幻肢痛──病生理變化及治療現況

Phantom Limb Pain-Review of Pathophysiology and Treatments

幻肢痛，指得是已被截掉的肢體產生的痛覺。十六世紀中期，Ambrose Pare率先提出類似的概念，而Silas Weir Mitcheely則是最早陳述＂幻肢痛＂這個名詞。50—78%的患者經歷了這樣的疼痛。大多數的案例中，這症狀會隨著時間減輕，但這疼痛可能非常嚴重甚至導致失能。基於患者的經驗背景不同，治療必須考慮多個面向，包含中樞、周邊及心理因素。我們回顧近年發表的文章，病生理學及相關治療，包括藥物療法、硬脊膜外麻醉、區域神經麻醉、經皮神經電刺激等。雖然這些治療的證據力常呈現不一致的結果，但仍提供我們臨床上選擇的多樣性。

Phantom limb pain is a painful sensation from the missing limb after amputation. The concept was first mentioned by Ambrose Pare in the mid-16th century. The earliest description “phantom pain” was provided by Silas Weir Mitchell. Fifty to seventy-eight percent of patients experience phantom pain after amputation. In most of the cases, it diminishes with time. But the pain may be severe and disabling. The treatment demands multidisciplinary approaches, including central, peripheral and psychological factors under the background of individual experiences. This paper reviewed the recent published papers regarding the pathophysiology and treatment, such as pharmacological therapy, epidural anesthesia, regional nerve block, transcutaneous electrical nerve stimulation, etc. Although evidences provide inconsistent support for these treatments, this review reminds us about various choices of treatments in the clinical practice.