication year. The strength of evidence was limited by case reports and case series in this review.

EXPERIENCE IN TREATMENT OF GUNSHOT WOUNDS OF LIMBS IN TRAUMATIC AMPUTATIONS DUE TO EXPLOSIVE TRAUMA

Abstract. Aim. To improve the results of surgical treatment in patients with traumatic limb amputations by developing diagnostic and treatment strategy for managing patients with soft tissue wounds of amputation stumps.&#x0D; Materials and methods. 283 wounded in-patients of Military Medical Clinical Center of the Central Region with gunshot traumatic limb amputations or their segments as a result of explosive injury were retrospectively studied during the period of February 24, 2022 to February 24, 2023.&#x0D; Results and discussion. Being admitted to the third level of medical service, surgical clinic, full-scale medical aid was provided to&#x0D; 283 wounded servicemen including surgical interventions with continuous intensive therapy. If necessary, the strategy of damage control surgery was continued and extended.&#x0D; Diagnostic and treatment strategy consisted of mandatory primary examination of amputation stump in the dressing room, X-ray examination of the limb, ultrasonography and Doppler ultrasound of the extremity (stump) vessels, and spiral computer tomography. 52 patients (18.37 %) underwent emergency operations. In 231 patients (81.63 %) treatment consisted of staged repeated (secondary if indicated) debridement of amputation stump and gunshot wounds of the limbs, and placement of VAC systems using negative pressure therapy. Repeated debridement was carried out every 3-5 days, performing necrectomy and using sanitation with antiseptic solutions. Polyurethane sponges were used to fill wound defect of the stump tissue, followed by 3-4 dermatotension sutures, and then VAC bandage was formed by conventional method.&#x0D; The following early complications occurred: bleeding — in 8 (2.83 %) patients, development of tension hematomas in 7 (2.47 %) and purulent inflammation in the form of suppuration, phlegmon and abscess in 43 (15.19 %) patients, requiring a greater number of repeated and secondary surgical debridements and placement of VAC systems. Late postoperative complications were: "defective stumps" in 17 (6.01 %) patients, ligature fistulas in 11 (3.89 %), formation of osteophytes in 3 (1.06 %), neurinoma — in 2 (0.71 %) and phantom pain syndrome in 11 (3.89 %) patients.&#x0D; Conclusions. To decrease the number of complications associated with purulent inflammation in amputation stump, primary surgical intervention should be carried out in the form of radical primary surgical debridement of gunshot wound, leaving long stump with no sutures. Following clear diagnostic and treatment strategy in managing patients with wound defects of soft tissues of amputation stumps in gunshot traumatic limb amputations leads to decreased number of postoperative complications.

Silent synapses in pain-related anterior cingulate cortex.

Synaptic plasticity such as Long-term potentiation (LTP) is a key mechanism for learning in central synapses including the cortex. There are two least two major forms of LTPs: presynaptic LTP and postsynaptic LTP. For postsynaptic LTP, the potentiation of AMPA receptor-mediated responses through protein phosphorylation is thought to be a key mechanism. Silent synapses have been reported in the hippocampus, but it is thought to be mainly present in the cortex during early development, and may contribute to maturation of the cortical circuit. However, recent several lines of evidence demonstrate that silent synapses may exist in mature synapses of adult cortex, and they can be recruited by LTP-inducing protocols, as well as chemical-induced LTP. In pain-related cortical regions, silent synapses may not only contribute to cortical excitation after peripheral injury, but also the recruitment of new cortical circuits as well. Thus, it is proposed that silent synapses and modification of functional AMPA receptors and NMDA receptors may play important roles in chronic pain, including phantom pain.

Comparison of efficacy of pregabalin with duloxetine in the management of patients with painful diabetic neuropathy.

Objectives: To compare pregabalin with duloxetine in terms of mean reduction in pain score, in the management of patients with painful diabetic neuropathy. Study Design: Randomized Controlled Trial. Setting: Department of Medicine, FMU &amp; Affiliated Hospitals, Faisalabad. Period: 1st March, 2020 to 3rd March 2021. Material &amp; Methods: A total of 180 patients with known diabetics of at least 5 years duration, 18 to 75 years of age were included. Patients with ischemic pain or other types of pain not related to diabetes such as arthritic pain or phantom pain secondary to amputations, CRF &amp; CLD were excluded. Group A received 150mg of Pregabalin at night before sleeping and was increased to 150mg twice daily after 02 week if VAS pain score reduction was found to be less than 50% from baseline. Group B received 60mg Duloxetine at bed time and it was increased to 120mg after 04 weeks if the VAS pain score was less than 50% after 04 weeks. The patients were again assessed after another 04 weeks to assess VAS Pain Score reduction. The primary outcome is pain as assessed by the Visual Analogue Score (VAS) at the end of 04 weeks from start of medications. Results: Age range in this study was from18 to75 years with mean age of 40.87±13.67 years. The mean age of patients in pregabalin group was 38.80 ± 13.01 years and in duloxetine group was 41.07 ± 13.85 years. Majority of the patients 34 (56.67%) were between 20 to 40 years of age. Mean reduction in pain in pregabalin group was 1.63 ± 1.07 while in duloxetine group was 3.23 ± 1.38 (p-value =0.0001). Conclusion: This study concluded that duloxetine had significantly greater pain reduction than pregabalin in the management of patients with painful diabetic neuropathy.

Graded motor imagery in orthopedic and neurological rehabilitation: A systematic review of clinical studies

Background/Aim: Graded motor imagery is an increasingly popular motion representation technique. However, treatment protocols for graded motor imagery vary depending on various diseases. This study aims to summarize the cases in which graded motor imagery therapy is used, study protocols, and outcome measures in studies. Methods: The literature search was done with Web of Science, Pubmed, Scopus, and PEDro databases. The last search was carried out on September 13, 2022. A series-specific bias risk assessment tool was used with randomized, non-randomized, and case reports. All clinical studies that performed graded motor imagery, available in full text, describing their methods and findings, were included. The gender of the participants was not significant. The intervention was graded motor imagery. Outcome measures were mainly pain severity, other pain-related measures (e.g., pressure pain threshold, pain catastrophe), range of motion, strength, reaction time, kinesiophobia, neurophysiological measures, depression, function, or quality of life measures. Results: Complex regional pain syndrome, distal radius fracture, phantom limb pain, stroke, cancer, pathological pain (phantom pain after amputation, pain after brachial plexus avulsion), elbow stiffness, frozen shoulder, chronic shoulder pain, and osteoarthritis conditions were included. The intervention duration in the studies varies from 2 to 8 weeks. A common outcome measure could not be determined among studies. The pain was assessed in 15 studies, although different rating scales were used. Graded motor imagery resulted in a reduction in pain in 14 of the 15 studies. Conclusions: Due to the heterogeneity of the studies, a general conclusion regarding the effect of the disease-specific intervention was not possible. Based on pain outcome, graded motor imagery effectively decreased pain severity in various painful conditions.

Clinical diagnosis and management of persistent idiopathic dentoalveolar pain

Introduction: Persistent idiopathic dentoalveolar pain (PIDP) is a type of chronic pain that affects the teeth and surrounding tissue, and it is a condition that has been puzzling dental practitioners for many years. Aim: To clarify some misconceptions about persistent idiopathic dentoalveolar pain and provides insight into its possible diagnoses. Methods: The electronic literature search was conducted between June 2003 and December 2022 in PubMed and Google Scholar using Mesh terms: pain, idiopathic pain, phantom pain, and dentoalveolar pain in the English language. Later, relevant articles were screened and read thoroughly. Results: After reviewing the various articles, it was found that PIDP is a disease of exclusion that is confined to the dentoalveolar region with profound, dull, and pressure-like sensations. Discussion: Most of the research on PIDP has centered on its occurrence rates, symptoms, and ways to treat it, as well as the possible causes behind it. Various studies have also investigated different forms of treatment, such as medication, nerve blocks, and psychological interventions, in an effort to manage PIDP.