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This version was published on January 1, 2008
American Journal of Hospice and Palliative Medicine®, Vol. 24, No. 6, 455-462 (2008)
DOI: 10.1177/1049909107304558

Incidence and Management of Phantom Limb Pain According to World Health Organization Analgesic Ladder in Amputees of Malignant Origin

Seema Mishra, MD

Department of Anaesthesia, Institute Rotary Cancer Hospital, mseema17{at}yahoo.co.in

Sushma Bhatnagar, MD

Department of Anaesthesia, Institute Rotary Cancer Hospital

Deepak Gupta, MD

Department of Anaesthesia, Institute Rotary Cancer Hospital

Alok Diwedi, MSc

Department of Biostatistics All India Institute of Medical Sciences, New Delhi, India

Antidepressants and anticonvulsants are currently considered to be the drug treatment of choice for neuropathic pain. Opioids are effective in relieving neuropathic pain, including phantom pain in the early postoperative course. The present study of 42 cancer patients with limb amputation was conducted to determine the incidence of phantom limb pain and phantom sensation and to test the utility of the World Health Organization 3-step analgesic ladder in phantom limb pain management. Patients were monitored monthly for the first 2 months postoperatively and every 2 months thereafter for 2 years. The World Health Organization analgesic ladder was followed for pain management. The patients complaining of phantom sensation, phantom pain, and stump pain decreased from 69%, 60%, and 31%, respectively, at 1 month to 32%, 32%, and 5%, at the end of 2 years with the addition of opioids. The World Health Organization analgesic ladder played significant role in phantom limb pain management.

Key Words: neuropathic pain • phantom limb • opioids • World Health Organization analgesic ladder • pain


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