Phantom limb, phantom pain and stump pain in amputees during the first 6 months following limb amputation

Abstract

The incidence and clinical picture of non-painful and painful phantom limb sensations as well as stump pain was studied in 58 patients 8 days and 6 months after limb amputation. The incidence of non-painful phantom limb, phantom pain and stump pain 8 days after surgery was 84, 72 and 57%, respectively. Six months after amputation the corresponding figures were 90, 67 and 22%, respectively. Kinaesthetic sensations (feeling of length, volume or other spatial sensation of the affected limb) were present in 85% of the patients with phantom limb both immediately after surgery and 6 months later. However, 30% noticed a clear shortening of the phantom during the follow-up period; this was usually among patients with no phantom pain. Phantom pain was significantly more frequent in patients with pain in the limb the day before amputation than in those without preoperative limb pain. Of the 67% having some phantom pain at the latest interview 50% reported that pains were decreasing. Four patients (8%), however, reported that phantom pains were worse 6 months after amputation than originally. During the follow-up period the localization of phantom pains shifted from a proximal and distal distribution to a more distal localization. While knifelike, sticking phantom pains were most common immediately after surgery, squeezing or burning types of phantom pain were usually reported later in the course. Possible mechanisms for the present findings either in periphery, spinal cord or in the brain are discussed.

Factors associated with phantom limb pain: a 3½-year prospective study

“…32 In addition, only one study 10 had a follow-up of two years with a drop-out rate of 41% of the original 58 patients, while in the other studies the follow-up did not exceed one year. 12,[15][16][17][18] A limitation of this study is the selection bias through exclusion and drop-out within six months after amputation. The excluded and dropped-out patients were significantly older and underwent an amputation because of peripheral vascular disease more often than the included amputees.…”

Cortical reorganization and phantom phenomena in congenital and traumatic upper-extremity amputees

“…Phantom limbs develop in 80± 100% of traumatic amputations; in about 50±80% of those cases they are painful (Jensen et al 1983;Sherman et al 1984). Whereas there is general agreement that painful and nonpainful phantom limbs occur in traumatic amputees whose amputations took place in adult life, there is conflicting data concerning persons whose amputation is congenital or occurred in early childhood.…”

Phantom limb sensations and phantom limb pain in child and adolescent amputees

“…Sherman, 1994), or a pain similar to pre-operative pain (Jensen et al, 1983(Jensen et al, , 1985Katz and Melzack, 1990). Phantom sensations and phantom pain typically begin within days ofthe amputation, and they tend to decrease in frequency and duration over time (Jensen et al, 1983(Jensen et al, , 1985.…”