Mechanism-Based Assessment and Management

Abstract

The first hints that there might be a rational clinical approach to relieving phantom limb pain came from attempts at relating treatment effectiveness to descriptions of the pain. Surveys and clinical experiences have demonstrated that virtually all amputees give consistent descriptions of their phantom pain. The most common descriptive groups are burning (including tingling, pins and needles, etc.), cramping (including tightness, squeezing, etc.), and shocking-shooting. Careful examination of survey responses and review articles showed that sympathectomies could be moderately successful in reducing burning phantom pain, but not other descriptors, for up to a year (Sherman, 1984). Interventions causing reduced muscle tension in the residual limb resulted in lower levels of cramping/squeezing descriptors of phantom pain but not of others (Sherman,1976). These early findings led to elucidation of physiological correlates of phantom pain and, eventually, to several effective management techniques based on them (Sherman, 1989a, 1989b).