Stump neuralgia

Description:

Stump neuralgias in extremities - one of the most serious pain syndromes. For the first time they were described in 1552 by Ambroise Paré, but still the mechanisms which are their cornerstone are not quite studied, and perspectives of their bystry elimination are very sad.

The percent of the people suffering from stump neuralgias is surprisingly high. At 72% of people stump neuralgias arose in the first 8 days after operation, in 6 months they were noted at 65%, two years later - at 60%. 60% of people continue to complain of a phantom extremity pains and in 7 years. However eventually the painful attacks become more rare.

Symptoms of the Stump neuralgia:

The stump neuralgia is one of manifestations of various phantom feelings. Bol treats exteroceptive feelings, along with the tactile, temperature, pressing feelings, an itch, etc. There can also be kinaesthetic feelings to which perception of position of the amputated extremity, its length, volume, and also the kinetic feelings including any and involuntary movements in extremities belongs. The most characteristic kinaesthetic feelings are perception of unusual position of an extremity, its shortening, distortion of the sizes. All these feelings happen the brightest directly after operation. Over time intensity of feelings weakens.

Reasons of the Stump neuralgia:

The classical stump neuralgia arises after amputation of an extremity, however this term is applicable also to the pain developing after amputation of any part of a body. Practically all patients who transferred amputations of extremities, and also some other bodies (a mammary gland, a penis, an anus, a nose, ears) have phantom feelings soon after crossing of a nerve, but they can appear and at any time after denervation. These feelings are not always painful and sometimes do not cause the complaint of patients. Most of specialists note that over time pain significantly decreases approximately at a half of patients.

Treatment of the Stump neuralgia:

Stump neuralgias it is difficult to treat therefore it is better to try to prevent them. Decrease in frequency and intensity of stump neuralgias in the postoperative period at patients with preoperative extremity pain note after epidural infusion of local anesthetics or morphine within 72 hours before operation.

Drug treatment.
At the short anamnesis of a stump neuralgia analgetics show positive effect. It is in certain cases shown long uses of narcotic analgetics.

Blockade of nerves.
Blockade of sympathetic nerves usually causes the minimum or temporary improvement, but in certain cases it is rather effective therefore even the small probability of permanent stopping of pain justifies carrying out sympathetic blockade at a refractory pain syndrome. The probability of achievement of lasting analgetic effect by blockade of touch nerves is lower, than at sympathetic blockade, even cases of paradoxical strengthening of pain after touch blockade are described.

Chemical or surgical destruction.
Chemical or surgical destruction of proximal somatosensory conduction paths is more risky, than temporary blockade as can lead to an aggravation of symptoms and therefore is not APPLIED to treatment of stump neuralgias.
Injections of local anesthetics in a stump practically do not influence stump neuralgias.