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Phantom Limb Pain
All,
I apologize that this is late in getting back to you.
I meet with our Physical Medicine and Rehab Specialist who comes to our institution with many years of rehab experience (he runs his own prosthetic clinic as well). He wanted me to pass on the following information from an e-mail he sent me. He was very happy to be of help to America's finest and here is what he had to say. He included some background followed by the signs and symptoms, and some medications that may be of use, followed by some adjuncts. As this field is growing, things will change over time, so please check with your physician if you are having any such issues with phantom limb pain/sensations.
"Phantom limb sensation was first described by Pare in 1551. Weir Mitchell introduced the concept of phantom limb sensation from Civil War amputees.
Introduction
Neuropathic pain develops after tissue trauma from surgical procedures. After peripheral nerve injury, changes such as sprouting spontaneous activity in nerve endings, and peripheral sensitization occur. With the loss of somatosensory input from distal nerves, the increased activity from damaged nerves leads to spontaneous pain and hyperalgesia. (This basic mechanism usually underlies most postoperative pain syndromes.)
Phantom sensation may occur in any appendage but most describe the extremities. Phantom sensation of the tongue, nose, penis, rectum, teeth, and breast have all been described. Phantom limb sensation is the perception of the continued presence of the amputated limb. The sensation is non-painful.
Phantom limb pain is painful sensations that are perceived to come from the amputated part of the limb. In the first month after amputation, 85 to 97% of patients experience phantom limb pain to some extent. At one year after amputation approximately 60% continue to have phantom limb pain. Less than 30% of amputees have phantom pain greater than 20 days of the month and greater than 15 hours per day. Phantom limb pain may occur months to years after an amputation, however, pain beginning greater than one year after amputation occurs in less than 10% of these cases.
Signs and symptoms
Burning, aching, cramping, crushing, twisting, tingling, drawing, grinding, and knife-like or shock-like pain can occur. Pain may vary with emotional stimulation or depression. Greater than 50% of phantom limb pain is provoked by emotional distress, urination, cough, defecation or even sexual activity. Pain may vary with emotional stimulation or depression, just as it may with chronic-pain syndromes.
Treatments
1) Medications
Tegretol
Chlorpromazine
Propanolol
Calcitonin (salmon) administered IV
Neurontin or Lyrica have also been used with success
Antidepressant medications
Tramadol
Ketamine may reduce spinal sensation via N-methyl D-aspartate receptor antagonism
Neuromodulation has been successful with implanted spinal stimulators as well as intrathecal pumps. Lastly, deep brain stimulation with electrodes have been described.
2) Nerve blocks with epidural blocks have been described. Also direct injections into the nerve ending as in a nerve block have been helpful.
3) Augmentative techniques such as hypnotherapy
These are just some of the things that would help . . . "
So, there you have it. I believe that the mirror technique described in the e-mail string above falls into the augmentative category.
I hope this helps.
Dutch
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