诊断与治疗 - 妙佑医疗国际

诊断

准确诊断并确定残肢痛的原因非常重要，因为有些原因或许是可逆的。诊断残肢痛的检查和医疗程序包括：

体格检查。医生会检查您的残肢，查看是否有皮肤皲裂、压疮和骨骼问题。医生还会查看是否有感染或肿块的体征。医生可能还会轻拍您的残肢，查看是否有疼痛症状，疼痛表明存在截肢术后可能形成的神经末梢缠结（神经瘤）。
影像学检查。可以利用 MRI、CT 扫描、X 线或超声波检查，协助排除其他可能的疼痛原因，或证实医生的诊断。通过这些检查可以发现骨折、骨挫伤和其他骨骼异常、肿瘤及感染。
血液检测。您可能需要进行一些血液检查，协助排除其他可能的疼痛原因，或证实医生的诊断。

残肢痛的治疗侧重于消除引起疼痛的根本原因（如有可能）。在伴有残肢痛的患者中，最后约有一半未经治疗便得到了改善。残肢痛的治疗方案可能涉及以下药物：

止痛药。对乙酰氨基酚（Tylenol 等）和非甾体抗炎药可能会有所帮助。有可能还需要阿片类等药效更强的药物。这些药物可能最有助于缓解皮肤、软组织、肌肉和骨骼问题引起的疼痛。
抗抑郁药。三环类抗抑郁药或选择性去甲肾上腺素再摄取抑制剂可能有助于缓解神经纤维损伤引起的疼痛。
抗惊厥药。加巴喷丁（Gralise、Neurontin）和普瑞巴林（Lyrica）有助于减轻神经纤维损伤引起的疼痛。一般认为，这些药物通过干扰神经信号的传递来减轻疼痛。
N-甲基-D-天冬氨酸（NMDA）激动剂。这些药物（包括氯胺酮）可以阻断导致神经元敏感度增加的事件。它们通常作为外用药物应用于皮肤，虽然在减轻疼痛方面非常有效，但发挥的疗效无法持续太久，同时也会带来明显的副作用。

其他治疗方案包括：

物理疗法和作业疗法。这些治疗包括截肢术前后所进行的运动，以及假肢的正确安装和使用。给残肢穿上紧身衣也可能会有所帮助。
按摩。轻轻按摩残肢有时可以减轻疼痛。
催眠。一项小型研究发现，进行三次催眠可以减轻这种病患的残肢痛。
神经阻滞。这些注射剂可阻断或关闭神经的疼痛信号。如果阻滞可使疼痛停止，它们便有助于减少残肢痛，还可能有助于诊断神经瘤。
神经调节。这些治疗通过对神经进行电刺激来减轻疼痛。脊髓刺激（SCS）、周围神经刺激（PNS）和经皮电刺激神经疗法（TENS）是可用于帮助缓解残肢痛的一些治疗方式。

Pain relievers. Acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) available without a prescription may help. Some people need stronger, prescription medicines, such as opioids.
Antidepressants. Tricyclic antidepressants or selective norepinephrine reuptake inhibitors may help with pain that nerve damage causes.
Anticonvulsants. Gabapentin (Gralise, Neurontin) and pregabalin (Lyrica) may help relieve pain that nerve damage causes. Experts believe these medicines block nerve signals to ease pain.
N-methyl-D-aspartic acid agonists, also called NMDA agonists. These medicines that you put on the skin, called topical, may include ketamine. They make nerve cells react less to pain. They may ease pain, but the effects don't last long. They also can cause serious side effects.

Physical and occupational therapy. These therapies involve exercises people do before and after removal of an arm or leg, called amputation. The therapies also include fitting a replacement arm or leg, called a prosthesis, and learning how to use it. Wearing garments that put pressure on the residual arm or leg, called compression garments, also may help.
Massage. Gentle massaging of the arm or leg sometimes can ease pain.
Hypnosis. A small study found that three sessions of hypnosis eased residual limb pain.

Nerve blocks. These shots, called injections, block or turn off a nerve's pain signals. They can help ease residual limb pain. And, if the block works, it may help diagnose a tangle of nerve endings, called a neuroma.
Neuromodulation. These treatments use electrical impulses, called stimulation, on a nerve to relieve residual limb pain. Treatments may include spinal cord stimulation, also called SCS, peripheral nerve stimulation, also called PNS, and transcutaneous electrical nerve stimulation, also called TENS.
Osseointegration. This newer procedure connects a replacement arm or leg, called a prosthesis, directly to bone. It may help people who have trouble with a standard prosthesis, including residual limb pain. This procedure is not widely available.
Regenerative peripheral nerve interface. Also called RPNI, this newer procedure helps prevent neuroma, a tangle of nerve endings that often forms after an amputation. It also helps prevent pain from neuromas that have formed. Neuromas are a major cause of residual limb pain.

RPNI involves putting the nerve endings into tissue from a muscle graft. The graft often comes from the part of the leg or arm that was removed. This procedure is not widely available.