Subscribe to RSS
DOI: 10.1055/s-2004-830019
Phantom Limb Pain
Publication History
Publication Date:
07 July 2004 (online)
![](https://www.thieme-connect.de/media/sns/200401/lookinside/thumbnails/10.1055-s-2004-830019-1.jpg)
First described in the 16th century, phantom limb pain (PLP) describes the painful sensations resulting from a lost body part, classically a lost limb. This article reviews the incidence, clinical course, pathophysiology, and current treatment options for PLP. The reported incidence of PLP varies widely from 0.5 to 90% because of sampling biases and the lack of differentiating PLP from stump pain or phantom sensations. The clinical course is rapid with symptoms typically occurring within the first week of limb loss and persisting for up to 2 years or more. Although both psychiatric and peripheral causes have been proposed, recent studies suggest a primary role of the central nervous system in the genesis of PLP. Treatment of PLP remains difficult, with no single modality sufficient to manage the pain. Optimal management currently involves a multidisciplinary approach involving physical treatments, pharmacologic intervention, and psychiatric therapy. Surgical options remain limited although novel interventions such as motor cortex stimulation may be beneficial.
KEYWORDS
Phantom limb pain - amputation - treatment
REFERENCES
- 1 Melzack R. Phantom limb pain. Patol Fiziol Eksp Ter. 1992; 4 52-54
- 2 Weinstein S M. Phantom limb pain and related disorders. Neurol Clin. 1998; 16 919-936
- 3 Davis R W. Phantom sensation, phantom pain, and stump pain. Arch Phys Med Rehabil. 1993; 74 79-91
- 4 Hill A. Phantom limb pain: a review of the literature on attributes and potential mechanisms. J Pain Symptom Manage. 1999; 17 125-142
- 5 Sherman R A. Stump and phantom limb pain. Neurol Clin. 1989; 7 249-264
- 6 Sherman R A, Sherman C J, Bruno G M. Psychological factors influencing chronic phantom limb pain: an analysis of the literature. Pain. 1987; 28 285-295
- 7 Melzack R. Pain: past, present and future. Can J Exp Psychol. 1993; 47 615-629
- 8 Davis R W. Successful treatment for phantom pain. Orthopedics. 1993; 16 691-695
- 9 Loeser J D. Phantom limb pain. In: Wilkins RH, Rengachary SS Neurosurgery, Vol III. New York; McGraw-Hill 1985: 2371-2373
- 10 Flor H, Elbert T, Muhlnickel W, Pantev C, Wienbruch C, Taub E. Cortical reorganization and phantom phenomena in congenital and traumatic upper-extremity amputees. Exp Brain Res. 1998; 119 205-212
- 11 Sherman R A, Sherman C J. Prevalence and characteristics of chronic phantom limb pain among American veterans. Am J Phys Med. 1983; 62 227-238
- 12 Wall G C, Heyneman C A. Calcitonin in phantom limb pain. Ann Pharmacother. 1999; 33 499-501
- 13 Bartusch S L, Sanders B J, D’Alessio J G, Jernigan J R. Clonazepam for the treatment of lancinating phantom limb pain. Clin J Pain. 1996; 12 59-62
- 14 Knox D J, McLeod B J, Goucke C R. Acute phantom limb pain controlled by ketamine. Anaesth Intensive Care. 1995; 23 620-622
- 15 Lamacraft G. Lignocaine for acute phantom limb pain reactivation by regional anaesthesia. Anaesthesia. 1996; 51 800
- 16 Lu T V. Acupuncture treatment for phantom limb pain. Altern Ther Health Med. 1998; 4 124
- 17 Weiss T, Miltner W H, Adler T, Bruckner L, Taub E. Decrease in phantom limb pain associated with prosthesis-induced increased use of an amputation stump in humans. Neurosci Lett. 1999; 272 131-134
- 18 Iacono R P, Linford J, Sandyk R. Pain management after lower extremity amputation. Neurosurgery. 1987; 20 496-500
- 19 Rath S A, Seitz K, Soliman N, Kahamba J F, Antoniadis G, Richter H P. DREZ coagulations for deafferentation pain related to spinal and peripheral nerve lesions: indication and results of 79 consecutive procedures. Stereotact Funct Neurosurg. 1997; 68 161-167
- 20 Kumar K, Wyant G M, Nath R. Deep brain stimulation for control of intractable pain in humans, present and future: a ten-year follow-up. Neurosurgery. 1990; 26 774-781
- 21 Levy R M, Lamb S, Adams J E. Treatment of chronic pain by deep brain stimulation: long term follow-up and review of the literature. Neurosurgery. 1987; 21 885-893
- 22 Roux F, Ibarrola D, Lazorthes Y, Berry I. Chronic motor cortex stimulation for phantom limb pain: a functional magnetic resonance imaging study: technical case report. Neurosurgery. 2001; 48 681-688
- 23 Saitoh Y, Shibata M, Sanada Y, Mashimo T. Motor cortex stimulation for phantom limb pain. Lancet. 1999; 353 212
- 24 Sol J C, Casaux J, Roux F E et al.. Chronic motor cortex stimulation for phantom limb pain: correlations between pain relief and functional imaging studies. Stereotact Funct Neurosurg. 2001; 77(1-4) 172-176
Oren SagherM.D.
Department of Neurosurgery, University of Michigan Health System, 1500 E. Medical Center Drive
Room 2128TC, Ann Arbor, MI 48109-0338
Email: osagher@umich.edu