Management of Phantom Limb Pain through Thalamotomy of the Centro-Median Nucleus

Background: Phantom limb syndrome is defined as the perception of intense pain or other sensations that are secondary to a neural lesion in a limb that does not exist. It can be treated using pharmacological and surgical interventions. Most medications are prescribed to improve patients’ lives; however, the response rate is low. In this case report, we present a case of phantom limb syndrome in a 42-year-old female with a history of transradial amputation of the left thoracic limb due to an accidental compression one year before. The patient underwent placement of a deep brain stimulator at the ventral posteromedial nucleus (VPM) on the right side and removal secondary to loss of battery. The patient continued to have a burning pain throughout the limb with a sensation of still having the limb, which was subsequently diagnosed as phantom limb syndrome. After a thorough discussion with the patient, a right stereotactic centro-median thalamotomy was offered. An immediate response was reported with a reduction in pain severity on the visual analogue scale (VAS) from a value of 9–10 preoperative to a value of 2 postoperative, with no postoperative complications. Although phantom limb pain is one of the most difficult to treat conditions, centro-median thalamotomy may provide an effective stereotactic treatment procedure with adequate outcomes.

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Phantom Limb Pain

10.1093/med/9780190271787.003.0013 ◽

2018 ◽

Author(s):

Kenneth D. Candido ◽

Teresa M. Kusper ◽

Alexei Lissounov ◽

Nebojsa Nick Knezevic

Keyword(s):

Alternative Therapy ◽

Phantom Limb Pain ◽

Body Part ◽

Phantom Limb ◽

Treatment Modalities ◽

Phantom Pain ◽

Limb Pain ◽

Surgical Interventions ◽

Neurologic Sequelae ◽

The 19Th Century

Post-amputation pain (PAP) has challenged clinicians for centuries. The first written record of this perplexing condition came from the 16th-century French military surgeon Ambrose Paré. The term phantom limb pain (PLP) was coined by Silas Weir Mitchell, who provided a comprehensive description of the condition during the 19th century. Since that time, the understanding of PLP has greatly expanded; however, our knowledge of the exact mechanisms underlying it is still very deficient. Amputation of a body part can result in one sequela or more than one neurologic sequelae occurring concurrently: phantom sensation, phantom pain, and stump pain. The incidence and prevalence vary across the spectrum of these syndromes. A myriad of treatment modalities are employed in an attempt to terminate PLP, including pharmacotherapy, injections, alternative therapy, surgical interventions, and neuromodulation. Despite an extensive search for effective therapeutic options, PLP remains a highly challenging and debilitating condition.

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Phantom Limb: A Phenomenological Study

The British Journal of Psychiatry ◽

10.1192/bjp.141.1.54 ◽

1982 ◽

Vol 141 (1) ◽

pp. 54-58 ◽

Cited By ~ 46

Author(s):

G. D. Shukla ◽

S. C. Sahu ◽

R. P. Tripathi ◽

D. K. Gupta

Keyword(s):

Upper Limb ◽

Lower Limb ◽

Phenomenological Study ◽

Phantom Limb Pain ◽

Phantom Limb ◽

Limb Pain ◽

Post Operative Period ◽

The Right ◽

Lower Limb Amputees

SummaryPhantom limb phenomena during the post-operative period were studied in 72 amputees. All were right handed. Phantom limb was present in 86.1 per cent of the cases, significantly more commonly following amputation of the right arm. Nearly half of the phantoms developed within the first 24 hours and another quarter in the next 24 hours, appearing earlier in lower limb amputees. Movements in the phantom were felt by three-quarters of the cases, an incidence unaffected by site or side of amputation. Telescopy was present in nearly two-thirds and phantom limb pain in over two-thirds, significantly more commonly in the upper limb amputees but uninfluenced by the side of amputation. Thirty-one of the patients dreamed that their limbs were intact.

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Contralateral Acupuncture for the Treatment of Phantom Limb Pain and Phantom Limb Sensation in Oncologic Lower Limb Amputee: A Case Report

Frontiers in Neuroscience ◽

10.3389/fnins.2021.713548 ◽

2021 ◽

Vol 15 ◽

Author(s):

Qin Guo ◽

Zhong Di ◽

Hong-fang Tian ◽

Quan-ai Zhang

Keyword(s):

Phantom Limb Pain ◽

Phantom Limb ◽

Treatment Technique ◽

Limb Pain ◽

Knee Amputation ◽

Lower Limb Amputee ◽

The Right ◽

Positive Effect ◽

Robust Evidence

Phantom limb pain (PLP) and phantom limb sensation (PLS) are common and distressing sequelae of amputation. Current pain management following amputation is challenging and unsatisfying. In this case study, a 74-year-old woman underwent above-knee amputation because of the rhabdomyosarcoma in the right leg. Despite several analgesics, pain was poorly controlled. The phantom limb pain and sensation were immediately reduced by the contralateral acupuncture, and abolished after the third session with no side-effects, no relapse during the next 9 months. Contralateral acupuncture showed positive effect on PLP and PLS in this case, but more robust evidence would be needed to support the efficacy of this treatment technique for indication.

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Can phantom limb pain be reduced/eliminated solely by techniques applied to peripheral nerves?

Journal of Neurorestoratology ◽

10.26599/jnr.2019.9040002 ◽

2019 ◽

Vol 1 (1) ◽

pp. 26-36

Author(s):

Damien P. Kuffler

Keyword(s):

Nervous System ◽

Neuropathic Pain ◽

Pain Treatment ◽

Negative Impact ◽

Phantom Limb Pain ◽

New Drugs ◽

Phantom Limb ◽

Limb Pain ◽

One Year

About 0.5% of the US population (1.7 million) is living with a lost limb and this number is expected to double by 2050. This number is much higher in other parts of the world. Within days to weeks of an extremity amputation, up to 80% of these individuals develop neuropathic pain presenting as phantom limb pain (PLP). The level of PLP increases significantly by one year and remains chronic and severe for about 10% of individuals. PLP has a serious negative impact on individuals’ lives. Current pain treatment therapies, such pharmacological approaches provide limited to no pain relief, some other techniques applied to the central nervous system (CNS) and peripheral nervous system (PNS) reduce or block PLP, but none produces long-term pain suppression. Therefore, new drugs or novel analgesic methods must be developed that prevent PLP from developing, or if it develops, to reduce the level of pain. This paper examines the potential causes of PLP, and present techniques used to prevent the development of PLP, or if it develops, to reduce the level of pain. Finally it presents a novel technique being developed that eliminates/reduces chronic neuropathic pain and which may induce the long-term reduction/elimination of PLP.

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Clinical Feasibility and Preliminary Outcomes of a Novel Mixed Reality Based System to Manage Phantom Pain for Patients with Lower Limb Amputation.: A Pilot Study

10.1101/2020.08.29.20133009 ◽

2020 ◽

Author(s):

Thiru M Annaswamy ◽

Kanchan Bahirat ◽

Gargi Raval ◽

Yu-Yen Chung ◽

Balakrishnan Prabhakaran

Keyword(s):

Lower Limb ◽

Mixed Reality ◽

Phantom Limb Pain ◽

Phantom Limb ◽

Limb Amputation ◽

Phantom Pain ◽

Mirror Therapy ◽

Limb Pain ◽

History Of ◽

Game Performance

Objective: This report describes the details of Mr. MAPP, a virtual mirror therapy system and the results of a clinical feasibility and evaluation study of a pilot sample of patients with history of lower limb amputation and phantom limb pain. Materials and Methods: Mr. MAPP system uses a Kinect V2 RGB-D camera to capture the patient, generates a live interactive 3D model, and incorporates it into a virtual exergame. Mr. MAPP mirrors their preserved limb and allows participants to visualize their amputated limb virtually and perform their prescribed exercise program. Mr. MAPP creates a digital diary of their therapy sessions by recording game performance and errors. Ten consecutive patients with history of limb loss and phantom pain were targeted for this pilot study. They received a Mr. MAPP system and a laptop for home use for 1-month. Outcome measures including pain intensity and pain interference measured on Numerical Rating Scale (NRS) and McGill Pain Questionnaire (MPQ) as well as functional outcomes measured on Patient Specific Functional Scale (PSFS) were obtained at baseline, and after 1-month. Results: Seven participants were enrolled, out of which four completed the study. The study was temporarily suspended due to restrictions imposed during the COVID-19 public health emergency. In-game performance data showed a trend towards improvement in most participants. Compared to baseline, NRS and MPQ scores at 1-month showed no clear trends. PSFS scores improved for 1 participant and remained unchanged for others. Conclusion: Gamified home exercises performed via a novel, mixed-reality system, Mr. MAPP, using which virtual mirror therapy was delivered, is feasible and has potential to improve pain and pain related function in patients with lower limb amputations and phantom limb pain.

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