Immediate and long-term phantom limb pain in amputees: Incidence, clinical characteristics and relationship to pre-amputation limb pain

The landmark paper discussed in this chapter is ‘Immediate and long-term phantom limb pain in amputees: Incidence, clinical characteristics and relationship to pre-amputation limb pain’, published by Jensen et al. in 1985. This study examined a cohort of older patients undergoing limb amputation, and carefully related pre-amputation pain to the development and nature of phantom limb pain. The authors demonstrated that a third of patients experienced pain similar to the pre-amputated limb pain immediately after amputation; patients who had experienced pre-amputation pain were more likely to experience phantom limb pain in the first 6 months after the amputation; and persistent phantom limb pain was more likely in patients who experienced stump pain after amputation. The study had clear implications for pain management but, importantly, it also demonstrated that peripheral pain, in the form of pre-amputation and stump pain, was important in determining the development and maintenance of phantom limb pain.

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Electrical stimulation of referred sensation area alleviates phantom limb pain

Restorative Neurology and Neuroscience ◽

10.3233/rnn-201132 ◽

2021 ◽

pp. 1-10

Author(s):

Michihiro Osumi ◽

Daisuke Shimizu ◽

Yuki Nishi ◽

Shu Morioka

Keyword(s):

Electrical Stimulation ◽

Single Case ◽

Phantom Limb Pain ◽

Phantom Limb ◽

Long Term Effects ◽

Limb Pain ◽

Short Term ◽

Analgesic Effects ◽

Stimulation Of

Background: Patients with brachial plexus avulsion (BPA) usually experience phantom sensations and phantom limb pain (PLP) in the deafferented limb. It has been suggested that evoking the sensation of touch in the deafferented limb by stimulating referred sensation areas (RSAs) on the cheek or shoulder might alleviate PLP. However, feasible rehabilitation techniques using this approach have not been reported. Objective: The present study sought to examine the analgesic effects of simple electrical stimulation of RSAs in BPA patients with PLP. Methods: Study 1: Electrical stimulation of RSAs for 60 minutes was conducted for six BPA patients suffering from PLP to examine short-term analgesic effects. Study 2: A single case design experiment was conducted with two BPA patients to investigate whether electrical stimulation of RSAs was more effective for alleviating PLP than control electrical stimulation (electrical stimulation of sites on side opposite to the RSAs), and to elucidate the long-term effects of electrical stimulation of RSAs. Results: Study 1: Electrical stimulation of RSAs evoked phantom touch sensations in the deafferented limb, and significantly alleviated PLP (p < 0.05). Study 2: PLP was alleviated more after electrical stimulation on RSAs compared with control electrical stimulation (p < 0.05). However, the analgesic effects of electrical stimulation on RSAs were observed only in the short term, not in the long term (p > 0.05). Conclusions: Electrical stimulation of RSAs not only evoked phantom touch sensation but also alleviated PLP in the short term. The results indicate that electrical stimulation of RSAs may provide a useful practical rehabilitation technique for PLP. Future studies will be required to clarify the mechanisms underlying immediate PLP alleviation via electrical stimulation of RSAs.

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Psychosocial predictors of long-term adjustment to lower-limb amputation and phantom limb pain

Disability and Rehabilitation ◽

10.1080/09638280410001708896 ◽

2004 ◽

Vol 26 (14-15) ◽

pp. 882-893 ◽

Cited By ~ 134

Author(s):

Marisol A Hanley ◽

Mark P Jensen ◽

Dawn M Ehde ◽

Amy J Hoffman ◽

David R Patterson ◽

...

Keyword(s):

Lower Limb ◽

Phantom Limb Pain ◽

Lower Limb Amputation ◽

Phantom Limb ◽

Limb Amputation ◽

Psychosocial Predictors ◽

Limb Pain

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Long-Term Intrathecal Infusion of Opioid and/or Bupivacaine in the Prophylaxis and Treatment of Phantom Limb Pain

Neuromodulation Technology at the Neural Interface ◽

10.1111/j.1525-1403.1998.tb00005.x ◽

1998 ◽

Vol 1 (3) ◽

pp. 111-128 ◽

Cited By ~ 8

Author(s):

Peter O. Dahm ◽

Petre V. Nitescu ◽

Lennart K. Appelgren ◽

Ioan D. Curelaru

Keyword(s):

Phantom Limb Pain ◽

Phantom Limb ◽

Limb Pain ◽

Intrathecal Infusion

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Treatment of Chronic Phantom Limb Pain Using a Trauma-Focused Psychological Approach

Pain Research and Management ◽

10.1155/2010/981634 ◽

2010 ◽

Vol 15 (2) ◽

pp. 65-71 ◽

Cited By ~ 53

Author(s):

C de Roos ◽

AC Veenstra ◽

A de Jongh ◽

ME den Hollander-Gijsman ◽

NJA van der Wee ◽

...

Keyword(s):

Pain Intensity ◽

Repeated Measures ◽

Psychological Intervention ◽

Psychological Treatment ◽

Phantom Limb Pain ◽

Phantom Limb ◽

Limb Pain ◽

Before And After

BACKGROUND: Chronic phantom limb pain (PLP) is a disabling chronic pain syndrome for which regular pain treatment is seldom effective. Pain memories resulting from long-lasting preamputation pain or pain flashbacks, which are part of a traumatic memory, are reported to be powerful elicitors of PLP.OBJECTIVE: To investigate whether a psychological treatment directed at processing the emotional and somatosensory memories associated with amputation reduces PLP.METHODS: Ten consecutive participants (six men and four women) with chronic PLP after leg amputation were treated with eye movement desensitization and reprocessing (EMDR). Pain intensity was assessed during a two-week period before and after treatment (mean number of sessions = 5.9), and at short- (three months) and long-term (mean 2.8 years) follow-up.RESULTS: Multivariate ANOVA for repeated measures revealed an overall time effect (F[2, 8]=6.7; P<0.02) for pain intensity. Pairwise comparison showed a significant decrease in mean pain score before and after treatment (P=0.00), which was maintained three months later. All but two participants improved and four were considered to be completely pain free at three months follow-up. Of the six participants available at long-term follow-up (mean 2.8 years), three were pain free and two had reduced pain intensity.CONCLUSIONS: These preliminary results suggest that, following a psychological intervention focused on trauma or pain-related memories, substantial long-term reduction of chronic PLP can be achieved. However, larger outcome studies are required.

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