An introduction to the issue of phantom limb pain

The missing limb often feels shorter and may feel as if it is in a distorted and painful position.

An introduction to the issue of phantom limb pain

Circulating epinephrine resulting from emotional distress can contribute to the sensitisation of the peripheral nervous system. In addition, prosthetic use significantly aids resolution of PLP, especially with the upper limb.

An introduction to the issue of phantom limb pain

Preparatory work to ensure the maintenance of joint range, normal symmetrical movement and proximal stabilisation will aid prosthetic fitting and successful use, This will potentially enhance the beneficial effect of limb wearing upon PLP. Assessment and decision-making The image below shows an assessment approach, which may help clinicians to determine the correct course of action required with a patient with PLP.

Phantom limb pain - Physiopedia

The assessment must commence by accurately identifying that PLP is indeed the issue. Knowledge of the different characteristics of each pain presentation will help the clinician to establish this from an assessment of their history: Eliminating the causes of RLP is therefore the priority as this will resolve or lessen PLP which is respondent to peripheral aggravators.

It also shows the degree to which central factors may have an ongoing influence. Immediate post-amputation management demands early effective analgesia and adjunctive measures include managing oedema using elastic stump socks, semi-rigid dressings and rigid plaster casts.

Post-acute management requires attention to both intrinsic and extrinsic causes of RLP. Extrinsic RLP will result from complications of wound healing and so infection must be excluded.

Tissue load and sheering forces placed on the limb due to a poor prosthetic fit will also evoke pain. A prosthetic review will improve fit and enable sensitised structures to be offloaded. Scar formation can also cause pain, particularly where there is nerve entrapment, or adhesions reducing the mobility of soft tissues.

In either case, scar management using soft tissue massage and moisturiser is recommended; silicone treatment can also be added if required. Besides improving tissue mobility, massage can be used to desensitise the residual limb.

Intrinsic causes of RLP can include ischaemia, joint dysfunction proximal to the residual limb, stress fracture, osteomyelitis and wound dehiscence. Occasionally where the bone has been improperly trimmed or formation of bone in extraskeletal soft tissue has occurred HOthen pain may result in high-pressure areas.

Investigations will be required and revision surgery may be considered; alternatively, prosthetic adjustment can be used to unload pressure areas. Neuroma is the most common cause of intrinsic RLP. Ectopic discharge may evoke a neuropathic response causing PLP.

Neuroma formation after amputation is normal, but when it becomes sensitised to mechanical or chemical stimuli, often exacerbated by entrapment, then problems ensue [8] [9]. Pain is intermittent and variable, but diagnosis is confirmed by a specific site of tenderness on palpation, which can be confirmed with an injection of local anaesthetic into the site.Phantom limb pain is defined as "pain that is localised in the region of the removed body part" (Siddle, ).

An introduction to the issue of phantom limb pain

It is a poorly understood clinical phenomenon that remains the subject of intense research due to the acute and chronic nature of the condition. This means that the appearance of phantom limb pain will usually be characterized by its sharpness. Also, it is not uncommon for people to relate the pain to the distal portion of their limb.

Although phantom pains may occur following amputation of body parts other than limbs,27 49 66 the present review will focus on clinical characteristics, mechanisms, treatment, and possible preventive measures of phantom pain after limb amputation.

The phantom . ISSUE BRIEF.

Introduction

5. National Medical Organization Recommendations. No guidance documents or recommendations from national medical organizations for the therapeutic use of cannabis or cannabinoids in the management of PLP were found.

References.

Clinical aspects

Alviar MJM, Hale T, Dungca M. Pharmacologic interventions for treating phantom limb pain. This study presents a review of the literature on the attributes and potential mechanisms involved in phantom limb pain, encompassing studies describing pain in the residual limb, phantom sensation and phantom limb pain, and the difficulties that may arise when making these distinctions.

Phantom limb pain (PLP) refers to ongoing painful sensations that seem to be coming from the part of the limb that is no longer there. The limb is gone, but the pain is real. The onset of this pain most often occurs soon after surgery.

Phantom limb pain | BJA: British Journal of Anaesthesia | Oxford Academic