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Results for “PHANTOM LIMB”

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At least 19 recordsLinked to original sources
PubMed1983

Phantom limb, phantom pain and stump pain in amputees during the first 6 months following limb amputation.

The incidence and clinical picture of non-painful and painful phantom limb sensations as well as stump pain was studied in 58 patients 8 days and 6 months after limb amputation. The incidence of non-painful phantom limb, phantom pain and stump pain 8 days after surgery was 84, 72 and 57%, respectively. Six months after amputation the corresponding figures were 90, 67 and 22%, respectively. Kinaesthetic sensations (feeling of length, volume or other spatial sensation of the affected limb) were present in 85% of the patients with phantom limb both immediately after surgery and 6 months later. However, 30% noticed a clear shortening of the phantom during the follow-up period; this was usually among patients with no phantom pain. Phantom pain was significantly more frequent in patients with pain in the limb the day before amputation than in those without preoperative limb pain. Of the 67% having some phantom pain at the latest interview 50% reported that pains were decreasing. Four patients (8%), however, reported that phantom pains were worse 6 months after amputation than originally. During the follow-up period the localization of phantom pains shifted from a proximal and distal distribution to a more distal localization. While knifelike, sticking phantom pains were most common immediately after surgery, squeezing or burning types of phantom pain were usually reported later in the course. Possible mechanisms for the present findings either in periphery, spinal cord or in the brain are discussed.

Aged↗
PubMed2004

Acupuncture treatment of phantom limb pain and phantom limb sensation in amputees.

Three case histories are presented in which amputees with acute or chronic phantom limb pain and phantom limb sensation were treated with Western medical acupuncture, needling the asymptomatic intact limb. Two out of the three cases reported complete relief of their phantom limb pain and phantom limb sensation. Acupuncture was successful in treating phantom phenomena in two of these cases, but a larger cohort study would be needed to provide more evidence for the success rate of this treatment technique for this indication.

Acupuncture Therapy↗
PubMed2006

Analgesia through the looking-glass? A randomized controlled trial investigating the effect of viewing a 'virtual' limb upon phantom limb pain, sensation and movement.

The extent to which viewing a 'virtual' limb, the mirror image of an intact limb, modifies the experience of a phantom limb, was investigated in 80 lower limb amputees before, during and after repeated attempts to simultaneously move both intact and phantom legs. Subjects were randomly assigned to one of two conditions, a control condition in which they only viewed the movements of their intact limb and a mirror condition in which they additionally viewed the movements of a 'virtual' limb. Although the mirror condition elicited a significantly greater number of phantom limb movements than the control condition, it did not attenuate phantom limb pain and sensations any more than the control condition. The potential of a 'virtual' limb as a treatment for phantom limb pain was discussed in terms of its ability to halt and/or reverse the cortical re-organisation of motor and somatosensory cortex following acquired limb loss.

Adult↗
PubMed1997

The relationship of phantom limb pain to other phantom limb phenomena in upper extremity amputees.

In thirty-two unilateral upper extremity amputees with and without phantom limb pain, various phantom limb phenomena were investigated. In general, the incidence of non-painful phantom limb sensations was higher in patients with phantom limb pain than in pain-free amputees. Kinesthetic and kinetic phantom limb sensations were reported more frequently than exteroceptive cutaneous sensations. There was a significant positive correlation between phantom limb pain and stump pain. Patients more frequently assigned sensory than affective pain qualities to their phantom limb pain, whereas no differences between pain qualities were observed for stump pain. No support was found for a relationship between the presence of telescoping (i.e., shrinkage of the phantom limb) and phantom limb pain. These findings point to central as well as to peripheral factors contributing to phantom limb pain.

Adult↗
PubMed1998

Phantom limb sensations and phantom limb pain in child and adolescent amputees.

OBJECTIVE: To provide a better understanding of the prevalence, correlates and quality of phantom sensations and phantom pain in child and adolescent amputees. DESIGN: Retrospective survey study. SETTING: Recruitment through the War Amputations of Canada. PARTICIPANTS: Sixty child and adolescent amputees aged 8-18 years who were missing a limb due to a congenital limb deficiency (n = 27) or surgery/trauma (n = 33). MAIN OUTCOME MEASURE(S): Questionnaire to assess the occurrence and correlates of phantom sensations and phantom pain. RESULTS: Forty-two percent of the total sample reported phantom sensations; 7.4% of the congenital group and 69.7% of the surgical group (chi2 = 23.70 with 1 df, P < 0.01.) Twenty-nine percent of the total sample reported phantom pain; 3.7% of the congenital group and 48.5% of the surgical group (chi2 = 14.67, with 1 df, P < 0.01). Eighty-eight percent of the amputees with phantom pain had stump pain, while 35.3% had phantom pain that was similar to pre-operative pain and 76.5% experienced pains other than phantom pain (e.g. headaches). Amputees identified exercise, objects approaching the stump, cold weather and 'feeling nervous' as the primary triggers of phantom sensations and/or phantom pain. CONCLUSION(S): Less than half of the sample experienced phantom sensations and phantom pain; however, the loss of a limb due to surgery is associated with an increase in the likelihood of experiencing these phenomena.

Adolescent↗
PubMed1992

Psychophysical correlates of phantom limb experience.

Phantom limb phenomena were correlated with psychophysiological measures of peripheral sympathetic nervous system activity measured at the amputation stump and contralateral limb. Amputees were assigned to one of three groups depending on whether they reported phantom limb pain, non-painful phantom limb sensations, or no phantom limb at all. Skin conductance and skin temperature were recorded continuously during two 30 minute sessions while subjects continuously monitored and rated the intensity of any phantom limb sensation or pain they experienced. The results from both sessions showed that mean skin temperature was significantly lower at the stump than the contralateral limb in the groups with phantom limb pain and non-painful phantom limb sensations, but not among subjects with no phantom limb at all. In addition, stump skin conductance responses correlated significantly with the intensity of non-painful phantom limb paresthesiae but not other qualities of sensation or pain. Between-limb measures of pressure sensitivity were not significantly different in any group. The results suggest that the presence of a phantom limb, whether painful or painless, is related to the sympathetic-efferent outflow of cutaneous vasoconstrictor fibres in the stump and stump neuromas. The hypothesis of a sympathetic-efferent somatic-afferent mechanism involving both sudomotor and vasoconstrictor fibres is proposed to explain the relationship between stump skin conductance responses and non-painful phantom limb paresthesiae. It is suggested that increases in the intensity of phantom limb paresthesiae follow bursts of sympathetic activity due to neurotransmitter release onto apposing sprouts of large diameter primary afferents located in stump neuromas, and decreases correspond to periods of relative sympathetic inactivity. The results of the study agree with recent suggestions that phantom limb pain is not a unitary syndrome, but a symptom class with each class subserved by different aetiological mechanisms.

Adult↗
PubMed2001

Reorganization of motor and somatosensory cortex in upper extremity amputees with phantom limb pain.

Phantom limb pain (PLP) in amputees is associated with reorganizational changes in the somatosensory system. To investigate the relationship between somatosensory and motor reorganization and phantom limb pain, we used focal transcranial magnetic stimulation (TMS) of the motor cortex and neuroelectric source imaging of the somatosensory cortex (SI) in patients with and without phantom limb pain. For transcranial magnetic stimulation, recordings were made bilaterally from the biceps brachii, zygomaticus, and depressor labii inferioris muscles. Neuroelectric source imaging of the EEG was obtained after somatosensory stimulation of the skin overlying face and hand. Patients with phantom limb pain had larger motor-evoked potentials from the biceps brachii, and the map of outputs was larger for muscles on the amputated side compared with the intact side. The optimal scalp positions for stimulation of the zygomaticus and depressor labii inferioris muscles were displaced significantly more medially (toward the missing hand representation) in patients with phantom limb pain only. Neuroelectric source imaging revealed a similar medial displacement of the dipole center for face stimulation in patients with phantom limb pain. There was a high correlation between the magnitude of the shift of the cortical representation of the mouth into the hand area in motor and somatosensory cortex and phantom limb pain. These results show enhanced plasticity in both the motor and somatosensory domains in amputees with phantom limb pain.

Adult↗
PubMedDate not supplied

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.

Adult↗
PubMed2005

Deep brain stimulation for phantom limb pain.

Phantom limb pain is an often severe and debilitating phenomenon that has been reported in up to 85% of amputees. Its pathophysiology is poorly understood. Peripheral and spinal mechanisms are thought to play a role in pain modulation in affected individuals; however central mechanisms are also likely to be of importance. The neuromatrix theory postulates a genetically determined representation of body image, which is modified by sensory input to create a neurosignature. Persistence of the neurosignature may be responsible for painless phantom limb sensations, whereas phantom limb pain may be due to abnormal reorganisation within the neuromatrix. This study assessed the clinical outcome of deep brain stimulation of the periventricular grey matter and somatosensory thalamus for the relief of chronic neuropathic pain associated with phantom limb in three patients. These patients were assessed preoperatively and at 3 month intervals postoperatively. Self-rated visual analogue scale pain scores assessed pain intensity, and the McGill Pain Questionnaire assessed the quality of the pain. Quality of life was assessed using the EUROQOL EQ-5D scale. Periventricular gray stimulation alone was optimal in two patients, whilst a combination of periventricular gray and thalamic stimulation produced the greatest degree of relief in one patient. At follow-up (mean 13.3 months) the intensity of pain was reduced by 62% (range 55-70%). In all three patients, the burning component of the pain was completely alleviated. Opiate intake was reduced in the two patients requiring morphine sulphate pre-operatively. Quality of life measures indicated a statistically significant improvement. This data supports the role for deep brain stimulation in patients with phantom limb pain. The medical literature relating to the epidemiology, pathogenesis, and treatment of this clinical entity is reviewed in detail.

Adult↗
PubMed1999

Coping with amputation and phantom limb pain.

Phantom limb pain is a common, distressing phenomenon that can occur after the amputation or denervation of a part of the body. No conclusive etiological models or theories have emerged, although the problem was identified some time ago. This empirical-diagnostic study deals with correlations between coping with limb loss, body image, and the occurrence of phantom limb pain. It is based on Melzack's concept of a neuromatrix. Coping strategies were evaluated using semistructured interviews and analysis of patients' drawings of their body images. The results of the study, based on 43 amputees, show a significant association between coping strategies and pain. Patients who cope better with the loss suffer less from phantom limb pain. A difference can also be noted in subjective representation of the body image: patients suffering from phantom limb pain tend to have an image of their bodies as a complete and undamaged entity.

Adaptation, Psychological↗
PubMedDate not supplied

Psychosocial predictors of long-term adjustment to lower-limb amputation and phantom limb pain.

PURPOSE: To evaluate the utility of a biopsychosocial model to predict long-term adjustment to lower-limb amputation and phantom limb pain (PLP). METHOD: One month after lower-limb amputation, 70 participants completed measures of PLP intensity, cognitions (catastrophizing, perceived control over pain), coping (pain-contingent rest), social environment (social support, solicitous responding), and functioning (pain interference, depressive symptoms). The measures of functioning were administered again at 1- and 2-years post-amputation. Multiple regression analyses were used to examine the ability of the psychosocial variables at 1-month post-amputation to predict changes in the functioning measures over time. RESULTS: The psychosocial variables at 1-month post-amputation, controlling for initial PLP intensity, accounted for 21% of the variance in change in depressive symptoms at 1-year (p < 0.05), and 27% and 22% (p's < 0.01 and 0.05, respectively) of the variance in change in pain interference and depressive symptoms, respectively, at 2-years post-amputation. Catastrophizing and social support were associated with decreases (improvement) in both criterion measures, while solicitous responding was associated with increases (worsening) in both measures. DISCUSSION: The findings support a biopsychosocial model of long-term adjustment to amputation and PLP. In addition, results suggest that some psychosocial variables are more important than others for predicting adjustment, providing important implications for early interventions after amputation.

Activities of Daily Living↗
PubMed2001

Effect of sensory discrimination training on cortical reorganisation and phantom limb pain.

Phantom limb pain is a frequent consequence of the amputation of a body part. Based on the finding that phantom limb pain is closely associated with plastic changes in the primary somatosensory cortex and animal data showing that behaviourally relevant training alters the cortical map, we devised a sensory discrimination training programme for patients with intractable phantom limb pain. Compared with a control group of medically treated patients, the training group had significant reductions in phantom limb pain (p=0.002) and cortical reorganisation (p=0.05) that were positively associated with improved sensory discrimination ability.

Adult↗
PubMedDate not supplied

Labat lecture. Phantom limbs.

A phantom limb is universally experienced after a limb has been amputated or its sensory roots have been destroyed. A complete break of the spinal cord also often leads to a phantom body below the level of the break. Furthermore, phantom breasts, genitals and other body areas occur in a substantial number of people after surgical removal or denervation of the body part. The most astonishing feature of a phantom limb (or other body area) is its incredible "reality" to the person. An examination of phantom limb phenomena has led to a new theory. It is proposed that we are born with a widespread neural network--the neuromatrix--for the body-self, which is subsequently modified by experience. The neuromatrix imparts a pattern--the neurosignature--on all inputs from the body, so that experiences of one's own body have a quality of self and are imbued with affective tone and cognitive meaning. The theory is presented with supporting evidence as well as implications for research.

Brain↗