W. Thomas Edwards

Trial of amitriptyline for relief of pain in amputees: results of a randomized controlled study.

OBJECTIVE To evaluate whether amitriptyline is more effective than placebo in improving phantom limb pain or residual limb pain. DESIGN Randomized controlled trial of amitriptyline for 6 weeks. SETTING University hospital. PARTICIPANTS Thirty-nine persons with amputation-related pain lasting more than 6 months. INTERVENTION Six-week trial of amitriptyline (titrated up to 125 mg/d) or an active placebo (benztropine mesylate). MAIN OUTCOME MEASURES Analyses were conducted to examine whether there was a medication group effect on the primary outcomes (average pain intensity) and secondary outcome measures (disability, satisfaction with life, handicap). RESULTS No significant differences were found between the treatment groups in outcome variables when controlling for initial pain scores. CONCLUSIONS Our findings do not support the use of amitriptyline in the treatment of postamputation pain.

Hypnosis as an Adjunct to Medical Care in the Management of Burger's Disease: A Case Report

Burgers disease is a peripheral vascular disorder characterized by constricted blood flow, ischemic pain, and necrotizing tissue processes. This report describes the application of a brief hypnosis intervention in conjunction with standard medical procedures to increase peripheral blood flow in a patient with advanced Burgers disease. Using suggestions for foot warming and increased blood flow, substantial increases in surface foot temperature were obtained prior to and following an epidural sympathectomy. As a result, the procedure contributed to keeping necrotic tissue loss to a minimum, decreasing ischemic pain, and hopefully preventing the need for amputation. Treatment gains were maintained through discharge and at two month follow up. The results suggest that hypnosis may serve as a parsimonious, yet efficacious adjunct to standard medical care in the management of reduced peripheral blood flow in patients with Burgers disease. Further, it illustrates the feasibility of hypnosis as an adjunct treatment in busy, inpatient hospital settings.

Initial electro-mechanical response to rearward perturbation

The objective of this study was to examine the combined electromyographic (EMG) and mechanical response to a rearward perturbation and to separate the response into three categories: preset properties of the muscle, reflex changes to the muscle, and active changes to the muscle. We hypothesized that an active response is required to maintain balance on a moving platform. Eleven healthy adult subjects stood on a platform oscillating at three frequencies (0.75, 1.0, and 1.25 Hz). Ankle extensor EMG activity and ankle moment were analyzed and compared for initial movement cycles. Timing of events in EMG and moment data were examined to separate observed changes into the three categories. Results showed an initial rise in ankle moment as the platform started to move backwards, followed by a more rapid reflex increase. After a slight drop, ankle moment again rose due to active response. By the third cycle of platform movement, the EMG and moment were synchronized with the platform movement, maintaining the body in a desired posture. Initial preset properties of the ankle extensor muscles combined with reflex activity were not sufficient to maintain balance. Following an initial reflex reaction, further active control was required to match the timing of the ankle moment and the platform motion and avoid a loss of balance. This study provides new insight for the rehabilitation of postural deficits.

Trial of amitriptyline for relief of pain in amputees: results of a randomized controlled study 11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated.

OBJECTIVE To evaluate whether amitriptyline is more effective than placebo in improving phantom limb pain or residual limb pain. DESIGN Randomized controlled trial of amitriptyline for 6 weeks. SETTING University hospital. PARTICIPANTS Thirty-nine persons with amputation-related pain lasting more than 6 months. INTERVENTION Six-week trial of amitriptyline (titrated up to 125 mg/d) or an active placebo (benztropine mesylate). MAIN OUTCOME MEASURES Analyses were conducted to examine whether there was a medication group effect on the primary outcomes (average pain intensity) and secondary outcome measures (disability, satisfaction with life, handicap). RESULTS No significant differences were found between the treatment groups in outcome variables when controlling for initial pain scores. CONCLUSIONS Our findings do not support the use of amitriptyline in the treatment of postamputation pain.

Trial of Amitriptyline for Relief of Pain in Amputees

OBJECTIVE To evaluate whether amitriptyline is more effective than placebo in improving phantom limb pain or residual limb pain. DESIGN Randomized controlled trial of amitriptyline for 6 weeks. SETTING University hospital. PARTICIPANTS Thirty-nine persons with amputation-related pain lasting more than 6 months. INTERVENTION Six-week trial of amitriptyline (titrated up to 125 mg/d) or an active placebo (benztropine mesylate). MAIN OUTCOME MEASURES Analyses were conducted to examine whether there was a medication group effect on the primary outcomes (average pain intensity) and secondary outcome measures (disability, satisfaction with life, handicap). RESULTS No significant differences were found between the treatment groups in outcome variables when controlling for initial pain scores. CONCLUSIONS Our findings do not support the use of amitriptyline in the treatment of postamputation pain.