Phantom limb

Of particular interest among the neurological causes of chronic pain is phantom limb pain, in which amputation or deafferentation of the limb (or other parts of the body) is regularly associated with persistence of the body image of the affected part. The phantom may be painless or painful and tends to shrink and eventually disappear over time. However, in about 50% of patients a painful phantom persists. The pain may be perceived in discrete parts of the phantom which may seem to move or feel as if fixed in a distorted position. 

Unlabeled Uses Relief of neuropathic pain, such as that experienced by patients with diabetic neuropathy or postherpetic neuralgia treatment of anxiety, bulimia nervosa, migraine, nocturnal enuresis, panic disorder, peptic ulcer, phantom limb pain... 

Phantom limb Amitriptyline 5 mg hs 6-year-old patient with osteogenic sarcoma Rogers, 1989... 

Rogers, A.G. (1989) Use of amitriptyline (Elavil) for phantom limb pain in younger children. J Pain Symptom Manage 4 96. 

Rusy, L.M., Troshynski, T.J., and Weisman, J. (2001) Gabapentin in phantom limb pain management in children and young adults report of seven cases. / Pain Symptom Manage 21 78—82. 

In 1997 Brose et al. published the result of a single case study. SNX-111, administered i.t. by continuous, constant-rate infusion, produced dose-dependent pain relief in a 43-year-old male patient with a 23-year history of intractable deafferentation and phantom limb pain secondary to brachial plexus avulsion and subsequent amputation. Dizziness, blurred vision, and lateral-gaze nystagmus... 

An individual s body image may be very stable. An intriguing example of this is the phantom limb phenomenon, when an arm or a leg is amputated, the patient almost always reports he can still feel the... 

Phantom Limbs, Neglect Syndromes, Repressed Memories, and Freudian Psychology... 

Pain occurs in various degrees, from dull and aching to piercing and intense. Acute pain is usually associated with tissue injury and, for the most part, occurs for only a short amount of time. Chronic pain, however, persists for long periods of time, even years after the injury that originally caused the pain has gone away. For example, severe bums can create scar tissue that can continue to cause excmciating discomfort. Certain disorders, such as arthritis or cancer, may also cause persistent pain. In the case of phantom limb pain, an individual may continue to perceive pain in an arm or leg that has been ampu-... 

An individual s body image may be very stable. An intriguing example of this is the phantom limb phenomenon. When an arm or a leg is amputated, the patient almost always reports he can still feel the limb, even though he can see and otherwise intellectually know it is not there. Sensations coming in from the severed nerve tracts are nonconsciously organized in the learned, habitual way so that the patient perceives the limb as still there. Most patients soon lose perception of their phantom limbs as they are subjected to considerable social pressure to do so. In some, however, the phantom limb persists in spite of all attempts to unlearn it. The sensations may or may not be painful. 

These include postherpetic neuralgia, phantom limb pain, peripheral neuropathies of various causes, central pain, e.g. following a stroke, compression neuropathies, and the complex regional pain syndromes (comprising causalgia, when there is nerve damage, and reflex sympathetic dystrophy, when there is tissue but no nerve injury) they present the most challenging problems. 

In a double-blind, placebo-controlled, crossover pilot study in three patients with cancer-associated postamputation phantom limb pain, oral dextromethorphan 60-90 mg bd or placebo were given for 1 week each, followed by dextromethorphan or placebo again (10). Dextromethorphan satisfactorily improved phantom Umb pain at a dosage of 60 mg bd in two patients and 90 mg bd in the third. Even though a relatively high total dose of dextromethorphan was used, there were no adverse effects. 

New onset, severe lightning pain after repeated subarachnoid blockade occurred in a 48-year-old man with pre-existing neuropathic pain after incomplete spinal cord injury, similar to previous reports in patients with phantom limb pain (202). 

Weinstein, S. Phantom limb pain and related disorders. Neurol. Clinic 1998, 16 (4), 919 935. 

Crick lists the references Ramachandran, V.S., "Blind Spots" Scientific American 266 86-91 "Perceptual Filling in of Artificially induced Scotomas in Human vision" Nature 350 699-702 and "Filling in Gaps in Perception Part 2, Scotomas and Phantom Limbs" Current Directions in... 

Neuropathic pain is severe chronic pain due to damage to sensory nerves. This is not because of tissue injury and can occur as a consequence of central nervous system disorders, such as stroke or multiple sclerosis, or because of malignancy, amputation (phantom limb pain) diabetic neuropathy or following infection with Herpes zoster (as shingles). Mechanisms underlying neuropathic pain are poorly understood. The pain is described as... 

A general study of the clinical effectiveness of massage by Ernst (1994) used numerous trials, with and without control groups. A variety of control interventions were used in the controlled studies including placebo, analgesics, transcutaneous electrical nerve stimulation, and so on. There were some positive effects of vibrational or manual massage, assessed as improvements in mobility, Doppler ow, expiratory volume, and reduced lymphedema in controlled studies. Improvements in musculoskeletal and phantom limb pain, but not cancer pain, were recorded in controlled studies. Uncontrolled studies were invariably positive. Adverse effects included thrombophlebitis and local in ammation or ulceration of the skin. 

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