Phantomschmerzen betreffen einen Großteil der amputierten Patienten und stellen eine
komplexe interdisziplinäre Herausforderung dar. Dieser Beitrag bietet einen strukturierten
Überblick zu Pathophysiologie, Risikofaktoren und differenzialdiagnostischen Aspekten.
Im Fokus stehen präventive und therapeutische Maßnahmen – von regionalanästhesiologischen
Verfahren über medikamentöse Strategien bis hin zu psychologischen und physikalischen
Ansätzen.
Abstract
Phantom pain (PP) is a neuropathic pain syndrome that occurs after limb amputation
and is perceived in the absent body part. Its exact pathophysiology remains unclear
but involves peripheral nerve lesions, central sensitization, and cortical reorganization.
Psychological and social factors also play a significant role in its manifestation.
Phantom pain after amputation shows wide variability, affecting up to 82% of patients
within the first postoperative year, with lifetime prevalence exceeding 80%, and higher
rates observed after proximal or major amputations (e.g., transfemoral). Symptoms
are typically described as intermittent, burning, or electric-like pain, often accompanied
by non-painful phantom sensations. Diagnosis requires thorough neurological evaluation,
detailed pain documentation, and the exclusion of differential diagnoses. Preventive
strategies include perioperative nerve blocks and adequate surgical soft tissue coverage.
Effective treatment is based on a
multimodal approach. Pharmacological options such as morphine and pregabalin have
shown efficacy, while others like tramadol or gabapentin appear less effective. Non-pharmacological
methods – including mirror therapy and transcutaneous electrical nerve stimulation
(TENS) – can support pain relief. Psychological interventions, particularly trauma-focused
therapy, may be beneficial, especially in patients with post-traumatic stress symptoms.
For optimal management, an individualized treatment plan combining pharmacological,
physical, and psychological strategies is recommended.
Schlüsselwörter
Weichteildeckung - Phantomschmerz - Amputation - Nervenblockade
Keywords
phantom pain - amputation - multimodal approach - nerve block - soft tissue coverage
