A new method of the phantom limb pain treatment

Abstract

The heavy phantom limb pain after surgical operation strike from 50% before 72% patient. The pathophysiology remains unclear and the treatment difficult and often unsuccessful. The unsatisfactory results of the pain therapy dictate need of searching for of the new methods of the treatment. On its nature phantom pains pertain to neuropatic pain. There are many messages about efficiency gabapentin in neuropatic pain syndrome appeared in recently. Alpha-lipoic acid and antiketogenic drugs is pathognomonic motivated treatment in neuropatic pain also. We tested the hypothesis that alpha-lipoic acid, gabapentin and sorbitol`s infusions and their combination are effective in treating phantom limb pain (FLP). Metods 46 patients at age from 31 before 80 years (at the average 62,1±8,6) were attracted in study. These patients existed pain in amputated limb after operation on cause of the diabetic foot syndrome. Patients have divided into two groups. In the first group entered 26 patients at age from 36 before 78 years (at the average 62,6±5,8), which in complex therapy got alpha-lipoic acid (600 mg/day), gabapentin (average dose 1500 mg/day) and sorbitol`s infusions (Reosorbilakt® , “Uriafarm”, Ukraine) in average dose 4-5 ml/kg/day. Vitamins, antibiotics, antiplatelet drugs entered in therapy program also. In the second (controlled) group entered 20 patients at age from 31 before 80 years (at the average 61,3±9,7 years), which got only traditional therapy. Patients of main and control groups did not differ on the main clinical and laboratory feature. Results In the first 3 days of postoperative period patients of the first group had average pain intensity on visual analogical score in 3,16±0,72 against 5,03±1,73 in control group (p<0,05); average morphine consumption at the first 72 hours after operation was accordingly 16,9±2,8 against 25,6±7,4 mg (p<0,05). Insomnia, night pains, petulance and anxiety were less felt by patients of the first group. Patients, acceptance specified combination promoted the quick normalization of the factors carbohydrate exchange. So, glycemia level fell in the first group with 13,45±2,07 before 7,13±1,95 mmol/l (p<0,05), in control group accordingly with 11,98±5,43 before 9,01± 1,84 mmol/l (p>0,05). Probably, this is connected with that surge “hormones of the stress” and contrinsuline hormones (adrenaline and cortisol, which provoke increasing a glycemia level and diabetic decompensation) fell in consequence of improvement of the analgesia. Follows to note that typical complications of other preparation, which are used in neuropatic pain treatment, did not exist. Conclusion The therapy efficiency of FLP is limited, only beside 30% patients get the relief of the pains. One of the possible ways of this problem decision can become use to combinations alpha-lipoic acid, gabapentin and sorbitol`s infusions.