Skip to main content
SpringerLink
Log in

Que faire devant une douleur d’amputation?

  • Published:
Douleur et Analgésie

Résumé

L’analyse rétrospective du suivi à long terme de 37 amputés de membre est l’occasion d’une revue de la littérature à la fois sur la physiopathologie et le traitement des douleurs d’amputation. Les conséquences morphologiques, neurochimiques et électrophysiologiques de la section nerveuse permettent d’en appréhender les psychophysiologiques et fourmissent des bases théoriques au traitement. Le principal écueil de ces thérapeutiques raisonnablement fondées réside dans leur faible taux de succès à long terme. Ceci débouche sur des considérations concernant la prévention des douleurs et d’éventuelles applications des recherches fondamentales en cours.

Summary

The long term follow up of 37 amputees with phantom limb and stump pain gave us an opportunity for reviewing the litterature about pathophysiology and pain relief modalities. The psychophysiological aspects as well as the theoric basis of pain management are well explained by the morphological, neurochemical and electrophysiological consequences of the nerve section. The low long term success rate of all therepeutics constitutes actually their main drawbacks. Thus, prevention of post amputation pain needs much consideration as do forthcoming clinical application of fundamental researches.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Bibliographie

  1. Loeser J.D.: Pain after amputation: phantom limb and stump pain. In:The management of pain, Bonica J.J., ed. 2nd ed. Lea & Fibiger. Philadelphia, pp. 2444–256, 1990.

    Google Scholar 

  2. Melzack R.: Phantom limbs and the concept of neuromatrix.TINS 13, 88–92, 1990.

    PubMed  CAS  Google Scholar 

  3. Katz J. andMelzack R.: Pain memories in phantom limb: review and clinical observations.Pain 43, 319–336, 1990.

    Article  PubMed  CAS  Google Scholar 

  4. Katz J., Vaccarino A.L., Coderre T.J. andMelzack R.: Injury prior to neurectomy alters the pattern of autotomy in rats.Anesthesiology 75, 876–883, 1991.

    Article  PubMed  CAS  Google Scholar 

  5. Guilbaud G., Kayser V. etLombard M.C.: Les différents modèles expérimentaux de la douleur chronique. Intérêt et critiques.In:La douleur et son traitement Jepu A.R., Arnette. Paris, pp. 67–93. 1988.

    Google Scholar 

  6. Devor M. andRaber P.: Heritability of symptoms in an experimental model of neuropathic pain.Pain 42, 51–67, 1990.

    Article  PubMed  CAS  Google Scholar 

  7. Dudai Y.:The neurobiology of memory. Oxford University Press. Oxford, 1989.

    Google Scholar 

  8. Mumenthaler M. andSchliack H.: Histopathological changes in peripheral nerve lesions.In:Peripheral nerve lesions: diagnosis and therapy, Mumenthaler M., Schliack H., eds, Georg Thieme Verlag, Stuttgart, pp. 13–19, 1991.

    Google Scholar 

  9. Barde Y.A.: Trophic factors and neuronal survival.Neuron 2, 1525–1534, 1989.

    Article  PubMed  CAS  Google Scholar 

  10. Schwartz M., Cohen A., Stein-Izsack C. andBelkin M.: Dichotomy of the glial cell response to axonal injury and regeneration.FASEB 3, 2371–2378, 1989.

    CAS  Google Scholar 

  11. Kinnman E., Aldskogius H., Weisenfeld-Hallin Z. andJohansson O.: Expansion of sensory innervation after peripheral nerve injury.Pain suppl. 5, S 22, 1990.

    Article  Google Scholar 

  12. Xu X.J., Dalsgaard C.J. andWiesenfeld-Hallin Z.: Spinal substance P and NMDA receptors are coactivated in the induction of central sensitization of the nociceptive flexor reflex.Neuroscience 51, 641–648, 1992.

    Article  PubMed  CAS  Google Scholar 

  13. Seltzer Z., Cohn S., Ginzburg R. andBeilin B.: Modulation of neuropathic pain behaviour in rats by spinal disinhibition and NMDA receptor blockade of injury discharge.Pain 45, 69–75, 1991.

    Article  PubMed  CAS  Google Scholar 

  14. Basbaum A.I., Chi S.I. andLevine J.D.: Peripheral and central contribution to persistent expression of the c-fos proto-oncogene in spinal cord after peripheral nerve injury.In:Hyperalgesia and allodynia, Willis W.D., ed., Raven Press, New York, pp. 295–304, 1992.

    Google Scholar 

  15. Honken D.B., Battisti W.P., Chesselet M.F., Murray M. andTessier A.: Expression of beta-preprotachykinin mRNA and tachykinins in rat dorsal root ganglion cells following peripheral or central axotomy.Neuroscience 39, 733–742, 1990.

    Article  Google Scholar 

  16. Wakisaka S., Kajander K.C. andBennett G.J.: Increased NPY-like immunoreactivity in rat sensory neurons following peripheral axotomy.Neuroscience Letters 124, 200–203, 1991.

    Article  PubMed  CAS  Google Scholar 

  17. Besse D.: Les récepteurs opioïdes au niveau des premiers relais médullaires des circuits de la douleur.Lettre de la douleur 18, 7–57, 1992.

    Google Scholar 

  18. Baker M. andBostock H.: Ectopic activity in demyelinated spinal root axons of the rat.J. Physiol. 451, 539–552, 1992.

    PubMed  CAS  Google Scholar 

  19. Ovelman-Levitt J.: The neurophysiology of deafferentation syndromes.In:Deafferentation pain syndromes: pathophysiology and treatment, Nashold B., Ovelmen-Levitt, J., eds, Raven Press, New York, pp. 103–123, 1991.

    Google Scholar 

  20. Titmus M.J. andFaber D.S.: Axotomy induced alterations in the electrophysiological characteristics of neurons.Prog. Neurobiol. 35, 1–51, 1990.

    Article  PubMed  CAS  Google Scholar 

  21. Howe J.R., Yaksh T.L. andGo V.L.: The effect of unilateral dorsal root ganglionectomies or ventral thizotomies on alpha 2—adrenoreceptor binding to, and the substance P, enkephalin, and neurotensin content of the cat lumbar spinal cord.Neuroscience 21, 385–394, 1987.

    Article  PubMed  CAS  Google Scholar 

  22. Kingery W.S. andVallin J.A.: The development of chronic mechanical hyperalgesia and colleteral sprouting following sciatic nerve section in rat.Pain 38, 321–332, 1989.

    Article  PubMed  CAS  Google Scholar 

  23. Ollat H.: Traitement pharmacologique de la douleur neuropathique.Rev. Neurol. 148, 521–531, 1992.

    PubMed  CAS  Google Scholar 

  24. Onghena P. andVan Houdenhove B.: Antidepressant induced analgesia in chronic non-malignant pain: a meta-analysis of 39 placebo-controlled studies.Pain 49, 205–219, 1992.

    Article  PubMed  CAS  Google Scholar 

  25. Sawynok J.: GABA-ergic mechanisms of analgesia: an update.Pharmacol. Biochem. Behav. 26, 463–474, 1987.

    Article  PubMed  CAS  Google Scholar 

  26. Willow M., Gonoi T., Postme S.W. andCatterall W.A.: Inhibition of voltage-sensitive sodium channels by local anesthetics and anticonvulsivants.In:Molecular and cellular mechanisms of anesthetics, Roth S.H., Miller K.W., eds, Plenum Medical Book Cy, New York, pp. 243–258, 1986.

    Google Scholar 

  27. Portenoy R.K.: Pharmacologic management of chronic pain.In:In:Pain syndromes in neurology, Fields H.L., ed., Butterworths, London, pp. 257–278, 1990.

    Google Scholar 

  28. Devor M., Govrin-Lippmann R. andRaber P.: Corticosteroids suppress ectopic neuronal discharge originating in experimental neuromas.Pain 22, 127–137, 1985.

    Article  PubMed  CAS  Google Scholar 

  29. Burchiel K.J. andRussel L.C.: Glycerol neurolysis: neurophysiological effects of topical glycerol application on rat saphenous nerve.J. Neurosurg. 63, 784–788, 1985.

    Article  PubMed  CAS  Google Scholar 

  30. Muller A., Sudbrack G. andLaugner B.: La tolérance aux opiacés existe-t-elle dans le traitement de la douleur chronique?Doul. et Analg. 5, 29–33, 1992.

    Article  Google Scholar 

  31. Racle J.P.: Utilisation des alpha-stimulants par voies intrathécale et péridurale.Ann. Fr. Anesth. Réanim. 9, 338–345, 1990.

    PubMed  CAS  Google Scholar 

  32. Xu X., Puke M.J.C. andWiesenfeld-Hallin Z.: The depressive effect of intrathecal clonidine on the spinal flexor reflex is enhanced after sciatic nerve section in rats.Pain 51, 145–151, 1992.

    Article  PubMed  CAS  Google Scholar 

  33. Glynn C.J., Dawson D. andSanders R.: A double-blind comparison between epidural morphine and epidural clonidine in patients with chronic non cancer pain.Pain 34, 123–128, 1988.

    Article  PubMed  CAS  Google Scholar 

  34. Farcot J.M., Mercky F. andGrasser C.: Clonidine par voie épidurale thoraco-lombaire ou sacrée dans les douleurs de déafférantation: possibilités, limites et suivi à long terme.Agressologie 30 139–142, 1989.

    PubMed  CAS  Google Scholar 

  35. Roberts W.J. andKramis R.C.: Sympathetic nervous system influence on acute and chronic pain.In:Pain syndromes in neurology, Fields H.L., ed., Butterworths, London, pp. 85–106, 1990.

    Google Scholar 

  36. Campbell J.N., Meyer R.A., Davis K.D. andRaja S.N.: Sympathetically maintained pain: a unifying hypothesis.In:Hyperalgesia and allodynia Willis W., ed., Raven Press, New York, pp. 141–149, 1992.

    Google Scholar 

  37. Mannheimer J.S. andLampe G.N.:Clinical transcutaneous electrical nerve stimulation. F.A. Davis Company, Philadelphia, 1986.

    Google Scholar 

  38. Meyerson B.A.: Electrical stimulation of the spinal cord and brain.In:The management of pain, Bonica J.J., ed., Lee & Fibiger, Philadelphia, 1990.

    Google Scholar 

  39. Tyrer S.P.:Psychology, psychiatry and chronic pain. Butterworth, Heinemann, 1992.

    Google Scholar 

  40. Bach S., Noreng M.E. andTjellden N.O.: Phantom limb pain in amputees during the first 12 months following limb amputation, after preoperative lumbar epidural block.Pain 33, 297–301, 1988.

    Article  PubMed  CAS  Google Scholar 

  41. Fisher A. andMeller Y.: Continuous postoperative analgesia by nerve sheath block for amputation surgery.Anesth. Analg., 72, 300–303, 1991.

    Article  PubMed  CAS  Google Scholar 

  42. Jaeger H. andMaier C.: Calcitonin in phantom limb pain: a doubleblind study.Pain 48, 21–27, 1992.

    Article  PubMed  CAS  Google Scholar 

  43. Yamamoto T. andYaksh T.L.: Spinal pharmacology of thermal hyperesthesia induced by constriction injury of sciatic nerve. Excitatory amino acid antagoniats.Pain 49, 121–128, 1992.

    Article  PubMed  CAS  Google Scholar 

  44. Kristensen J.D., Svensson B. andGordh T.: The NMDA-receptor antagonist CPP abolishes neurogenic «wind-up pain» after intrathecal administration in humans.Pain 51 249–253, 1992.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Consultation de la Douleur, Hôpital Civil, F-67000, Strasbourg

    A. Muller

Authors
  1. A. Muller
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Texte présenté lors du Congrès de la SOFRED des 8 et 9 octobre 1992.

About this article

Cite this article

Muller, A. Que faire devant une douleur d’amputation?. Doul. et Analg. 6, 41–47 (1993). https://doi.org/10.1007/BF03019255

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03019255

Key words

Search

Navigation