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Chapter 25 - Phantom Limb Pain

from Part V - Extremities

Published online by Cambridge University Press:  01 December 2023

By
Vwaire Orhurhu  and
Kevin Bennett
Edited by
Omar Viswanath  and
Ivan Urits
Omar Viswanath
Affiliation:
Creighton University, Omaha
Ivan Urits
Affiliation:
Southcoast Brain & Spine Center, Wareham
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Summary

Phantom limb pain (PLP) is a common source of distress and discomfort post-amputation. Up to 85% of amputees will experience PLP at some point and many cases become chronic pain conditions. While the pain has been well documented for decades, the exact pathophysiology is still unclear, and thus hindering a more accurate means of treatment. Patients with significant pain in the limb pre-amputation, lack of psychological counseling, and more proximal amputations in general seem to be more prone to pain; however, the presentation of PLP varies greatly from case to case. There are many noninvasive therapies, exercises, and medications that are recommended as first-line treatment, but the most effective and best-evidenced treatments involve electrical stimulation of peripheral nerves. Despite this lead on a promising treatment, the quality of evidence supporting or refuting any given modality is overall weak and requires much more homogenous study to truly be analyzed for efficacy.

Keywords

phantom limb painleg painamputationnerve painpost-amputation pain
Type
Chapter
Information
Cambridge Handbook of Pain Medicine , pp. 205 - 212
Publisher: Cambridge University Press
Print publication year: 2023

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References

Hsu, E, Cohen, SP. Postamputation pain: Epidemiology, mechanisms, and treatment. J Pain Res. 2013;6:121–136.Google ScholarPubMed
Ziegler-Graham, K, MacKenzie, EJ, Ephraim, PL, Travison, TG, Brookmeyer, R. Estimating the prevalence of limb loss in the United States: 2005 to 2050. Arch Phys Med Rehabil. 2008;89:422–429.CrossRefGoogle ScholarPubMed
Flahaut, M, Laurent, NL, Michetti, M et al. Patient care for postamputation pain and the complexity of therapies: Living experiences. Pain Manag. 2018;8:441–453.CrossRefGoogle ScholarPubMed
Padovani, MT, Martins, MRI, Venâncio, A, Forni, JEN. Anxiety, depression and quality of life in individuals with phantom limb pain. Acta Ortop Bras. 2015;23:107–110.CrossRefGoogle ScholarPubMed
Limakatso, K, Bedwell, GJ, Madden, VJ, Parker, R. The prevalence and risk factors for phantom limb pain in people with amputations: A systematic review and meta-analysis. PLoS One. 2020;15(10):e0240431.CrossRefGoogle ScholarPubMed
Flor, H, Elbert, T, Knecht, S et al. Phantom-limb pain as a perceptual correlate of cortical reorganization following arm amputation. Nature. 1995;375(6531):482–484.CrossRefGoogle ScholarPubMed
Melzack, R. Pain and the neuromatrix in the brain. J Dent Educ. 2001;65(12):1378–1382.CrossRefGoogle ScholarPubMed
Flor, H. Phantom-limb pain: Characteristics, causes, and treatment. Lancet Neurol. 2002;1(3):182–189.CrossRefGoogle ScholarPubMed
Bekrater-Bodmann, R, Schredl, M, Diers, M et al. Post-amputation pain is associated with the recall of an impaired body representation in dreams – results from a nation-wide survey on limb amputees. PLoS One. 2015;10(3):e0119552.CrossRefGoogle ScholarPubMed
Anderson-Barnes, VC, McAuliffe, C, Swanberg, KM, Tsao, JW. Phantom limb pain: A phenomenon of proprioceptive memory? Med Hypotheses. 2009;73(4):555–558.CrossRefGoogle ScholarPubMed
Anderson, ML. What phantom limbs are. Conscious Cogn. 2018;64:216–226.CrossRefGoogle Scholar
Lendaro, E, Hermansson, L, Burger, H et al. Phantom motor execution as a treatment for phantom limb pain: Protocol of an international, double-blind, randomised controlled clinical trial. BMJ Open. 2018;8:e021039.CrossRefGoogle ScholarPubMed
Padovani, MT, Martins, MRI, Venâncio, A, Forni, JEN. Anxiety, depression and quality of life in individuals with phantom limb pain. Acta Ortop Bras. 2015;23:107–110.CrossRefGoogle ScholarPubMed
Sahu, A, Gupta, R, Sagar, S, Kumar, M, Sagar, R. A study of psychiatric comorbidity after traumatic limb amputation: A neglected entity. Ind Psychiatry J. 2017;26:228–232.Google ScholarPubMed
Vase, L, Egsgaard, LL, Nikolajsen, L et al. Pain catastrophizing and cortical responses in amputees with varying levels of phantom limb pain: A high-density EEG brain-mapping study. Exp Brain Res Springer-Verlag. 2012;218:407–417.CrossRefGoogle ScholarPubMed
Herrador Colmenero, L, Perez Marmol, JM, Martí-García, C et al. Effectiveness of mirror therapy, motor imagery, and virtual feedback on phantom limb pain following amputation: A systematic review. Prosthet Orthot Int. 2018;42(3):288–298.CrossRefGoogle ScholarPubMed
Xie, HM, Zhang, KX, Wang, S et al. Effectiveness of mirror therapy for phantom limb pain: A systematic review and meta-analysis. Arch Phys Med Rehabil. 2022;103(5):988–997.CrossRefGoogle ScholarPubMed
Wu, C, Tella, P, Staats, P et al. Analgesic effects of intravenous lidocaine and morphine on postamputation pain. Anesthesiology. 2002;96(2):841–848.CrossRefGoogle ScholarPubMed
Huse, E, Larbig, W, Flor, H, Birbaumer, N. The effect of opioids on phantom limb pain and cortical reorganization. Pain. 2001;90(1–2):47–55.CrossRefGoogle ScholarPubMed
Eichenberger, U, Neff, F, Sveticic, G et al. Chronic phantom limb pain: The effects of calcitonin, ketamine, and their combination on pain and sensory thresholds. Anesthesia & Analgesia. 2008;106(4):1265–1273.CrossRefGoogle ScholarPubMed
Alviar, MJ, Hale, T, Dungca, M. Pharmacologic interventions for treating phantom limb pain. Cochrane Database Syst Rev. 2016;10(10):CD006380.Google ScholarPubMed
McAuley, J, van Gröningen, R, Green, C. Spinal cord stimulation for intractable pain following limb amputation. Neuromodulation Technol Neural Interface. 2013;16:530–536.CrossRefGoogle ScholarPubMed
Deng, Z, Li, D, Zhan, S et al. Spinal cord stimulation combined with anterior cingulotomy to manage refractory phantom limb pain. Stereotact Funct Neurosurg. 2018;96:204–208.CrossRefGoogle ScholarPubMed
Eldabe, S, Burger, K, Moser, H et al. Dorsal root ganglion (DRG) stimulation in the treatment of phantom limb pain (PLP). Neuromodulation. 2015;18:610–617.CrossRefGoogle ScholarPubMed
Cornish, P, Wall, C. Successful peripheral neuromodulation for phantom limb pain. Pain Med. 2015;16:761–764.CrossRefGoogle ScholarPubMed
Malavera, A, Silva, FA, Fregni, F, Carrillo, S, Garcia, RG. Repetitive transcranial magnetic stimulation for phantom limb pain in land mine victims: A double-blinded, randomized, sham-controlled trial. J Pain. 2016;17:911–918.CrossRefGoogle ScholarPubMed

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