Chillese 1.

Paill

幻肢痛 病理⽣理学
Phantom Limb Pain- Review of Pathophysiology and Treatments
Foot-Jull uill-Hua kuo5.6..

截肢
Phantom limb pain is a painful sensation from the missing limb after amputation.
th
The concept was first mentioned by Ambrose Pare in the mid-16 century. The earliest
(C h i n ese J . Pain
description “ phantom pain" was provided by Silas Weir Mitchel l. Fifty to seventy-eight
20 15;2 5 (1 ): 41 - 47)
percent of patients experience phantom pain after amputation. In most of the cases , it
減少
diminishes with time. But the pain may be severe and disabling. The treatment
多崇科 wmum
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6 -
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demands multidisciplinary approaches , including central , peripheral and psychological .II
LU
n " .1n
r “
factors under the background of individual experiences. This paper reviewed the recent
published papers regarding the pathophysiology and treatment , such as
藥理 硬膜外醉 經
pharmacological therapy, epidural anesthesia , regional nerve block , transcutaneous
电神經刺激
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.

The concept of phantom pain , that is the pa inful
sensation from the missing part of the body, was first
mention ed by Ambrose Pare , a Fre nch surgeon of the
th
mid_16 century for the Kings of France . [I] Silas Weir
讫 意志運动
spontaneous and will ed movements . In cont ra st ,
kinesthetic components indicate the size , shape and
positi on from the part of the mi ssing body. Whereas ,
extero ceptive perceptions include touch , pressure ,
振动
temperature , itch , and vibration , that phantom pains was
classified into thi s category. Due to a greater intensity

Mitchell , the famous Civ il War surgeon , gave the than phantom sensati on s, Weinstein distinguishes pain

earliest de scription of the unique , painful phenomenon ,
as the term "phantom pain ." [2] The published
literatures usually distinguish phantom sensation from
phantom pain. Weinstein has proposed that phantom
动感
sensations can be di vided into three categories : kinetic
運动元件 外感受性的
sensations , kinesthetic components , and exteroceptive
感规
perceptions. [3] Kinetic se nsations are the percep tion of
fonn sensation. Surprisingly, phantom pain could occur
in many regions of the body, such as eyes , tongue ,
直腸膀光⼦宮
breast , rectum , bladder, uterine or penis. [4-10] By far,
limbs are the most commonly reported body part
associated with a " phanto m." Limbs amputations are
外周动脈閉塞性疾病
performed due to peripheral arterial occlus ive disease ,
爐糖尿病
diabetes mellitus , or traumatic events. Neverthe less ,

1 Departmel/t of Cathay Gel/eral Hospital, Ne ll' Taipei

1 Departmel/t of Cathay General Hospital, Taipei Taiwa l/
J Departmel/t ofEmergel/cy llfedicil/ e, Sijhih Cathay Gel/ eral Hmpital, Ne ll' Taipei City, Taiwal/
' Departmel/ t ofEmergel/cy Gel/eral Hospital, Taipei City, Taiwa l/
5 Departmel/t ofPlastic S lIrgery, Sijhih Cathay Gel/eral Hospital, Ne ll' Taipei City, Taiwa l/
'Departmel/ t ofPlastic Cathay Gel/ eral Hospital, Taipei Taiwa l/
*Correspolllle l/ce allthor: YII-Che l/ Kilo
Add: Departmel/t of Plastic S lIrgery, Sijhih Cathay Gel/eral No.2, L l/. 59, Jia l/chel/g Rd. , Sijhih Dist. , Ne ll' Taipei City 221, Taiwllll
+886-2-26482121
Email: com.tw

41
 重

休感
運动⽪質 發 神經塑性变化

截肢

鄰近表⽰區 初級

体感頗

記憶輸入 橳鄰
径

⾝体計劃

刺痛攣

修改 神經衝动

㿸 固有感知 前庭

系統 可 後天⾝

傾向

免好無損

周圍神經橫斷 > 先天性截肢名

神經元
,

背根神經節細胞 中央

敏化 幻党 殘餘肢痛

表現 敏化 神經瘤
形成

脫落 過度興奮 表 機械

神經元可塑性 䰪
⼀

化学刺激

, 㿳

殘餘肢体神經瘤

⽪質重新對圖 必然放电 ⾝体像影

機制 体記憶

⽪質的
 經⽪电神經刺激

深部⼤腦 、 脊髓刺激

殘肢痛

腹側尾丘腦核
。

後柱 ?

視意⼀感知解離

下肢
 Pholl!om

Ambrose

Weir

(C hinese J. Pain 2015 ; 25(1):41-47)

02-26482121
yuchenkuo520 @yahoo .com.tw

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