Phantom Limb Pain: Mechanisms and Treatment Approaches (original) (raw)
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Recent advances in understanding and managing phantom limb pain
F1000Research
Post-amputation phantom limb pain (PLP) is highly prevalent and very difficult to treat. The high-prevalence, high-pain intensity levels, and decreased quality of life associated with PLP compel us to explore novel avenues to prevent, manage, and reverse this chronic pain condition. This narrative review focuses on recent advances in the treatment of PLP and reviews evidence of mechanism-based treatments from randomized controlled trials published over the past 5 years. We review recent evidence for the efficacy of targeted muscle reinnervation, repetitive transcranial magnetic stimulation, imaginal phantom limb exercises, mirror therapy, virtual and augmented reality, and eye movement desensitization and reprocessing therapy. The results indicate that not one of the above treatments is consistently better than a control condition. The challenge remains that there is little level 1 evidence of efficacy for PLP treatments and most treatment trials are underpowered (small sample sizes...
Mirror Therapy for Phantom Limb Pain
Phantom limb pain is a painful sensation that is perceived in a body part that no longer exists. To control this pain, many methods have been used such as medication, physical treatment, nerve block, neuromodulation, surgical treatment and mirror therapy. However, until now, there effects have been uncertain. We report the successful reduction of phantom limb pain using mirror therapy when other treatments initially failed to control the pain. (Korean J Pain 2012; 25: 272-274)
Mirror treatment of lower limb phantom pain: A case study
Purpose: Phantom limb pain (PLP) can be an enduring and distressing experience for people with amputations. Previous research has shown that 'mirror treatment' can reduce PLP for some people who have an upper limb amputation, and that it can increase a sense of motor control over the phantom in people with lower limb amputations who are not reporting PLP. There has been no previous report of therapeutic 'mirror treatment' for lower-limb phantom pain. Method: We present the first case study of the use of 'mirror treatment' in a person with a lower limb amputation who was reporting PLP at the time of treatment. Results: During the intervention there was a significant reduction in his PLP, an increase in sense of motor control over the phantom and a change in aspects of the phantom limb that was experienced. Conclusion: This case study, conducted in a conventional clinical setting, supports the potential of 'mirror treatment' for PLP in people with a lower limb amputation.
Psychophysical Contributions to Phantom Limb Pain
Can J Psychiatry. 1992 Jun;37(5):282-98
Recent studies of amputees reveal a remarkable diversity in the qualities of experiences that define the phantom limb, whether painless or painful. This paper selectively reviews evidence of peripheral. central and psychological processes that trigger or modulate a variety of phantom limb experiences. The data show that pain experienced prior to amputation may persist in the form of a somatosensory memory in the phantom limb. It is suggested that the length and size of. the phantom limb may be a perceptual marker of the extent to which sensory input from the amputation stump have re-occupied deprived cortical regions originally subserving the amputated limb. A peripheral mechanism involving a sympathetic-efferent somatic-afferent cycle is presented to explain fluctuations in the intensity of paresthesias referred to the phantom limb. While phantom pain and other sensations are frequently triggered by thoughts and feelings. there is no evidence that the painful or painless phantom limb is a symptom of a psychological disorder. It is concluded that the experience of a phantom limb is determined by a complex interaction of inputs from the periphery and widespread regions of the brain subserving sensory, cognitive, and emotional processes. .
Phantom Limb Pain: A Review of the Literature on Attributes and Potential Mechanisms
This study presents a review of the literature on the attributes and potential mechanisms involved in phantom limb pain, encompassing studies describing pain in the residual limb, phantom sensation and phantom limb pain, and the difficulties that may arise when making these distinctions. A variety of theories have been proposed to explain causal mechanisms for phantom limb pain. Conceptually, research into phantom limb pain is informed by the particular theory of chronic pain that is dominant at the time the research is undertaken. For example, early physiological theories on the etiology of phantom limb pain were grounded in specificity or pattern theories of pain. Later physiological research was based on the framework provided by Gate Control Theory and focused on identifying peripheral, spinal, and central neural mechanisms. Psychological explanations were grounded in psychoanalytic or personality theories of chronic pain which propose that phantom limb pain results from pre-amputation psychological disturbance. Despite numerous studies examining phantom limb pain, much of this research has both conceptual and methodological shortcomings. As such, the application of these research findings to clinical practice has limited utility.
A comparison of the effects of mirror therapy and phantom exercises on phantom limb pain
TURKISH JOURNAL OF MEDICAL SCIENCES
Background and aim: Although mirror therapy (MT) and phantom exercises (PE) have been shown to reduce pain, the efficacy of these methods in terms of pain, quality of life (QoL) and psychological status (PS) has not been investigated and compared to date. The aim of this study was to determine whether there is any difference between MT and PE in the treatment of phantom limb pain (PLP). Materials and methods: Forty unilateral transtibial amputees (aged 18-45 YR) participated in this study. Subjects were randomly divided into ‘MT group’ and ‘PE group’. QoL was assessed using Short-Form 36 (SF-36), psychological status using the Beck Depression Inventory (BDI) and pain intensity using a Visual Analog Scale (VAS), before and at the end of the program, and on the 3rd and 6th months thereafter. Results: All assessments for all parameters improved significantly in both groups (p<0.05). Comparison of the two groups revealed a significant difference in changes for VAS and BDI in all meas...
Advances in the Treatment of Phantom Limb Pain
Current Physical Medicine and Rehabilitation Reports, 2014
Phantom limb pain (PLP) continues to place a significant emotional and physical burden on amputees and remains a challenge for those treating amputees. Despite advances in psychological, pharmacologic, and interventional therapies, treatment modalities and research results show promise, but there is no evidence to highly recommend any particular treatment. This review concludes that the best treatment approach is a measured and diligent trial of multiple modes of treatment. As researchers forge forward toward definitively establishing etiologies, focused treatment options may become available. Until then, PLP is an area that calls for intense research and which will continue to challenge the clinician caring for the amputee population.
Pain practice : the official journal of World Institute of Pain, 2015
To describe the development and content of a clinical framework for mirror therapy (MT) in patients with phantom limb pain (PLP) following amputation. Based on an a priori formulated theoretical model, 3 sources of data collection were used to develop the clinical framework. First, a review of the literature took place on important clinical aspects and the evidence on the effectiveness of MT in patients with phantom limb pain. In addition, questionnaires and semi-structured interviews were used to analyze clinical experiences and preferences of physical and occupational therapists and patients suffering from PLP regarding the application of MT. All data were finally clustered into main and subcategories and were used to complement and refine the theoretical model. For every main category of the a priori formulated theoretical model, several subcategories emerged from the literature search, patient, and therapist interviews. Based on these categories, we developed a clinical flowchar...
Effectiveness of Mirror Therapy in Reducing Phantom Limb Pain
https://www.ijhsr.org/IJHSR\_Vol.6\_Issue.2\_Feb2016/40.pdf, 2016
Introduction: Amputation is the removal of part or all of a body part that is enclosed by skin. Most of individuals suffer from phantom limb pain in the region of their absent limb may be described as burning, cramping, stabbing in nature. Mirror therapy is the most promising method of treatment of phantom limb pain. Aim: To assess the effectiveness of mirror therapy on reducing phantom limb pain among amputated patients in selected hospitals of Punjab. Materials & methods: A quasi experimental (two group pre test post test) research design was chosen for the study. Convenient sampling technique with random assignment was used to select 60 amputated patients having phantom limb pain. The subjects in experimental group (n=30) were provided mirror therapy and conventional therapy and in control group (n=30) only conventional therapy was provided. Numeric Pain Rating Scale (0-10) and Socio demographic performa was used to collect the data. Results: Phantom limb pain among amputated patients after 1 week of mirror therapy (p value was 0.013) and after 2 weeks of mirror therapy (p value was 0.000) at p value ˂0.05 in experimental group as compared to control group. There was significant difference in phantom limb pain after 1 and 2 week of mirror therapy in experimental and control group. Conclusion: The study concluded that mirror therapy was effective in reducing phantom limb pain after 2 weeks (twice for 10 minutes) of intervention in experimental group.
Know Pain Know Gain: proposing a treatment approach for phantom limb pain
Journal of the Royal Army Medical Corps, 2013
Phantom limb pain affects between 50 and 80% of amputees. With an increasing number of battle casualties having had an amputation after combat trauma, it is inevitable that both primary and secondary care clinicians will come into contact with a patient with phantom limb pain (PLP). It is widely acknowledged that its complex aetiology means that this condition is often poorly understood and difficult to manage. A growing pathophysiological understanding is shedding new light on the mechanisms which underlie PLP. Knowledge of these mechanisms will inform treatment and enable clinicians to plan and implement solutions which make a difference to those individuals with this condition. This paper seeks to outline current research into this condition and proposes an approach to treatment. This approach has been formulated from an amalgamation of clinical experience working with battle casualties at the Defence Medical Rehabilitation Centre, Headley Court.