An introduction to the issue of phantom limb pain

Circulating epinephrine resulting from emotional distress can contribute to the sensitisation of the peripheral nervous system. In addition, prosthetic use significantly aids resolution of PLP, especially with the upper limb. Preparatory work to ensure the maintenance of joint range, normal symmetrical movement and proximal stabilisation will aid prosthetic fitting and successful use, This will potentially enhance the beneficial effect of limb wearing upon PLP. Assessment and decision-making The image below shows an assessment approach, which may help clinicians to determine the correct course of action required with a patient with PLP.

An introduction to the issue of phantom limb pain

Phantom Limb Pain: Mechanisms and Treatment Approaches

Abstract Br J Anaesth ; Other major reasons for amputation and phantom pain are peripheral vascular disease and neoplasms.

Today, it is common knowledge that virtually all amputees experience phantom sensations, painful or not, after limb amputation. However, in some amputees, the phantom becomes the site of severe pain, which may be exceedingly difficult to treat.

An introduction to the issue of phantom limb pain

A large number of different treatments have been suggested but the vast majority of studies concerning the treatment of phantom pain are based on small groups with no controls.

A clear and rational treatment regimen is difficult to establish as long as the underlying patophysiology is not fully known.

Clinical aspects

The development of animal models mimicking neuropathic pain, together with research in other neuropathic pain conditions, have contributed significantly to our understanding of phantom pain. It is now clear that nerve injury is followed by a series of changes in the peripheral and the central nervous system and that these changes may play a role in the induction and maintenance of chronic phantom pain.

Although phantom pains may occur following amputation of body parts other than limbs, 27 49 66 the present review will focus on clinical characteristics, mechanisms, treatment, and possible preventive measures of phantom pain after limb amputation.

An introduction to the issue of phantom limb pain

The phantom complex includes three different elements. Painful sensations referred to the absent limb. Any sensation in the absent limb, except pain.

Pain localized in the stump. These elements often coexist in each patient and may be difficult to separate. 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.

It is also generally agreed that the incidence of pain is similar following civilian or military accidents. Eight months before a diagnosis of diabetes, he began to complain of typical diabetic neuropathy pain in the phantom leg, which was followed by a similar pain complaint in the intact limb.

Houghton and collaborators asked amputees to specify on a scale of 0 to 10 the degree of phantom pain at 6 months, 1, 2 and 5 yr after amputation. Nine amputees were in constant pain, nine had attacks of pain a few times per day and the rest only experienced phantom pain weekly or less.

A few patients more vivid and colourful descriptions. However, as can be seen from Figure 1the relation is not simple. Immediately after amputation the patient experienced phantom pain localized to the open drainage site, which was no longer there.

This was done using different word descriptors, the McGill Pain Questionnaire and their own words. However, when comparing preoperative and postoperative pain descriptions, the incidence of actual similarity was not higher in patients who claimed similarity than in those who found their phantom pain did not resemble pain experienced preoperatively.

This indicates that patients memory of their pain does not always reflect the truth. Stump and phantom pain are interrelated phenomena and several authors have reported a higher prevalence of phantom pain among amputees with coexistent stump pain compared with amputees without stump pain.

These include obvious pathology such as infection, bone spurs, neuromas and adherent and wrinkled scars. Phantom sensation Phantom sensation is experienced by almost everyone who undergoes limb amputation, but it is rarely a clinical problem.


The sensation can be very vivid and often includes feelings of posture and movement. Over time, the phantom sensation may fade. Phantom sensation and phantom pain are interrelated.Phantom limb pain (PLP) refers to ongoing painful sensations that seem to be coming from the part of the limb that is no longer there.

The limb is gone, but the pain is real. The onset of this pain most often occurs soon after surgery. 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.

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. Phantom limb pain (PLP) is a complex phenomenon that includes a wide variety of symptoms ranging from tingling and itching to burning and aching.

[11] [12] Until recently, the dominant hypothesis for the cause of phantom limbs was irritation in the severed nerve endings (called " neuromas ").Specialty: Neurology.

Introduction. Phantom limb sensation and phantom limb pain is a very common issue after amputations. In recent years there has been accumulating data implicating 'mirror visual feedback' or 'mirror therapy' as helpful in the treatment of phantom limb sensation and phantom limb pain.

Aug 14,  · 1. Introduction. The concept of phantom limb pain (PLP) as being the pain perceived by the region of the body no longer present was first described by .

Phantom limb - Wikipedia