PHANTOM LIMB PAIN: MECHANISM AND TREATMENT APPROACHES
INTRODUCTION:
The first medical description of phantom limb pain (PLP) as being the pain perceived by the region of the body no longer present was first given by Ambrose pare (1510 – 1590) a French military surgeon. Subsequent studies by Charles Bell (1830),Magendie (1833),Rhone (1842),Gueniot (1861) and other provided detailed description of the phenomenon and in 1871 , Mitchell coined the term ‘phantom Limb’. Phantom limb pain is a common sequel of amputation occurring in up to 80% of people who undergo the procedure. In modern times traumatic amputation originating from Wars and Landmine explosions in all over the world are tragic cause of phantom limb pain in otherwise healthy
…show more content…
Some nociceptive afferent input also sprouts into the Lamina II of the dorsal horn of spinal cord (which respond to noxious stimulation).which results in increased neuronal activity, expansion of neuronal receptive field and hyperexcitibility of other region. This process is called central sensitization. Sensitization of dorsal horn neuron is mediated by the increased activity of NMDA receptor and release of glutamate and neurokinins. The stump or phantom pain is evoked by repetitive stimulation of the stump the phenomenon is known as “windup phenomenon” in which there is up regulation of the receptors in the respective …show more content…
Table: Treatments for Phantom Limb Pain
Pharmacotherapy Surgical/invasive procedures Adjuvant therapy
Opioids Stump revision transcutaneous nerve stimulation Morphine Nerve block Mirror therapy
Tramadol Neurectomy Biofeedback
Tricyclic Antidepressants Rhizotomy Temperature biofeedback Amitriptyline Cordotomy Electro myographic biofeedback
Nortriptyline Lobectomy Massage
Imipramine Sympathectomy
Therapy would consist of psychosocial and emotional issues to help deal with limb amputations, post traumatic
The pain that patients report is out of proportion to the severity of the injury. The pain gets worse, rather than better, over time. Eventually the joints become
In the article, “Sometimes Pain Is a Puzzle That Can’t Be Solved”, Abigail Zuger, the author, describes her own experiences with pain along with some examples and generalizations about the feeling. She claims that she is “ruled by (her) elbow” and “it is (her) constant companion, whimpering, and tugging at (her) sleeve.” She goes on to say that many people have the same problems, especially when drugs, “like naproxen and ibuprofen” are unhelpful and “might as well be cornflakes.” Finally, she explains how far we have advanced in the medical field, but “ none of (the) knowledge has translated into new treatments,” to help people such as herself.
Phantom Limb Pain. Phantom limb, a common medical issue for amputees, refers to ongoing painful sensations stemming from the location where the limb used to be. About 70 percent of amputee patients experience phantom limb pain and it can be chronic and debilitating. Virtual reality games are used to help alleviate phantom limb pain by picking up on nerve inputs from the brain and using virtual limbs to gain control.
One form of pain is physical pain by being inured. This type of pain was one of the most common, and caused many people to die in the war. Paul got hurt in the All Quiet on the Western Front and was forced to go to a hospital to get surgery. He saw many others with blown off hand and limbs and considered himself lucky that he still had all of his. If a soldier had a wound in the hand and it would take a lot of time and care to heal they would often just amputate part of the arm.
Mirror box therapy was developed specifically for patients with phantom limb syndrome. Treatment involves using an uncovered box with a mirror bisecting it. Two holes are cut out of the front on either side of the bisecting mirror. The patient places the intact limb into one hole of the box and the stump of the amputated limb into the other hole. A patient looking from the side of the intact limb will see that limb, along with a reflection of that limb in the mirror, giving the illusion of the presence of the amputated limb.
Scientists believe this to be due to the fact that there is still leftover representation of the amputated organ in the brain. So even though the limb is no longer attached to the body, part of the somatosensory cortex responsible for it still exists, projecting the sensation of the limb past the new body boundaries. Most of the amputees also experience chronic pain in the limb that seems to be unaffected by painkillers. The sensation is usually that of fingers or toes cramping up or being curled unnaturally. The research on the topic is ongoing and several different theories
Prosthetic limbs consists of a fitted socket, an internal structure, knee cuffs and belts that are attached to the body. Prosthetics socks cushion the area of contact and realistic-looking skin. Prosthetic devices are lightweight because its material is made from plastic. Some parts of the limb are made of wood and rubber. One model of a prosthetic limb is the leg, which is made of layers of stockinet cloth.
Later in the recovery room I begun to feel the difference, the heaviness of my leg the swelling, and overall numbness endured by the mandatory nerve block. After 30 minutes the redressed me in my snap up sweats, and a ratty old soccer shirt. slowly placed me into a wheel chair and eased me into the back seat of my mothers suv. The first two weeks were easy, staying in bed, while watching television not allowing my self to even think about putting weight on my leg even to use the bathroom. The only struggle was showering, my incision was to new to be wet, without fear of infection;therefore I had to sit in my shower with chair covering my leg with a 12 gallon trash bag securely fastened around my leg propped up to decrease swelling.
Breakey (1997) stated that after amputation that cause the triple loss of ability, perception and physical performance, is not only just a misplacement of a physical limb. Individual who undergo lower limb amputation would need a walking aid, such as a walking stick, a crutch, a wheelchair or a prosthesis to mobilize (Breakey, 1997). Fortunately, there are a few cases that some of the amputees still remain their independence in their daily routine by utilizing their prosthesis, even though massive of obstacles faced by them following low limb amputation (Mac Neill, Pauley, Yudin, 2008). Amputees’ participation in their social activity has a significant change from before as they suffer from the difficulty to walk independently post amputation. Because of this obstacle, people with lower limb amputation often suffer from mentally side effect, for examples, stress, anxiety and depression (Breakey, 1997).
The summer of 2016, I was lucky enough to volunteer at Dr. Leonid Tafler 's private practive of Family Medicine. Dr. Tafler is a DO physician, who performs osteopathic manipulation under anesthesia. He has been involved in research with this practice of manipulation under anesthesia, and has had many positive results; most of his patients report decreased, or no pain at all after this procedure. Being in Dr. Tafler 's office, I not only saw first hand how using one 's own body to heal themselves can be extremely beneficial, but I also saw how a DO physician treats their patients. Dr. Tafler was very kind to his patients, as well as culturally competent.
I vividly remember my first wound care patient. He was a 65+ years old diagnosed with neuropathy, post incision and drainage. His foot had an incision along his first phalange that was deep enough to expose his extensor tendon. It was not the wound that
Additional Disciplines There are varieties of disciplines that use the concept of pain. Understanding the concept of pain provides other disciplines, such as nursing, dietitians, physical therapists, massage therapists, pharmacists, mental healthcare workers, and pastoral care staff to deliver the proper management and treatment of pain. In addition, various disciplines, such as a dental surgeon, also use the concept of pain to gauge the threshold of stimuli. Dietitians One discipline other than nursing that understands the concept of pain is a dietitian. Many illnesses cause pain and therefore prevent proper nutrition in the diet of a patient.
The nerves in her knees received impulse that sent back down from the spinal cord and thus she is experiencing more severe pain than the reality it is (Winterowd, Beck, & Gruener, 2003). Marina’s catastrophic thinking and emotions are the aspects of her pain level to be worsening. This has triggered the
Brandt van Soolen RC 522 Amputation Medical and Psychosocial Aspects of Amputation Amputation is the term used to describe the partial or complete loss of a portion of the body. Depending on the reason for amputation, it can impact activities, functions, and psychosocial adjustment. Although the term amputation is commonly associated with the loss of an extremity, it is also used to categorize the loss of other body parts (e.g. an earlobe or parts of the nose from frostbite). Amputation can result from trauma or it may be a surgically procedure utilized in the management of other conditions (e.g. amputating toes or the whole foot in the management of diabetes).