Nursing care in patients with phantom limb syndrome. Bibliographic review PDF

Preview

Summary

It is estimated that around 15% of the world's population lives with some type of disability. This number is growing due to the aging of the population and the global increase in chronic health problems associated with disability, such as diabetes, cardiovascular diseases and mental disorders. Withi...

Description

Nursing care in patients with phantom limb syndrome. Bibliographic review. It is estimated that around 15% of the world's population lives with some type of disability. This number is growing due to the aging of the population and the global increase in chronic health problems associated with disability, such as diabetes, cardiovascular diseases and mental disorders. Within this concept we find physical disabilities, among which are those derived from amputations, understood as amputation to the removal of some part of the body, usually a limb.1,2 Amputation is usually required when there is progressive peripheral vascular disease (diabetes mellitus the most common), fulminant gas gangrene, trauma (crushing, burns, frostbite, explosions…), congenital malformations, chronic osteomyelitis or malignant tumors. Upper limb amputation is less common.2 there are around 59,000 amputees, it is the second country in the world with the most lower limb amputations due to diabetes, with a rate of 3.19 for every 1,000 affected. Regarding prevalence, there are no major differences by sex, or by rural or urban habitat, although as age increases, this prevalence also increases.3 Amputation is used to relieve symptoms, improve function, and most importantly, save or improve the quality of life of the patient. Among the complications that can occur with amputation are: bleeding, infection, loss of skin continuity, joint contracture, and phantom limb pain, which is the focus of this review.2 Phantom limb pain or PLP (Phantom Limb Pain) was first described in the 16th century by Ambroise Paré. Its origin is not clear and currently, a multifactorial genesis is suggested that includes changes in the central nervous system and in peripheral factors caused by the lesion of the peripheral nerves. PLP refers to the presence of painful sensations in an absent limb and is classified as pain of origin

1

neuropathic. The incidence varies from 2% to 80% regardless of etiology, gender, level of amputation and age.2,4,5 The International Association for the Study of Pain (IASP) defines pain as: "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage." Which suggests that pain is not just a physiological process, but an experience that people interpret individually, regardless of whether there is an actual injury to the body. This can help explain why patients experience PLP.6 Some physical, psychological, and weather-induced factors can increase the risk of PLP. Therefore, the existence of pain prior to amputation, pain derived from the contralateral intact limb, emotional triggers such as stress, depression or thinking about amputation, and temperature fluctuations can contribute to its development.7 Although PLP is often associated with an amputated limb, phantom pain and phantom sensations can occur in other areas of the body that have been surgically removed or lost to trauma. These include: sinuses, nose, tongue, teeth, penis, and the inner organs.8 The pain often comes in the form of attacks that vary in duration from a few seconds, to minutes, or hours. Likewise, different types of pain and sensations have been described (Table I) that must be identified in order to treat the problem we encounter with precision and accuracy.9

Table I. Types of pain or sensation. TYPES OF PAIN OR SENSATION - Stump pain. Acute, nociceptive pain occurs in the remaining part of the body from which the limb was amputated. It can be a risk factor for developing PLP. - Phantom pain. It is experienced in the part of the body that is no longer there. It can be: burning, cramps, stitches, throbbing, tingling, etc. - Phantom sensation. Sensation different from the pain experienced in the part

of the

body

that

is

no

longer there.

Example:

feeling

of

uncomfortable position, change in temperature, movement, heaviness or numbness.

-

Telescopic. The distal end of the phantom limb is felt progressively closer to or even within the stump. Source: 8.

The

global

epidemiological

context

requires

updating

of

nursing

professionals in relation to the care of patients with phantom limb syndrome, through

their

own

interventions and those that require

compliance with medical treatment and their relationships with the rest of the patients. health professionals.10 Early aggressive management of pain prior to amputation and postoperative pain is known to be important in reducing the risk of developing PLP. Regular assessment of pain and initiation of specific therapies are essential. Nurses are in a unique position to prepare patients prior to surgery for the experience of phantom pain and to reinforce the assimilation of these feelings as normal after the operation.11 For all these reasons, it was decided to carry out this bibliographic review in order to visualize the impact of this condition that is on the rise and to combine the knowledge available about it, as a consequence of the increase in life expectancy and with it, the chronification of The diseases.

1. OBJECTIVES a. GENERAL -

Carry out a review of the existing scientific literature in English and Spanish about phantom limb pain and the nursing care to be developed for its prevention and treatment.

b. SPECIFIC -

Analyze the multitude of strategies available for the management of phantom limb pain.

-

Examine the different interventions to be performed by the nursing staff in the control of phantom limb syndrome, as well as the possibility of acquiring other competences in relation to

said

syndrome.

-

To determine the importance of the creation of multidisciplinary teams as a strategy for treating phantom limb syndrome and guaranteeing proper continuity of care.

2. METHODOLOGY The collection of information for the development of the chosen topic was carried out dividing the search into the following phases: definition of the selection criteria, bibliographic search of the published scientific literature, selection of titles that meet the selection criteria, review of the selected articles in full text and finally, analysis and synthesis of all the information collected.

Search strategy developed and selection of articles to analyze: A review of the scientific literature was performed by means of a retrospective bibliographic search in different databases: CUIDEN, DIALNET, IBECS, LILACS, MEDLINE, SCIELO. The search period was between January and February 2020. To determine the search descriptors, the keywords of the primary articles were identified and the Virtual Health Library was consulted, obtaining the following descriptors as the most appropriate keywords: “nursing care” or “nursing care”, “phantom limb "Or" phantom limb "," amputation "or" amputation "," pain management "or" pain management ". To focus and refine the search, different descriptors were combined with each other using the Boolean operator "AND". In addition, additional filters were established in the search such as: -

Publication date of the articles in the last 10 years (2010-2020).

-

Spanish / English language.

-

Full text availability.

Once all the criteria mentioned above had been applied, 161 references were obtained, which are shown below (table II):

Table II. Search profile. "NURSIN G CARE " AND

"NURSING

"PHANTOM

"NURSING

CARE ”AND AMPUTATI ON

LIMB ”AND "PAIN

CARE ”AND AMPUTATION

MANAGEMEN T"

AND

"PHANT OM LIMB "

TOT AL

TAKE CARE DIALNE T IBECS

0

3

1

"PAIN MANAGEMEN T" 0

1

6

2

1

0

1

4

0

LILACS

3

8

1

2 7

MEDLIN E

3

f i f t e e n 1 2

8 6

3

SCIELO

0

7

4

0

TOTAL

7

4 4

1 0 5

5

1 0 4 el e v e n 1 6 1

4 1 0 5

Source: self made.

The titles and abstracts of the total articles were analyzed and 94 references that were not related to the subject of the review were discarded, which can be included as shown in the following table (Table III):

Table III. Topics considered exclusion. ISSUES CONSIDERED OF EXCLUSION -

Articles focused on the cause of amputation, such as: diabetic foot, vascular disease or oncological processes.

-

Publications focused on acutely traumatic amputations (accidents).

-

Articles focused solely on pharmacological treatment.

-

Publications that only talk about the pathophysiology of phantom pain. Source: self made.

Next, 21 duplicate articles were manually removed. Of the remainder, 26 were discarded that did not meet the selection criteria indicated in the following table (Table IV):

Table IV. Selection criteria. INCLUSION CRITERIA

EXCLUSION CRITERIA

Articles with publication date

-

-

between the years 2010-2020. Spanish and / or English language.

-

Possibility

-

of

-

Publications

get

what

of

get

original. Publications that do not address thematic in a specific way.

-

he full text article. -

Impossibility he

Publications that move away from the field of health.

do

-

reference to humans.

Works that address personal narratives, situations or cases specific clinics. Source: self made.

Results: Finally, the total of articles selected for the review were 20, to which was added an article obtained manually from the Nursing journal and an article from the ANDADE website, making a total of 22 references (table V) . It also includes the consultation of the books "Medical-surgical Nursing" and "Classification of Nursing Interventions (NIC)", along with the following web pages: ADAMPI, WHO and AMPUTEE COALITION.

Table V. Search results. TITLE

AUTHOR /S

YE AR

Phantom limb pain

Kern

U,

in

practice.

Busch

V,

Still a lot of work to

Müller

R,

do !.4

Kohl

daily

20 12

KIND OF

AREA OF

STUDY

STUDY

Observation al analytical study

of usefulness of therapies in the pain management.

M, Body

Birklein F. Ochoa MC,

incompleteness in

Bustamante

the post-amputee with limb pain ghost:

Analysis

Qualitati

Experiences

ve-

patients

with

S,

descripti

phantom

limb

Hernández

ve study

pain.

Article

Care

20 15

C.

Qualitative study.5 Dealing with phantom

Fieldsen

D,

20 11

of

limb

pain despues de

amputation.6 Assistive

pain

for

management

specialized of Nursing.

Ghoseiri

technologies

of review

Wood S.

20 18

K,

Narrative

Therapies in the

review

management of phantom

Allami

limb

pain.

in people with M,

amputation:

Soroush to literature review.7

MR, Rastkhadiv

Dealing

with

the

MY. Quinlan

20 14

Narrative

Care of

review

nursing

specter of phantom

-

limb pain.8

Colwell

therapies

A.

pain

21. Phantom pain.9

Wolff

20 11

TO,

management. History,

review

diagnosis, therapies

en E, Kleef

and

Huygen

care

in

F,

he

Pope

pain management

JE, Systematic

review:

care

ghost. 20 16

Systematic

Skilled nursing

review

care.

20 11

Narrative

Multidisciplinary

review

care and

L, Monk

of Nursing in people

Mekhail N. Castle

in

Narrative

Vanduynhov

M,

and

AND, carrying

Espinoza B.

phantom pain amputated limb.10 Pain management in patients following

Chapman S.

limb amputation.

theories eleven

of the pain.

The effect of mirror therapy

on

Yıldırım

20 16

M,

the

Kanan N.

Quasi-

Therapies

experimental

pain

study

management and

management

in

care

specialized of of phantom limb pain.12 Imagery

Nursing.

for

Kubes LF.

20 15

self-

Narrative

Therapies in

review

healing

he pain

and

management.

integrative nursing practice.13 The effects of graded

Limakatso

motor imagery and

K, Cut

its

20 16

Protocol of systematic

components

review

Therapies in he pain management.

L, Parker R. on

phantom

limb

pain and disability in upper and lower limb amputees: to systematic review protocol.14 Lessons

learned

from

early

rehabilitation

of

complex trauma at the Royal Center for

20 17

Pope Yes,

care and

pain management.

AL, Wareham AP.

A,

Feedback to the

Sano

Y,

cheek during

Osumi

M,

virtual

Sumitani M,

visual

Kumagaya

enhances

review

therapies in the

Ichinose

therapy

Multidisciplinary

Vickerstaff

Defense Medicine.fifteen Somatosensory

feedback

Narrative

S, Kuniyoshi Y.

20 17

Descriptive

Therapies in the

observationa

management of

l study

phantom pain.

limb

pain alleviation for phantom arms.16 Mirror therapy for phantom limb and stump

pain:

a

randomized controlled trial

in

Ol

20 18

hS, Vanheng

Y,

Randomized

Analysis of the

controlled

therapeutic

clinical trial

effect of mirror therapy for the

Danielsson clinical

control

L, Husum H.

phantom

landmine

of limb

pain.

amputees in 17

Cambodia. The analgesic effect

Gallace

of crossing the arms.18

20 11

Experimenta

Evaluation of

l study

therapeutic

TO, Cake

efficacy.

DME, Moseley GL, Exorcising the

Iannetti GD. Virani A.

ghost of phantom

20 14

Narrative

Care

review

nursing specialists.

limb.twenty Start-up of a nurseled clinic to patients with

Tofthagen

20 19

C,

Article

Creation

of upgrade

of specific

Visovsky

centers

C, of

Eckelman

watch out. AND, Clatterbuck neuropathy peripheral.twenty-one

The importance of multidisciplinary

B, Leggatt M, Buck H Suction cup C.

20 16

Article

healthcare. of critical

teams in the Attention of the

Multidisciplinary

review

amputee patient.22 Trajectory of

Griffin SC,

phantom limb pain

Curran S,

relief using mirror

Chan

SB,

therapy:

Baker

CI,

retrospective

Pasquina

of

two

Retrospecti

Analysis of the

ve analysis

utility

of

AWY,

Finn

analysis

20 17

of

limb

pain

two

management

studies

therapies ghost.

PF, et al.

24

studies. Mirror therapy:

a

20 17

Wittkopf

potential intervention

for

Narrative

Therapies in

review

he

P, Johnson

pain

M.

management.

pain management.25 The effects

of

mirror

on

pain

therapy and

motor

Barbin

20 16

Systematic

Therapeutic

review

efficacy.

20 12

Systematic

Techniques

J, Seetha

control of phantom limb in amputees:

V, Boxes

to systematic review.26

JM, Paysant J, Pérennou

Mind-Body

D. Moura VL,

interventions

Faurot KR, Gaylord

for treatment of phantom limb pain in persons with

SA,

Mann JD, Sill M, Lynch C, et al.

review of intervention in phantom limb pain, duration, follow-up

amputation.27 and evaluation.

3. DEVELOPMENT After reviewing the selected documents, reading them comprehensively, comparing them, categorizing their contents and, together with personal reflection, the following categories of analysis have been generated to be studied in greater depth: 1. A multitude of approach strategies for the treatment of phantom limb syndrome. 2. Acquisition of skills and professional nursing care. 3. Importance of creating multidisciplinary t...