Phantom Limb Pain: A Review of the Literature on Attributes and Potential Mechanisms (original) (raw)
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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. .
A Study on Relationship among Phantom Limb Pain
Various phantom limb phenomena were researched using 32 unilaterally amputated upper extremity patients, some of whom experienced phantom limb pain and some of whom did not. In general, individuals who suffered from phantom limb had a greater incidence of non-full phantom limb sensations than amputees who did not experience any from their amputations. Exteroceptive cutaneous sensations were reported less frequently than kinesthetic and kinetic phantom limb experiences, which were reported more frequently. Phantom limb and stump were found to have a substantial and positive link with one another. Patients typically attributed sensory rather than affective characteristics to their phantom limb, however for stump; no differences were identified between qualities.
Factors associated with phantom limb pain: a 31/2-year prospective study
Clinical Rehabilitation, 2010
Objective: To analyse the prevalence of phantom (limb) pain over time and to analyse factors associated with phantom (limb) pain in a prospective cohort of amputees. Design: A multicentre longitudinal study. Patients: One hundred and thirty-four patients scheduled for amputation were included. Methods: Patients filled in questionnaires before amputation, and postal questionnaires six months, 1½ years and 2½ years to a maximum of 3½ years after amputation. Preoperative assessment included patients' characteristics, date, side and level of, and reason for amputation. The follow-up questionnaires assessed the frequencies of the experienced phantom pain, prosthetic use and walking distance. The occurrence of phantom pain was defined as phantom pain a few times a day or more frequently. Results: Pre-and postoperative questionnaires were available filled in by 85 amputees (33 females and 52 males). The percentage of lower limb amputees with phantom pain was the highest at six months after amputation, and of upper limb amputees at 1½ years. In general, more women than men experienced phantom pain. One and a half years and 2½ years after amputation the highest percentages of the lower limb amputees used their prosthesis more than 4 hours a day (66%), after that time this percentage decreased to 60%. The results of the two-level logistic regression analysis to predict phantom pain show that phantom pain was less frequently present in men (odds ratio (OR) ¼ 0.12), in lower limb amputees (OR ¼ 0.14) and that it decreased in due course (OR ¼ 0.53 for 1 year). Conclusion: Protective factors for phantom pain are: being male, having a lower limb amputation and the time elapsed since amputation.
The International Journal of Psychiatry in Medicine, 1988
Phantom limb pain, which affects a majority of amputees, must be distinguished from phantom limb sensation, a universal consequence of limb amputation. Although the characteristics and time course of phantom limb pain are well described in the literature, no single theoretical approach can fully account for the contradictory aspects of this condition, thus its underlying mechanisms remain unclear. Theories concerning the etiology of phantom limb pain categorized as peripheral, central and psychological have given rise to a myriad of treatment approaches.
Phantom Limb Pain: Mechanisms and Treatment Approaches
Pain Research and Treatment, 2011
The vast amount of research over the past decades has significantly added to our knowledge of phantom limb pain. Multiple factors including site of amputation or presence of preamputation pain have been found to have a positive correlation with the development of phantom limb pain. The paradigms of proposed mechanisms have shifted over the past years from the psychogenic theory to peripheral and central neural changes involving cortical reorganization. More recently, the role of mirror neurons in the brain has been proposed in the generation of phantom pain. A wide variety of treatment approaches have been employed, but mechanism-based specific treatment guidelines are yet to evolve. Phantom limb pain is considered a neuropathic pain, and most treatment recommendations are based on recommendations for neuropathic pain syndromes. Mirror therapy, a relatively recently proposed therapy for phantom limb pain, has mixed results in randomized controlled trials. Most successful treatment outcomes include multidisciplinary measures. This paper attempts to review and summarize recent research relative to the proposed mechanisms of and treatments for phantom limb pain.
Making sense of phantom limb pain
Journal of Neurology, Neurosurgery, and Psychiatry, 2022
Phantom limb pain (PLP) impacts the majority of individuals who undergo limb amputation. The PLP experience is highly heterogenous in its quality, intensity, frequency and severity. This heterogeneity, combined with the low prevalence of amputation in the general population, has made it difficult to accumulate reliable data on PLP. Consequently, we lack consensus on PLP mechanisms, as well as effective treatment options. However, the wealth of new PLP research, over the past decade, provides a unique opportunity to reevaluate some of the core assumptions underlying what we know about PLP and the rationale behind PLP treatments. The goal of this review is to help generate consensus in the field on how best to research PLP, from phenomenology to treatment. We highlight conceptual and methodological challenges in studying PLP, which have hindered progress on the topic and spawned disagreement in the field, and offer potential solutions to overcome these challenges. Our hope is that a constructive evaluation of the foundational knowledge underlying PLP research practices will enable more informed decisions when testing the efficacy of existing interventions and will guide the development of the next generation of PLP treatments.
Phantom Limb Pain After Lower Limb Trauma
The International Journal of Lower Extremity Wounds, 2011
Phantom sensations, that is, sensations perceived in a body part that has been lost, are a common consequence of accidental or clinical extremity amputations. Most amputation patients report a continuing presence of the limb, with some describing additional sensations such as numbness, tickling, or cramping of the phantom limb. The type, frequency, and stability of these phantom sensations can vary immensely. The phenomenon of painful phantom sensations, that is, phantom limb pain, presents a challenge for practitioners and researchers and is often detrimental to the patient’s quality of life. In addition to the use of conventional therapies for chronic pain disorders, recent years have seen the development of novel treatments for phantom limb pain, based on an increasing body of research on neurophysiological changes after amputation. This article describes the current state of research in regard to the demographics, causal factors, and treatments of phantom limb pain.
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.
British Journal of Anaesthesia, 2001
d Phantom limb pain: Painful sensations referred to the absent limb. d Phantom limb sensation: Any sensation in the absent limb, except pain. d Stump pain: Pain localized in the stump. These elements often coexist in each patient and may be dif®cult to separate. Clinical aspects Incidence Early literature suggested that the incidence of phantom pain was as low as 2%. However, more recent studies report incidences of 60±80% (Table 1). The discrepancy in reported frequencies mainly occurred because early studies based prevalence rates on patients' request for pain treatment. This will substantially underestimate the problem of phantom pain as many amputees, at least in the past, were reluctant to report pain to health care providers. Sherman and Sherman (1983) reported that, although 61% of amputees with phantom pain had discussed the problem with their doctor, only 17% were offered treatment and a large proportion of the rest were told that they were mentally disturbed. 80 The occurrence of phantom pain seems to be independent of age in adults, gender and level, or side of amputation. 37 46 54 59 80 Phantom pain is less frequent in young children and congenital amputees. In a recent study of 60 child and adolescent amputees who were missing a limb because of congenital limb de®ciency (n=27) or surgery/ trauma (n=33), the incidence of phantom pain was 3.7% in the congenital group and 48.5% in the surgical group. 99 Some authors have suggested a relationship between