What is Phantom Limb?

Phantom limb

If someone has had an area of a leg or arm amputated, there are many cases where the patient will still experience the pain of the limb. It is most common in leg and arm amputees but can also be present when other body parts are removed like breasts. The pain usually occurs within 6 months of the amputation and can last anywhere from a couple hours to years without treatment.

The cause is not yet known, but researchers believe it is related to nerves in the brain and spinal cord rewire when they lose signal with the missing limb, its then believed that they will send pain signals as they sense something is wrong. It may also just be caused by the damaged nerve endings and damaged tissues.

Phantom limb syndrome was first described in 1552 by French surgeon Ambroise pare, who operated on wounded soldiers and wrote about patients who complained of pain in amputated limbs. The same syndrome was later observed and noted by a Scottish physician William Porterfield who wrote an account of phantom limb syndrome in the 18th century, following the amputation of one of his legs. He was the first person to consider sensory perception as the underlying explanation of the condition.  In the 1990s researchers found the ability of neurons in the brain to modify their connections and behaviour. Phantom limb pain was found to be specifically by map expansion neuroplasticity, in which brain regions, each dedicated to performing one type of function and reflected in the cerebral cortex as “maps,” can acquire areas of the unused phantom map.

What they feel?

Burning, shooting, pins and needles, twisting, electric shocks, itch, feels the temperature of the limb, movements

   Can we treat phantom limb with drugs?

The pain involved with phantom limb can be  treated via many different drug therapies.

 some examples include tricyclic antidepressants which can change the chemicals which send pain signals.  Another example is anticonvulsants which help with nerve pain. Or it may be treated with standard painkillers.

More commonly phantom limb is treated with non-drug therapy as drugs so not cure but treats the symptoms.

A.            Nerve stimulation- Uses transcutaneous electrical nerve stimulation, which send weak electrical signals to sticky patches that are placed on the skin. This usually interrupts the pain signals.

B.            Mirror box therapy- This involves a box with no lid and two holes with a mirror in the centre. The amputated limb goes in one hole while the intact limb goes in the other side. This means when the patient looks into the box they see the intact limb in the mirror and this tricks the brain into thinking that it has both limbs. The changes in the brain that contribute to the success of this therapy are not completely understood, and information from long-term studies on the use of mirror box therapy is scant, although several patients have reported long-term relief.

C.           Acupuncture

D.           Changing the mindset-  encouraging the patient to find distractions and think positively.

Natasha Lynch

https://www.webmd.com/pain-management/guide/phantom-limb-pain#1 https://academic.oup.com/bja/article/87/1/107/304236 https://www.britannica.com/science/map-expansion

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