Phantom Limb Essay

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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
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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

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