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Phantom limb pain

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Abstract

Phantom pain is experienced by 60% to 80% of patients following limb amputation but is only severe in about 5% to 10% of cases. The mechanisms underlying pain in amputees are not fully understood, but factors in both the peripheral and central nervous system play a role. Treatment of phantom pain is not successful; a recent study on prevention of phantom pain showed negative results. The future may reveal new specific drugs for treatment.

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References and Recommended Reading

  1. Houghton AD, Nicholls G, Houghton AL, et al.: Phantom pain: natural history and association with rehabilitation. Ann R Coll Surg Engl 1994, 76:22–25.

    PubMed Central  CAS  PubMed  Google Scholar 

  2. Wartan SW, Hamann W, Wedley JR, et al.: Phantom pain and sensation among British veteran amputees. Br J Anaesth 1997, 78:652–659.

    Article  CAS  PubMed  Google Scholar 

  3. Nikolajsen L, Ilkjær S, Krøner K, et al.: The influence of preamputation pain on postamputation stump and phantom pain. Pain 1997, 72:393–405.

    Article  CAS  PubMed  Google Scholar 

  4. Jensen TS, Krebs B, Nielsen J, et al.: Phantom limb, phantom pain and stump pain in amputees during the first 6 months following limb amputation. Pain 1983, 17:243–256.

    Article  CAS  PubMed  Google Scholar 

  5. Sherman RA, Sherman CJ: Prevalence and characteristics of chronic phantom limb pain among American veterans. Am J Phys Med 1983, 62:227–238.

    CAS  PubMed  Google Scholar 

  6. Wilkins KL, McGrath PJ, Finley GA, et al.: Phantom limb sensations and phantom limb pain in child and adolescent amputees. Pain 1998, 78:7–12.

    Article  CAS  PubMed  Google Scholar 

  7. Flor H, Elbert T, Muhlnickel W, et al.: Cortical reorganization and phantom phenomena in congenital and traumatic upper-extremity amputees. Exp Brain Res 1998, 119:205–212. Finds a positive relationship between phantom pain and the amount of reorganization in nine traumatic amputees. Five congenital amputees had no phantom pain and cortical reorganization was minimal.

    Article  CAS  PubMed  Google Scholar 

  8. Rajbhandari SM, Jarett JA, Griffiths PD, et al.: Diabetic neuropathic pain in a leg amputated 44 years previously. Pain 1999, 83:627–629.

    Article  CAS  PubMed  Google Scholar 

  9. Jensen TS, Krebs B, Nielsen J, et al.: Immediate and long-term, phantom limb pain in amputees: incidence, clinical characteristics and relationship to pre-amputation pain. Pain 1985, 21:267–278.

    Article  CAS  PubMed  Google Scholar 

  10. Krane EJ, Heller LB: The prevalence of phantom sensation and pain in paediatric amputees. J Pain Symptom Manage 1995, 10:21–29.

    Article  CAS  PubMed  Google Scholar 

  11. Montoya P, Larbig W, Grulke N, et al.: The relationship of phantom limb pain to other phantom limb phenomena in upper extremity amputees. Pain 1997, 72:87–93.

    Article  CAS  PubMed  Google Scholar 

  12. Jensen TS, Nikolajsen L: Phantom pain and other phenomena after amputation. In Textbook of Pain, edn 4. Edited by Wall PD, Melzack R. Edingburgh: Churchill Livingstone; 1999:799–814.

    Google Scholar 

  13. Katz J, Melzack R: Pain memories in phantom limbs: review and clinical observations. Pain 1990, 43:319–336.

    Article  CAS  PubMed  Google Scholar 

  14. Hill A, Niven CA, Knussen C: Pain memories in phantom limbs: a case study. Pain 1996, 66:381–384.

    Article  CAS  PubMed  Google Scholar 

  15. Devor M and Seltzer Z: Pathophysiology of damaged nerves in relation to chronic pain. In Textbook of Pain, edn 4. Edited by Wall PD, Melzack R. Edingburgh: Churchill Livingstone; 1999:129–164.

    Google Scholar 

  16. Coderre TJ, Katz J: Peripheral and central hyperexcitability: differential signs and symptoms in persistent pain. Behav Brain Sci 1997, 20:404–419.

    CAS  PubMed  Google Scholar 

  17. Woolf CJ, Thompson SWN: The induction and maintenance of central sensitization is dependent on N-methyl-D-aspartic acid receptor activation; implications for the treatment of post-injury pain hypersensitivity states. Pain 1991, 44:293–299.

    Article  CAS  PubMed  Google Scholar 

  18. Woolf CJ, Shortland, Coggeshall RE: Peripheral nerve injury triggers central sprouting of myelinated afferents. Nature 1992, 355:75–78.

    Article  CAS  PubMed  Google Scholar 

  19. Flor H, Elbert T, Knecht S, et al.: Phantom limb pain as a perceptual correlate of massive cortical reorganization in upper limb amputees. Nature 1995, 375:482–484.

    Article  CAS  PubMed  Google Scholar 

  20. Larbig W, Montaya P, Flor H, et al.: Evidence for a change in neural processing in phantom limb pain patients. Pain 1996, 67:275–283.

    Article  CAS  PubMed  Google Scholar 

  21. Birbaumer N, Lutzenberger W, Montoya P, et al.: Effects of regional anaesthesia on phantom limb pain are mirrored in changes in cortical reorganization. J Neurosci 1997, 17:5503–5508.

    CAS  PubMed  Google Scholar 

  22. Jaeger H, Maier C: Calcitonin in phantom limb pain: a double-blind study. Pain 1992, 48:21–27.

    Article  CAS  PubMed  Google Scholar 

  23. Nikolajsen L, Hansen CL, Nielsen J, et al.: The effect of ketamine on phantom pain: a central neuropathic disorder maintained by peripheral input. Pain 1996, 67:69–77.

    Article  CAS  PubMed  Google Scholar 

  24. Nikolajsen L, Gottrup H, Kristensen AGD, et al.: Memantine (a N-methyl D-aspartate receptor antagonist) in the treatment of neuropathic pain following amputation or surgery: a randomised, double-blind, cross-over study. Poster presented at 9th World Congress on Pain, Vienna. Analg Anesth 1999, in press.

  25. Eisenberg E, Kleiser A, Dortort A, et al.: The NMDA (N-methyl-D-aspartate) receptor antagonist memantine in the treatment of postherpetic neuralgia: a double-blind, placebocontrolled study. Eur J Pain 1998, 2:321–327.

    Article  CAS  PubMed  Google Scholar 

  26. Katz J, Melzack R: Auricular transcutaneous electrical nerve stimulation (Tens) reduces phantom limb pain. J Pain Symptom Manage 1992, 2:73–83.

    Google Scholar 

  27. Seltzer Z, Beilin B, Ginsburg R, et al.: The role of injury discharge in the induction of neuropathic pain behavior in rats. Pain 1991, 46:327–336.

    Article  CAS  PubMed  Google Scholar 

  28. Bach S, Noreng MF, Tjéllden NU: Phantom limb pain in amputees during the first 12 months following limb amputation, after preoperative lumbar epidural blockade. Pain 1988, 33:297–301.

    Article  CAS  PubMed  Google Scholar 

  29. Jahangiri M, Jayatunga AP, Bradley, et al.: Prevention of phantom pain after major lower limb amputation by epidural infusion of diamorphine, clonidine and bupivacaine. Ann R Coll Surg Engl 1994, 76:324–326.

    PubMed Central  CAS  PubMed  Google Scholar 

  30. Schug SA, Burell R, Payne J, et al.: Preemptive epidural anaesthesia may prevent phantom limb pain. Reg Anesth 1995, 20:256.

    CAS  PubMed  Google Scholar 

  31. Katsuly-Liapis I, Georgakis P, et al.: Preemptive extradural analgesia reduces the incidence of phantom pain in lower limb amputees [abstract]. Br J Anesth 1996, 76:125.

    Google Scholar 

  32. Nikolajsen L, Ilkjær S, Krøner K, et al.: Randomised trial of epidural bupivacaine and morphine in prevention of stump and phantom pain in lower-limb amputation. Lancet 1997, 350:348–354. The only paper without major problems with design, randomization, blinding, and statistical power to examine the effect of epidural analgesia on the prevention of phantom pain.

    Article  Google Scholar 

  33. Fisher A, Meller Y: Continuous postoperative regional analgesia by nerve sheath block for amputation surgery—a pilot study. Anesth Analg 1991, 72:300–303.

    Article  CAS  PubMed  Google Scholar 

  34. Elizaga AM, Smith DG, Sharar SR, et al.: Continuous regional analgesia by intraneural block: effect on postoperative opioid requirements and phantom limb pain following amputation. J Rehab Res Dev 1994, 31:179–187.

    CAS  Google Scholar 

  35. Pinzur MS, Garla PGN, Pluth T, et al.: Continous postoperative infusion of a regional anaesthetic after an amputation of the lower extremity. J Bone Joint Surg 1996, 78:1501–1505.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Anesthesiology and Danish Pain Research Center, University of Aarhus, Aarhus Kommunehospital, Building 1 C,Nørrebrogade 44, 8000, Aarhus C, DK, Denmark

    Lone Nikolajsen MD, PhD

  2. Department of Neurology and Danish Pain Research Center, University of Aarhus, Aarhus Kommunehospital, Building 1 C,Nørrebrogade 44, 8000, Aarhus C, DK, Denmark

    Troels Staehelin Jensen MD, PhD

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  1. Lone Nikolajsen MD, PhD
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  2. Troels Staehelin Jensen MD, PhD
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Nikolajsen, L., Jensen, T.S. Phantom limb pain. Current Review of Pain 4, 166–170 (2000). https://doi.org/10.1007/s11916-000-0052-0

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  • DOI: https://doi.org/10.1007/s11916-000-0052-0

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