Phantom phenomena and body scheme after limb amputation: A literature review

Abstract

Phantom phenomena are subject of various, often inconsistent, descriptions, and new concepts and treatment approaches emerge. The aim of the study is to describe contemporary terminology and developments in the field, and to share personal experience. A review of English and French language literature, published prior to 27th February, 2012, extracted from PubMed/MEDLINE, Google.fr, GoogleScholar databases, and by hand searching of selected full text papers and textbooks with correspondence to personal clinical experience was performed. The terminology and classification of phantom phenomena sensations, relations between intensity and character of phantom pain to the etiology and level of amputations, as well as the influence of presence and intensity of pre-operative limb pain and post-operative stump pain on phantom phenomena are described. The benefits of mirror therapy and early introduction of prosthesis and applying functional prosthesis are also presented, with a glance at other conservative and surgical treatment approaches.

Mirror Therapy for Phantom Limb Pain at a Pediatric Oncology Institution

“…Proximal amputations are associated more frequently with PLP than are distal amputations. 1 By their nature, the hemipelvectomy and the forequarter amputation are much more painful procedures with more difficult recovery periods. Patients who undergo those surgeries are expected to require higher consumption of pain medications than are those who undergo more distal amputations.…”

“…1 According to the literature, 60% to 90% of amputees experience PLP at some point in their lifetime. 2 Phantom limb pain can occur whether the amputation is traumatic or surgical, and the incidence is generally higher after a traumatic loss or if there is a pre-existing painful condition, as opposed to a planned surgical amputation of a non-painful limb.…”

“…6 The incidence of PLP is thought to be lower in children than in adults, and PLP has not been reported in children younger than 4 years. 1 …”

“…Several factors have been evaluated for predictive value of success with MT, including pre-amputation pain, time between the amputation and beginning of MT, presence of telescoping sensation, distal vs. proximal amputations, and upper-vs. lower-extremity amputations. 1,2 …”

Percutaneous image-guided cryoablation for the treatment of phantom limb pain in amputees: a pilot study

“…PLP-pain perceived to originate from an absent body part after amputation-represents the symptomatic end manifestation of ectopic inputs along this transformed pathway (19)(20)(21). Numerous studies have reported on interventions at different points along this altered pathway, from direct and indirect cortical modulation to surgical resection of the distal residual nerve (and at many points in between), yet no accepted guidelines for treatment have emerged (21)(22)(23)(24)(25)(26). Treatment strategies targeting the peripheral nerve, such as catheter placement for infusion of anesthetic postoperatively, peripheral neuromodulation, lidocaine injections, and cryoanalgesia guided by nerve stimulation, have been reported more recently as potentially efficacious (27)(28)(29)(30).…”