Adequacy of amputation analgesia as a factor preventing the triggering of pain memory in the genesis of phantom pain syndrome
Ovechkin, A.M.; Kukushkin, M.L.; Gnezdilov, A.V.; Reshetniak, V.K.
Anesteziologiia i reanimatologiia 1995(2): 56-59
1995
ISSN/ISBN: 0201-7563 PMID: 7645778 Document Number: 449664
Examinations of 72 patients with a history of amputation of the lower limb showed that preamputation pain may be transformed into phantom pain via "pain memory" mechanisms. This fact is confirmed by similarity of the verbal structure of preamputation pain and phantom pain syndrome, which are particularly expressed in the patients operated on under total anesthesia. At the same time, the share of patients considering phantom pain identical to preamputation pain is much lower among those operated on under prolonged perioperative epidural anesthesia, and no "pain memory" phenomena are observed in this group 6 months after surgery. Prolonged epidural anesthesia provides a pain-free period before surgery by disrupting the time relationship between nociceptive impulsation entry in the CNS structures and amputation, thus preventing fixation of 'pain experience' survived in the memory. The adequacy of intraoperative analgesia attained by prolonged epidural anesthesia plays the crucial role in prevention of realization of the "pain memory" effect.