Amitriptilina como droga preemptiva na dor do membro fantasma após amputação.

Abstract

Introduction: Phantom limb pain is among the most difficult chronic pain to be treated, and is a frequent complication of amputation (60-80%), being severe in only 5-10% of cases. Many drugs have been tested as a treatment of phantom limb pain, with little success so far. But little is known about preventive ways to avoid phantom limb pain. Amitriptyline is currently a pharmacological option for the treatment of acute pain, but was never preemptively administered to control chronic pain. Objectives: To compare the frequency of incidence of phantom limb pain in patients undergoing amputation between the groups that received preemptive use of amitriptyline and placebo. Materials and Methods: A clinical trial, randomized, placebo-controlled, double-blind. Patients with limb amputation statement, which had their pain assessed by visual analog scale (VAS), Faces Scale of Pain and Numerical Pain Scale, before surgery and then randomized into two groups, amitriptyline 25 mg and placebo. Upon the completion of the full or partial limb amputation, patients were evaluated again by the tests mentioned in the 7th day after surgery. Results: In total 84 patients were randomized, but only 18 remained by the end of the study. There was no statistical difference sufficient to support the hypothesis that preemptive amitriptyline prevents the emergence of phantom limb pain (p = 0.9522; RR = 0.9545, 95% CI 0.2092 to 4.356). Conclusions: The study sample was small to be able to display a statistically significant p value (p <0.05), losses are expected in clinical trials with more patients will be able to better establish the relationship of preemptive amitriptyline with limb pain of appearance ghost.