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Phantomschmerz

Psychologische Behandlungsstrategien

Phantom limb pain

Psychological treatment strategies

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Zusammenfassung

Wie andere chronische Schmerzsyndrome ist auch der Phantomschmerz durch Lern- und Gedächtnisprozesse gekennzeichnet, die den Schmerz aufrechterhalten und maladaptive plastische Veränderungen des Gehirns verstärken. Deshalb sind auch hier psychologische Interventionen, die maladaptive Gedächtnisspuren verändern, sinnvoll. Neben dem Schmerzbewältigungstraining und Biofeedbackverfahren als traditionelle Ansätze finden neuere Entwicklungen wie sensorisches Diskriminationstraining, Spiegeltherapie, Vorstellungstraining, Prothesentraining oder Training in der virtuellen Realität Anwendung. Diese Verfahren verändern nicht nur den Phantomschmerz, sondern auch die damit einhergehenden plastischen Veränderungen des Gehirns.

Abstract

Similar to other pain syndromes phantom limb pain is characterized by learning and memory processes that maintain the pain and increase maladaptive plastic changes of the brain: therefore, psychological interventions that change maladaptive memory processes are useful. In addition to traditional psychological interventions, such as pain management training and biofeedback, more recent developments that involve sensory discrimination training, mirror treatment, graded motor imagery, prosthesis training and training in virtual reality are interesting. These interventions not only reduce phantom limb pain but also reverse the associated maladaptive brain changes.

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Literatur

  1. Jensen TS, Krebs B, Nielsen J et al (1985) Immediate and long-term phantom limb pain in amputees: incidence, clinical characteristics and relationship to pre-amputation limb pain. Pain 21:267–278

    Article  CAS  PubMed  Google Scholar 

  2. Sherman RA, Sherman CJ (1983) Prevalence and characteristics of chronic phantom limb pain among American veterans. Results of a trial survey. Am J Phys Med 62:227–238

    CAS  PubMed  Google Scholar 

  3. Nikolajsen L, Jensen TS (2006) Phantom limb. In: McMahon S, Koltzenburg M (Hrsg) Wall and Melzack’s textbook of pain. Churchill-Livingstone, London, S 961–971

  4. Sherman RA (1997) Phantom pain. Plenum Press, New York

  5. Vase L, Nikolajsen L, Christensen B et al (2011) Cognitive-emotional sensitization contributes to wind-up-like pain in phantom limb pain patients. Pain 152:157–162

    Article  PubMed  Google Scholar 

  6. Hanley MA, Jensen MP, Ehde DM et al (2004) Psychosocial predictors of long-term adjustment to lower-limb amputation and phantom limb pain. Disabil Rehabil 26:882–893

    Article  PubMed  Google Scholar 

  7. Jensen MP, Ehde DM, Hoffman AJ et al (2002) Cognitions, coping and social environment predict adjustment to phantom limb pain. Pain 95:133–142

    Article  PubMed  Google Scholar 

  8. Wei F, Zhuo M (2001) Potentiation of sensory responses in the anterior cingulate cortex following digit amputation in the anaesthetised rat. J Physiol 532:823–833

    Google Scholar 

  9. Willoch F, Rosen G, Tolle TR et al (2000) Phantom limb pain in the human brain: unraveling neural circuitries of phantom limb sensations using positron emission tomography. Ann Neurol 48:842–849

    Article  CAS  PubMed  Google Scholar 

  10. Elbert TR, Flor H, Birbaumer N et al (1994) Extensive reorganization of the somatosensory cortex in adult humans after nervous system injury. Neuroreport 5:2593–2597

    Article  CAS  PubMed  Google Scholar 

  11. Flor H, Elbert T, Knecht S et al (1995) Phantom-limb pain as a perceptual correlate of cortical reorganization following arm amputation. Nature 375:482–484

    Article  CAS  PubMed  Google Scholar 

  12. Price DD, Verne GN, Schwartz JM (2006) Plasticity in brain processing and modulation of pain. Prog Brain Res 157:333–352

    Article  PubMed  Google Scholar 

  13. Yang TT, Gallen CC, Ramachandran VS et al (1994) Noninvasive detection of cerebral plasticity in adult human somatosensory cortex. Neuroreport 5:701–704

    Article  CAS  PubMed  Google Scholar 

  14. Cohen LG, Bandinelli S, Findley TW et al (1991) Motor reorganization after upper limb amputation in man. Brain 114:615–627

    Article  PubMed  Google Scholar 

  15. Karl A, Birbaumer N, Lutzenberger W et al (2001) Reorganization of motor and somatosensory cortex in upper extremity amputees with phantom limb pain. J Neurosci 21:3609–3618

    Google Scholar 

  16. Kew JJ, Ridding MC, Rothwell JC et al (1994) Reorganization of cortical blood flow and transcranial magnetic stimulation maps in human subjects after upper limb amputation. J Neurophysiol 72:2517–2524

    Google Scholar 

  17. Lotze M, Flor H, Grodd W et al (2001) Phantom movements and pain. An fMRI study in upper limb amputees. Brain 124:2268–2277

    Article  CAS  PubMed  Google Scholar 

  18. Nikolajsen L, Ilkjaer S, Jensen TS (2000) Relationship between mechanical sensitivity and postamputation pain: a prospective study. Eur J Pain 4:327–334

    Article  CAS  PubMed  Google Scholar 

  19. Nikolajsen L, Ilkjaer S, Kroner K et al (1997) The influence of preamputation pain on postamputation stump and phantom pain. Pain 72:393–405

    Article  CAS  PubMed  Google Scholar 

  20. Flor H, Turk DC (2011) Chronic pain: an integrated biobehavioral approach. IASP Press, Seattle/WA

  21. Harden RN, Houle TT, Green S et al (2005) Biofeedback in the treatment of phantom limb pain: a time-series analysis. Appl Psychophysiol Biofeedback 30:83–93

    Article  PubMed  Google Scholar 

  22. Moura VL, Faurot KR, Gaylord SA et al (2012) Mind-body interventions for treatment of phantom limb pain in persons with amputation. Am J Phys Med Rehabil 91:701–714

    Article  PubMed  Google Scholar 

  23. Lotze M, Grodd W, Birbaumer N et al (1999) Does use of a myoelectric prosthesis prevent cortical reorganisation and phantom limb pain? Nat Neurosci 2:501–502

    Article  CAS  PubMed  Google Scholar 

  24. Weiss T, Miltner WH, Adler T et al (1999) Decrease in phantom limb pain associated with prosthesis-induced increased use of an amputation stump in humans. Neurosci Lett 272:131–134

    Article  CAS  PubMed  Google Scholar 

  25. Dietrich C, Walter-Walsh K, Preissler S et al (2012) Sensory feedback prosthesis reduces phantom limb pain: proof of a principle. Neurosci Lett 507:97–100

    Article  CAS  PubMed  Google Scholar 

  26. Flor H, Denke C, Schaefer M et al (2001) Effect of sensory discrimination training on cortical reorganisation and phantom limb pain. Lancet 375:1763–1764

    Article  Google Scholar 

  27. Huse E, Preissl H, Larbig W et al (2001) Phantom limb pain. Lancet 358:1015

    Article  CAS  PubMed  Google Scholar 

  28. Ramachandran VS, Rogers Ramachandran D, Cobb S (1995) Touching the phantom limb. Nature 377:489–490

    Article  CAS  PubMed  Google Scholar 

  29. Brodie EE, Whyte A, Waller B (2003) Increased motor control of a phantom leg in humans results from the visual feedback of a virtual leg. Neurosci Lett 341:167–169

    Article  CAS  PubMed  Google Scholar 

  30. Hunter JP, Katz J, Davis KD (2003) The effect of tactile and visual sensory inputs on phantom limb awareness. Brain 126:579–589

    Article  PubMed  Google Scholar 

  31. Brodie EE, Whyte A, Niven CA (2007) Analgesia through the looking-glass? A randomized controlled trial investigating the effect of viewing a ‚virtual‘ limb upon phantom limb pain, sensation and movement. Eur J Pain 11:428–436

    Article  PubMed  Google Scholar 

  32. Chan BL, Witt R, Charrow AP et al (2007) Mirror therapy for phantom limb pain. N Engl J Med 357:2206–2207

    Google Scholar 

  33. Halligan PW, Hunt M, Marshall JC et al (1996) When seeing is feeling; acquired synaesthesia or phantom touch? Neurocase 2:21–29

    Article  Google Scholar 

  34. Rock I, Victor J (1964) Vision and touch: an experimentally created conflict between the two senses. Science 143:594–596

    Article  CAS  PubMed  Google Scholar 

  35. Diers M, Christmann C, Koeppe C et al (2010) Mirrored, imagined and executed movements differentially activate sensorimotor cortex in amputees with and without phantom limb pain. Pain 149:296–304

    Article  PubMed  Google Scholar 

  36. Moseley GL, Gallace A, Spence C (2008) Is mirror therapy all it is cracked up to be? Current evidence and future directions. Pain 138:7–10

    Article  PubMed  Google Scholar 

  37. Ersland L, Rosén G, Lundervold A et al (1996) Phantom limb imaginary fingertapping causes primary motor cortex activation: an fMRI study. Neuroreport 8:207–210

    Article  CAS  PubMed  Google Scholar 

  38. Roux FE, Ibarrola D, Lazorthes Y et al (2001) Virtual movements activate primary sensorimotor areas in amputees: report of three cases. Neurosurgery 49:736–742

    CAS  PubMed  Google Scholar 

  39. Mercier C, Reilly KT, Vargas CD et al (2006) Mapping phantom movement representations in the motor cortex of amputees. Brain 129:2202–2210

    Article  PubMed  Google Scholar 

  40. Giraux P, Sirigu A (2003) Illusory movements of the paralyzed limb restore motor cortex activity. Neuroimage 20(Suppl 1):107–111

    Article  Google Scholar 

  41. MacIver K, Lloyd DM, Kelly S et al (2008) Phantom limb pain, cortical reorganization and the therapeutic effect of mental imagery. Brain 131:2181–2191

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  42. Moseley GL (2006) Graded motor imagery for pathologic pain. A randomized controlled trial. Neurology 67:2129–2134

    Article  PubMed  Google Scholar 

  43. Cole J, Crowle S, Austwick G et al (2009) Exploratory findings with virtual reality for phantom limb pain; from stump motion to agency and analgesia. Disabil Rehabil 31:846–854

    Article  PubMed  Google Scholar 

  44. Sato K, Fukumori S, Matsusaki T et al (2010) Nonimmersive virtual reality mirror visual feedback therapy and its application for the treatment of complex regional pain syndrome: an open-label pilot study. Pain Med 11:622–629

    Article  PubMed  Google Scholar 

  45. Alviar MJ, Hale T, Dungca M (2011) Pharmacologic interventions for treating phantom limb pain. Cochrane Database Syst Rev:CD006380

    Google Scholar 

  46. Moseley GL, Flor H (2012) Targeting cortical representations in the treatment of chronic pain: a review. Neurorehabil Neural Repair 26:646–652

    Article  PubMed  Google Scholar 

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Correspondence to M. Diers or H. Flor.

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Diers, M., Flor, H. Phantomschmerz. Schmerz 27, 205–213 (2013). https://doi.org/10.1007/s00482-012-1290-x

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