Phantom Limb Pain

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ProdpranJessica

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Phantom limb pain

• Phantom limb pain refers to mild to extreme pain felt in the area where a limb has been amputated.

• Phantom limb sensations usually will disappear or decrease over time; when phantom limb pain continues for more than six months, however, the prognosis for improvement is poor.

The concept of Phantom Limb Pain as being in pain that feels like it's coming from a body part that's no longer there. Doctors once believed this post-amputation phenomenon was a psychological problem, but experts now recognize that these real sensations originate in the spinal cord and brain.

Introduction

What are the

symptoms?

• In addition to pain in the phantom limb, some people experience other sensations such as tingling, cramping, heat, and cold in the portion of the limb that was removed. Any sensation that the limb could have experienced prior to the amputation may be experienced in the amputated phantom limb.

What causes it?

• Less painkillers during the amputation or the painkillers wasn`t effective enough.

• Before amputation patient had a really strong traumatic pain.

• Although the limb is no longer there, the nerve endings at the site of the amputation continue to send pain signals to the brain that makes the brain think the limb is still there. Sometimes, the brain’s memory of pain is retained and is interpreted as pain, regardless of signals from injured nerves

Treatments•Mirror therapy•Relaxation techniques•Massage of the amputation area•Injections with local anesthetics and/or steroids•Surgery to remove scar tissue entangling a nerve•Physical therapy•TENS (transcutaneous electrical nerve stimulation) of the stump•Neurostimulation techniques such as spinal cord stimulation or deep brain stimulation•Medications such as pain-relievers, neuroleptics,antidepressants, beta-blockers, and sodium channel blockers.• Prosthesis

Treatment of Phantom pain

• Nonpharmacological treatment• Transcutaneous Electrical

Never Stimulation (TENS)

- Standard device , inexpensive

- Safe and easy to use

- Using battery to control

- Generates to the skin to activate the effected nerves.

Prosthesis- Help to regain the feeling

of loosing limb- An electrical prosthetic

limb moved by signals.

Mirror Therapy• was first introduced by

Ramachandran in 1996

• persons with amputated limb use either a mirror or mirror box to reflect an image of the intact limb. It is hypothesized that this works by preventing cortical restructuring

• patients with PLP showed a decrease in pain at the 6-month follow-up (Diers, 2010)

• mechanisms underlying the effects of mirror training or motor imagery, are still unclear

Mirror box therapy

How to avoid the phantom limb pain?

• Right operation technics.

• Effective painkillers during the procedure and after it.

• Good stump care and rehabilitation.

1. Christopher V Boudakian, DO PGY-4Rusk RehabilitationNYU Langone Medical Center

2. 2010 Lippincott Williams & Wilkins Volume 16, September 2010

3. http://www.slideshare.net/KksKerst/phantom-limb-pain

4. http://www.webmd.com/pain-management/guide/phantom-limb-pain

References