The phantom limb

Thesis (M.D.)—Boston Universit

Etiology of phantom limb syndrome: Insights from a 3D default space consciousness model

In this article, we examine phantom limb syndrome to gain insights into how the brain functions as the mind and how consciousness arises. We further explore our previously proposed consciousness model in which consciousness and body schema arise when information from throughout the body is processed by corticothalamic feedback loops and integrated by the thalamus. The parietal lobe spatially maps visual and non-visual information and the thalamus integrates and recreates this processed sensory information within a three-dimensional space termed the ‘‘3D default space.’’ We propose that phantom limb syndrome and phantom limb pain arise when the afferent signaling from the amputated limb is lost but the neural circuits remain intact. In addition, integration of conflicting sensory information within the default 3D space and the loss of inhibitory afferent feedback to efferent motor activity from the amputated limb may underlie phantom limb pain

Pain Quality Descriptors in Persons with Limb Loss

Background: Phantom limb pain is very common, and its pain quality descriptors give insight to the lived experience of phantom limb pain. Significance: This study reports unique phantom limb pain quality descriptor categories

Phantom Limb Pain: Implications for Treatment When the Mechanisms Are Unknown

During the Civil War, American physician Silas Weir Mitchell was the first to coin the “phantom” to the sensations individuals experienced in their nonintact limb following limb amputation. Even though physicians have been aware of phantom sensations, and similarly phantom limb pain, for over a century, the mechanism for the pain is not well understood. Because the mechanisms are not well understood, my thesis provides a bioethical framework for clinicians in order to treat phantom limb pain. The thesis begins with an introduction to the history of phantom limb pain and the current theories available to explain the phenomenon. It then looks at the treatments available for phantom limb pain and focuses specifically on mirror therapy. Mirror therapy is a noninvasive, physical therapy practice available for phantom limb pain. Through the framework provided, my thesis argues that mirror therapy should be the first treatment presented to patients experiencing phantom limb pain. It concludes with my own theory of why phantom limb could exist, and further directions of where research and treatment should be focused on phantom limb pain

Phantom Limb Pain

Phantom limb pain is pain that is perceived in a part of the body which is no longer present. It is estimated that 80 percent of amputees experience phantom limb pain. Although the term is “phantom limb pain” the feeling is often more of a burning, twisting, itching, or pressure sensation than pain. The exact mechanism of phantom limb pain is unknown although proposed mechanisms include pain origination from either the central nervous system or the peripheral nervous system. Since the exact mechanism of phantom limb pain is unknown, treating this pain may be difficult. Treatments include pharmacological and nonpharmacological. Pharmacological treatments include NSAIDs, opioids, anti-convulsants, beta-blockers, and calcium channel blockers. Non-pharmacological treatments include mirror therapy, cognitive behavioral therapy, acupuncture, guided imagery, massage, and biofeedback. Amputees experiencing phantom limb pain typically have the best outcome with a multi-disciplinary approach that includes both pharmacological and non-pharmacological management

Nursing Management and Mirror Therapy for Phantom Limb Pain

Phantom limb pain may occur after the accidental removal or surgical amputation of a limb. Phantom limb pain is the experience of pain in the limb that is no longer present. The clinical management of phantom limb pain is essential in the overall reduction of patient rehabilitation and poor patient outcomes. A patient’s degree of phantom limb pain is influenced by their personal response to loss and pain and can have devastating effects to a person’s social performance, occupational role, family role, relationships, and involvement in activities or hobbies. Like most chronic pain, phantom limb pain decreases the quality of life. Not all amputees who suffer from chronic pain respond to traditional therapies. The purpose of this integrated review of the literature was to explore current research and determine the efficacy of mirror therapy in the treatment of Phantom limb pain in amputees. A database search of CINAHL, PubMed (MEDLINE), and OneSearch was conducted. Mirror therapy had no reported side effects, was inexpensive, and was capable of being practiced at home and at the bedside. Relevant findings in the literature revealed a significant decrease in phantom limb pain when using mirror therapy for more than 4 weeks. Although limited research on the use of mirror therapy as an intervention for amputees, existing research supports the efficacy of mirror therapy for the management of phantom limb pain. Nurses and healthcare providers need education on mirror therapy to advocate for their patients to ensure the best possible outcome and reduction of phantom limb pain. Further research on mirror therapy is needed

Pain Management Resource Guide for Caregivers of Children with Phantom Limb Pain

Approximately 80% of children, under the age of 18, develop phantom limb pain within one year after receiving an amputation (Burgoyne, Billups, Jiron, Kaddoum, Wright, Bikhazi, Parish, & Pereiras, 2012; Krane & Heller, 1995). Research on treating phantom limb pain has been focused on the adult population and often includes the use of pharmacological interventions (Subedi & Grossberg, 2011). Because phantom limb pain can cause psychological and physical dysfunction, it can negatively impact a child\u27s ability to engage in everyday life. Currently, no holistic treatment guides are available for caregivers to refer to when helping their child manage his or her phantom limb pain. The P.L.P. (Play Learn Persevere) is a resource guide created for occupational therapists to give to caregivers of children with phantom limb pain. This product is intended to be introduced by occupational therapists working in acute care settings with children who have undergone a unilateral amputation. The P.L.P. is designed to help caregivers manage their child\u27s phantom limb pain by using the physical and psychosocial activities provided in the resource guide

Sääriamputoitujen henkilöiden kokemuksia aavesäryistä ja niiden hoitomuodoista

Opinnäytetyön tavoitteena oli selvittää sääriamputoitujen henkilöiden kokemuksia aavesäryistä sekä niiden hoitomuodoista. Opinnäytetyötä varten toteutettiin kolme teemahaastattelua, jotka noudattivat laadullisen tutkimuksen periaatteita. Haastateltavat valittiin yhteistyössä Haltija Group Oy:n kanssa ja haastattelut toteutettiin heidän toimitiloissaan. Teoreettinen viitekehys perustui aavesärkyjä ja niiden hoitoja käsitteleviin tutkimuksiin. Aavesärkyjen esiintyvyys henkilöillä, joilla on amputaatio, on suurta, ja ne vaikuttavat merkittävästi elämänlaatuun. Erilaisia hoitomuotoja on runsaasti, mutta vain pientä osaa niistä on tutkittu. Yhtä kaikille toimivaa hoitomuotoa ei ole, jonka vuoksi aihetta olisi tärkeää tutkia lisää. Aavesärkyjen mekanismien parempi tunteminen voisi edesauttaa oikean hoitomuodon löytämistä. Opinnäytetyössä käsitellään sääriamputaatioita sekä määritellään aavesärkyjen, aavetuntemusten ja tynkäsärkyjen erot. Lisäksi perehdymme neljään eri hoitomuotoon, jotka ovat peiliterapia, TENS, lääkehoito ja vaihtoehtoiset hoidot. Vaihtoehtoisiin hoitomuotoihin kuuluvat akupunktio ja jooga. Teemahaastatteluiden kolme pääaihetta olivat aika ennen amputaatiota, amputaation jälkeen jääneet kivut sekä aavesärkyihin annetut hoidot. Haastatteluiden tulokset ja teoriassa esitetyt tutkimustulokset eivät täysin kohdanneet. Esimerkiksi peiliterapia ja TENS on tutkitusti todettu tehokkaiksi hoitomuodoiksi, mutta haastateltavat eivät kokeneet näistä olevan hyötyä. Jatkossa olisi hyvä perehtyä paremmin aavesärkyjen syntyyn tarkemmin, jotta niiden hoitoa voitaisiin kehittää. Aavesärkyihin ei ole olemassa hoitosuosituksia, joten niiden laatiminen helpottaisi kuntoutumista. Opinnäytetyö on suunnattu kuntoutusalan ammattilaisille, alan opiskelijoille sekä aavesäryistä kärsiville henkilöille.The purpose of this Bachelor’s Thesis was to find out experiences of phantom limb pain and different treatments in transtibial amputees. For the Thesis we implemented three theme interviews that followed principles of qualitative research. The interviewees were selected with Haltija which is a Finnish Assistive Technology Company and interviews were performed in their office. The theory is based on researches of phantom limb pain and its treatment. The incidence of phantom limb pain is high with amputees and it affects their quality of life. There are many different treatments for phantom limb pain but only few of them are well known. There is not one treatment that suits everyone and therefore there should be more studies on the subject. Better knowledge of mechanisms of phantom limb pain would help to find better options for treatments. In the Bachelor’s Thesis we go through transtibial amputations and define the differences between phantom limb pain, phantom limb sensation and stump pain. In addition, we take a look at four different treatments for phantom limb pain: mirror therapy, TENS, pharmacological treatment and optional treatment which includes acupuncture and yoga. In the theme interviews we had three main subjects that were time before amputation, the pain after amputation and the treatments for phantom limb pain. The results of the interviews and theory did not match fully. For example mirror therapy and TENS had no effect on our interviewees even though they are known to be effective treatments. In the future it would be useful to know the origin of phantom limb pain so their treatments could be improved. There are no treatment recommendations for phantom limb pain that could help rehabilitation. This study can be utilized by professionals and students of rehabilitation and for persons who suffer phantom limb pain

Phantom Limb Pain: Low Frequency Repetitive Transcranial Magnetic Stimulation in Unaffected Hemisphere

Phantom limb pain is very common after limb amputation and is often difficult to treat. The motor cortex stimulation is a valid treatment for deafferentation pain that does not respond to conventional pain treatment, with relief for 50% to 70% of patients. This treatment is invasive as it uses implanted epidural electrodes. Cortical stimulation can be performed noninvasively by repetitive transcranial magnetic stimulation (rTMS). The stimulation of the hemisphere that isn't involved in phantom limb (unaffected hemisphere), remains unexplored. We report a case of phantom limb pain treated with 1 Hz rTMS stimulation over motor cortex in unaffected hemisphere. This stimulation produces a relevant clinical improvement of phantom limb pain; however, further studies are necessary to determine the efficacy of the method and the stimulation parameters