Coaptation of Cutaneous Nerves for Intractable Stump Pain and Phantom Limb Pain after Upper Limb Amputation

A systematic descriptive survey was carried out on a clinic population with acquired upper limb amputation in which clear distinctions were made between phantom experiences, pre-amputation pain and stump pain. It was found that of 76 participants 96% reported phantom experiences and 84% were currently experiencing phantom limb phenomena (PLP). Sixty-nine percent (69%) of those currently experiencing phantom phenomena stated that the phantoms were painful. Significant relationships were found between frequency of phantom experiences and side and level of amputation. In addition, the presence of ‘trigger’ points reported by a sub group of participants was found to be associated with the frequency of phantoms and painful phantoms. This finding could provide support for cortical reorganisation post amputation. It is suggested that detailed individual ‘profiling’ of phantom experiences is important and would have the following implications: it would contribute to existing knowledge and provide new insights into the central nervous system's reorganisation post-amputation; it would provide an accurate way of representing amputees’ anomalous perceptions; it would alert health professionals to the presence, variety and extent of PLP following amputation.

Download Full-text

Risk factors for post-amputation pain

10.1093/med/9780198834359.003.0066 ◽

2018 ◽

Author(s):

Tudor Phillips

Keyword(s):

Older Patients ◽

Clinical Characteristics ◽

Phantom Limb Pain ◽

Phantom Limb ◽

Limb Amputation ◽

Limb Pain ◽

Experienced Pain ◽

Stump Pain ◽

Peripheral 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.

Download Full-text

Driving ability following upper limb amputation

Prosthetics and Orthotics International ◽

10.1177/0309364612473500 ◽

2013 ◽

Vol 37 (5) ◽

pp. 391-395 ◽

Cited By ~ 6

Author(s):

Helena Burger ◽

Črt Marinček

Keyword(s):

Upper Limb ◽

Phantom Limb Pain ◽

Phantom Limb ◽

Driving Ability ◽

Limb Amputation ◽

Safe Driving ◽

Amputation Level ◽

Upper Limb Amputation ◽

Retrospective Clinical Study ◽

Limb Deficiency

Background:In the existing literature, there is scarce information about subjects with upper limb amputation and driving.Objectives:The aim of this study was to find out how frequently subjects following upper limb amputation have problems when driving; most frequently proposed adaptations and, when possible, factors that influence driving ability.Study design:Retrospective clinical study.Methods:Medical records were reviewed of all subjects following upper limb amputation who had been amputated in the last 5 years and those with congenital upper limb deficiency who in the last 5 years turned 17.Results:Out of 37 subjects, 7 did not attend the clinic for assessment of driving abilities. They were significantly older at the time of the amputation ( p < 0.001). To the remaining 30 who attended driving assessment, zero to four car adaptations (two on average) were proposed. There were no correlations between the number of suggested car adaptations and the age at the time of the amputation, amputation level, education and severity of phantom limb pain. Type of prosthesis also did not influence the number of car adaptations.Conclusions:Most people following upper limb amputation need at least one car adaptation for safe driving.Clinical relevanceMost people following upper limb amputation need car adaptations for safe driving. Assessment of driving abilities has to be a part of comprehensive rehabilitation of these persons.

Download Full-text