PHANTOM PAIN &

PHANTOM SENSATION

INTRODUCTION• Phantom sensation: resembles the

somatosensory experience of the physical limb before amputation, including warmth, itching, sense of position, and mild squeezing

• Phantom pains: when phantom sensations become intense enough for the amputee to define them as painful

Non-painful sensations in the amputated part.

The feeling that the absent limb is still there.

The presence of this phenomenon is usually described in terms of numbness, pressure, position, temperature, or needles and pins.

Examples: The perception of the

position of the limb The sensation that

something is touching the limb

Sensations of warmth or cold Sensations of movements

Phantom limb pain refers pain sensation in the area where a limb has been amputated.

The pain can be a burning, tingling, itching, or cramping sensation or even a more painful sharp, stabbing, or shooting pain.

PREDICTIVE FACTOR Prior experience with pain prior

to amputation Climatic conditions: changes in

air pressure and temperature Stress . Inactivity Periodic illness - Colds, flu,

infections

Etiology • Reorganization of the sensory cortex

receives information from the spinal cord about the sense of touch, pressure, pain, and the perception of the position of body parts and their movements.

Etiology• NERVE DAMAGE OUTSIDE OF THE BRAIN OR SPINAL CORD:

the unprotected nerve endings are exposed to electromagnetic fields, this causes irritation, which the brain perceives as pain and other types of discomfort.

OTHERS

• Unknown; thought to arise from changes in the motor and sensory portions of the brain.

Effective treatment

psychological

pharmacological

rehabilitation

Drug/MedicineIncrease peripheral blood flow to the limb to alleviate chronic pain.

AnaestheticsCertain "trigger points" on or near the point of amputation may be injected with local anaesthetics for temporary relief, treatment has to be repeated.

Transcutaneous electrical nerve stimulation (TENS)(TENS) is non invasive method of electrical stimulation through intact skin and primarily aims to provide a degree of pain relief.

Transcutaneous- through the skin

AcupunctureAcupuncture stimulates central nervous system to release the body's natural pain-relieving endorphins.

Massage/stump wrapping/baths and applications of hot packs/ultrasound. Increased peripheral central input may provide at least temporary partial relief of the phantom pain.

Sympathectomy Surgical procedure that destroys nerves in the

sympathetic nervous system. Increase blood flow to the limb decrease the

burning sensation of phantom pain.

BiofeedbackA method that uses the mind and body to control a body function that the body normally regulates automatically, such as skin temperature, muscle tension, heart rate, or blood pressure.

Mirror TherapyWhen patients with chronic pain issues anticipate movements to be painful, mirrors help deceive them into thinking that they are not experiencing pain via dynamic feedback to their brains.

Stump percussion (tapping)This technique activates the automatic reflex which makes us ignore things which are very repetitive. This reflex will dull the tenderness in areas of your hand that are touched repeatedly.

Heat applicationSoothing warmth has been reported to help deal with occasional bouts of phantom limb pain. Warm baths, a heating pack, a Magic Bag, or wrapping the stump in warm, soft fabric can increase circulation. There are also rubs and gels which generate heat.

FarablocFarabloc is a fabric which contains extremely thin steel threads but looks and feels like linen. The makers state that Farabloc has a shielding effect from ions and magnetic influences, which protects damaged nerve endings. It stimulates blood circulation and produces a pleasant feeling of warmth.

Relaxation techniquesThe relaxation technique is related to the hypnosis treatment by use the use of mind and body to control the pain in both techniques.

Physical TherapyPhantom limb exercises plus prosthetic training are more effective in reducing phantom limb pain than routine prosthetic training plus a general exercise program.

Brain Stimulation Inserts tiny electrodes in the brain. A small electrical current delivered to the brain can sometimes relieve pain.

REFERENCES h

ttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3198614/

http://www.medmerits.com/index.php/article/phantom_limb_pain/P10

http://www.mayoclinic.org/diseases-conditions/phantom-pain/basics/treatment/con-20023268

http://ntuh.sicu.org.tw/readfile.php?doc=reading&id=Phantom%20pain.ppt