References

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9. Pons TP, Garraghty PE, Ommaya AK, et al. Massive cortical reorganization after sensory deafferentation in adult macaques. Science 1991; 252: 1857-1860.

10. Flor H, Elbert T, Knecht S. Phantom limb pain as a perceptual correlate of cortical reorganization following arm amputation. Nature 1995; 375: 482-484.

11. Flor H, Elbert T, Muhlnickel W. Cortical reorganization and phantom phenomena in congenital and traumatic upper-extremity amputees. Exper Brain Res 1998; 119: 205-212.

12. Birbaumer N, Lutzenberger W, Montoya P, et al. Effects of regional anesthesia on phantom limb are mirrored in changes in cortical reorganization in upper limb amputees. J Neurosci 1997; 17: 5503-5508.

13. Huse E, Larbig W, Flor H, et al. The effect of opioids on phantom limb pain and cortical reorganization. Pain 2001; 90: 47-55.

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17. Richardson C, Glenn S, Nurmikko T, Horgan M. Incidence of phantom phenomena including phantom limb pain 6 months after major lower limb amputation in patients with peripheral vascular disease. Clin J Pain 2006; 22: 353-358.

Box 19.1 Interventions for the management of phantom limb pain

Supported by evidence (ranked according to evidence level)

Gabapentin

Tricyclic antidepressants Opioids (morphine, tramadol) Ketamine (IV)

Calcitonin (IV) (acute phase only)

Use of a Farabloc (a metal threaded sock)

Sensory discrimination training

Refuted by evidence

Memantine (20-30 mg/day)

Epidural treatment (started 18 h before amputation)

Perineural blocks (started postoperatively)

Commonly used interventions currently unproven

Pregabalin

Various anticonvulsants (except gabapentin)

Antidepressants (except tricyclic antidepressants)

Opioids (methadone, oxycodone)

Physical therapy

Acupuncture

Hypnosis

Mirror treatment

Spinal cord stimulation

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38. Nikolajsen L, Gottrup H, Kristensen AGD, et al. Memantine (a N-methyl D-aspartate receptor antagonist) in the treatment of neuropathic pain following amputation or surgery: a randomized, double-blind, cross-over study. Anesth Analg 2000; 91: 960-966.

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41. Schley M, Topfner S, Wiech K, et al. Continuous brachial plexus blockade in combination with the NMDA receptor antagonist memantine prevents phantom pain in acute traumatic upper limb amputees. Eur J Pain 2007; 11(3): 299-308

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