Phantom Limb Pain

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Phantom Limb Pain (PLP) is a type of pain that localizes to a missing (amputated) limb. Pain that localizes to other missing organs is termed phantom pain. PLP and phantom pain have very similar mechanisms and treatment options.

Contents

Types

PLP is categorized according to the reason for the missing limb and the severity of the pain.

Signs and Symptoms

Since examination of the phantom limb is usually impossible, objective and observable signs of PLP are very few. Symptoms of PLP, i.e., what the patient experiences, are of pain that reminds him or her of the missing limb being compressed, distorted, or otherwise injured; adjectives such as "stabbing" and "throbbing" are often used to describe the pain.

Causes

PLP is caused by a injury to peripheral nerves that, under normal circumstances, transmit pain signals to the brain. The injury and subsequent healing process may leave the nerves especially likely to continue transmitting the "pain" signal after the amputation.

Treatment

Treatment options range from as-needed use of nonprescription analgesics to implantable pumps that deliver narcotics straight to the central nervous system. Many pharmacological options are commonly employed to treat PLP, and several choices are supported by at least one controlled study showing a positive effect. These include opioids, [1] calcitonin,[2] gabapentin,[3] ketamine,[4] and dextromethorophan.[5] Intrathecal (IT) drug delivery is sometimes employed to lessen systemic side effects[6] use of drugs such as fentanyl, [7] [8] and combination morphine/bupivicaine[9] for treating PLP has been reported.

Chances of developing Phantom Limb Pain

PLP affects as many as 80% of amputees at some time.[10]

History

PLP was first described by a French military surgeon in 1551.[11]


References

  1. Huse E, Larbig W, Flor H, Birbaumer N. The effect of opioids on phantom limb pain and cortical reorganization. Pain. 2001 Feb 1;90(1-2):47-55. Abstract
  2. Jaeger H, Maier C. Calcitonin in phantom limb pain: a double-blind study. Pain. 1992 Jan;48(1):21-7. Abstract
  3. Bone M, Critchley P, Buggy DJ. Gabapentin in postamputation phantom limb pain: a randomized, double-blind, placebo-controlled, cross-over study. Reg Anesth Pain Med. 2002;27(5):481-486.
  4. Nikolajsen L, Hansen CL, Nielsen J, Keller J, Arendt-Nielsen L, Jensen TS. The effect of ketamine on phantom pain: a central neuropathic disorder maintained by peripheral input. Pain. 1996;67(1):69-77.
  5. Ben Abraham R, Marouani N, Weinbroum AA. Dextromethorphan mitigates phantom pain in cancer amputees. Ann Surg Oncol. 2003;10(3):268-274.
  6. Prager JP. Neuraxial medication delivery: the development and maturity of a concept for treating chronic pain of spinal origin. Spine. 2002;27(22):2593-2605
  7. Do Ouro S, Esteban S, Sibirceva U, Whittenberg B, Portenoy R, Cruciani RA. Safety and tolerability of high doses of intrathecal fentanyl for the treatment of chronic pain. J Opioid Manag. 2006;2(6):365-368.
  8. Jacobson L, Chabal C, Brody MC. Relief of persistent postamputation stump and phantom limb pain with intrathecal fentanyl. Pain. 1989;37(3):317-322.
  9. Talu GK, Erdine S. Intrathecal morphine and bupivacaine for phantom limb pain: a case report. Pain Pract. 2005;5(1):55-57.
  10. Flor H. Phantom-limb pain: characteristics, causes, and treatment. Lancet Neurol. 2002 Jul;1(3):182-9. Abstract
  11. Sherman RA, Devor M, Heermann-Do K. Phantom pain. New York: Plenum Press; 1997.
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