Phantom Sensation And Pain Underlying Mechanisms And Innovative Treatments
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Phantom Sensation and Pain: Underlying Mechanisms and Innovative Treatments
Major limb amputation affects a large number of people worldwide, with estimates in the United States as high as 2 million. One of the most common conditions following limb amputation is phantom limb sensation. The majority of patients who have undergone traumatic limb loss also experience phantom limb pain (PLP). There is no consensus on potential differences in the frequency or severity of phantom pain between men and women. This project is seeking out studies that look at the experience of PLP: what people feel, frequency and duration of PLP episodes, if there is a difference in experience between men and women, as well as if there is a relationship between PLP experiences and cause of amputation. Although PLP has been recognized since the mid-16th century, the etiology is still unknown. There are several proposed mechanisms, including learned paralysis, cortical reorganization, and proprioceptive memory. It has been proposed that the mechanism of learned paralysis, whereby PLP arises because the brain does not receive visual feedback that a motor movement has occurred, thus creating the sensation that the limb is paralyzed. Cortical reorganization theory states that areas near those corresponding to the amputated limb slowly expand into those corresponding to the amputated limb. This theory has been supported by the correlation of more severe PLP with increased neural plasticity. Proprioceptive memory refers to a theory that the brain remembers sensations associated with specific perceived positions of the phantom limb. While many treatments for PLP have yielded little success, mirror therapy (MT) appears to be a promising method for relieving PLP. Several small-scale studies have been conducted to evaluate the efficacy of MY, with most patients seeing some reduction in PLP. One group performed the first randomized, sham-controlled study demonstrating that MT was more effective in reducing PLP in lower-limb amputees compared to covered mirror therapy or mental visualization of movements. The efficacy of nearly complete pain relief continued for at least 2 years after therapy. The physiological reason for mirror therapy’s effectiveness remains unknown, but the effectiveness would correspond with the theory of cortical reorganization in that MT would reset the original reorganization present in the brain before amputation and would also support the theory of proprioceptive memories in that it could remove recall of those memories. This project will discuss further investigation into the factors relating to success in MT, as well as the efficacy of MT in relation to proposed mechanisms that cause PLP. Discussion of other forms of novel treatment will also be included. This Research Topic attempts to further explain the etiology of phantom limb pain, better understand the experience of phantom limb pain, and explore treatment options for phantom limb pain. This project will include a review of the current understanding of phantom limb pain, its causes, and treatment.
Phantom and Stump Pain
Author: J. Siegfried
language: en
Publisher: Springer Science & Business Media
Release Date: 2012-12-06
The phenomenon of phantom limb was described in medical literature at least as early as 1545 by Ambroise Pare, according to the notes in the translation of Lemos' dissertation, "On the Continuing Pain of an Amputated Limb", by Price and Twombly [9]. This strange experience was brought to public attention by a popular essay anonymously published 1866 by Mitchell concerning the story of George Dedlow, a quadriamputee who described his invisible limbs [7]. In 1871 Mitchell wrote under his own name, and was the. first to use the term "phantom limb" [8]. In this work, he also corrected some erroneous beliefs that had arisen from his 1866 essay [13]. Most amputees report feeling a phantom limb almost immediately after amputation of an arm or a leg [11]. It is a positive sensation, usually described as tingling or numbness, which is not painful. The most distal parts of the limb, particulary the digits, thumb, and index, are the strongest and most persisting phantom sites, and may be the only parts to appear even after removal of a whole limb. The elbow or knee is sometimes involved, the forearm or lower leg rarely, and the upper arm and thigh almost never [5]. The phantom thus appears to consist predominantly of those parts which have the most extensive representa tion in the thalamus and in the cerebral cortex.
Oxford Textbook of Vascular Surgery
Author: Matthew M. Thompson
language: en
Publisher: Oxford University Press
Release Date: 2016-07-28
The Oxford Textbook of Vascular Surgery draws on the expertise of over 130 specialist contributors to encompass the field of vascular surgery. Through the use of figures, findings of contemporary trials, and additional online content, this textbook is an excellent study material for surgical trainees entering their final two years of training, in addition to serving as an effective reference source for practicing surgeons. This volume discusses the epidemiology, vascular biology, clinical features and management of diseases that affect the vasculature and contains dedicated chapters which address topics such as paediatric surgery, damage control surgery, and amputations. The text follows a logical framework which complements the published Intercollegiate Surgery Curriculum making it particularly useful in preparation for the Intercollegiate Examination. The online version of The Oxford Textbook of Vascular Surgery is free for twelve months to individual purchasers of this book and contains the full text of the print edition, links to external sources and informative videos demonstrating current surgical techniques, making this a valuable resource for practicing surgeons. The field of vascular surgery has advanced rapidly in recent years and has expanded to include the techniques of interventional radiology and cardiology which are also extensively covered in this volume, making it an authoritative modern text. By combining contemporary evidence-based knowledge with informative figures, online resources and links to the current training curriculum, The Oxford Textbook of Vascular Surgery is a highly valuable source of information and will become the standard reference text for all who study vascular disease and its treatment.