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Acute Neuropathic Pain
Published in Pamela E. Macintyre, Stephan A. Schug, Acute Pain Management, 2021
Pamela E. Macintyre, Stephan A. Schug
Phantom limb pain is defined as any painful sensations that are referred to the absent body part and is estimated to occur in up to 85% of patients (Schug et al, 2020). The pain is independent of gender, cause (elective or traumatic amputation), or side of amputation but appears to have a lower incidence in children and congenital amputees. The pain usually occurs in the distal portion of the missing limb and may resemble any preamputation pain in character and localization. Often the limb is described as being in a hyperextended or otherwise unnatural position. Phantom pain can develop immediately following amputation or have a delayed onset; in 75% of patients it occurs within the first few days, often in connection with stump pain (Hsu & Cohen, 2013).
Pain pathways
Published in Alison Twycross, Anthony Moriarty, Tracy Betts, Paediatric Pain Management a multi-disciplinary approach, 2018
Alison Twycross, Anthony Moriarty, Tracy Betts
It is important to remember that because the transmission of the nerve impulse is dependent on a number of nerves, varying in type, purpose and effects, the nervous system can be modified at a number of different sites. It is easy to imagine that the system could break down. The descending pathways could be damaged resulting in the continuing transmission of pain impulses to the brain, producing chronic pain. Using the analogy of the post office, everybody’s mail is delivered to you.The connections between the spinal cord and the sympathetic nerves could be damaged, resulting in sympathetic dystrophies that accompany chronic pain. There are no recordings that the mail has been delivered.The loss of a limb does not change the descending pathways or spinal reflexes that would normally modulate nerve impulses from the limb. The brain thinks that the limb is still attached, resulting in ‘phantom limb’ pain. Receiving imaginary mail.
The body in illness
Published in Havi Carel, Illness, 2018
Another example given by Merleau-Ponty is the phantom limb. A phantom limb is the sensation, which may be painful, emanating from a body part (usually a limb) that has been amputated. The phantom limb feels painful or itchy, but the real limb has been removed, sometimes a long time ago. This phenomenon has been a riddle to physicians for centuries. How can a limb that is no longer there cause any sensation at all? What exactly is hurting when the phantom limb hurts? This baffling phenomenon could not be accounted for by a physical naturalistic explanation, because the nerve endings that seem to be sending pain signals to the person’s brain are simply not there. How can you experience pain or tickling in a hand that was amputated years ago?
Pain issues in the victims with lower-limb amputation: 10 years after the 2008 Sichuan earthquake
Published in Disability and Rehabilitation, 2022
Qian Wang, Caiyun Chen, Sheng Zhang, Yiming Tang, Hongxia Wang, Xue Zhou, Man-sang Wong
The Prostheses Evaluation Questionnaire (PEQ) is a comprehensive outcome measure specifically used for the individuals with lower-limb amputation [23–25]. The version of PEQ used in this study was translated and tested to be valid and reliable by a team of Chinese researchers in 2004 [17]. The simplified Chinese characters were converted from the traditional Chinese characters for local survey purpose. In the PEQ, 15 questions specifically cover the amputation-related pain including phantom limb sensation (PLS), PLP, RLP, NALP, and BP. Phantom limb sensation is described as the feelings like pressure, tickle, or a sense of position or location of the amputated limb. This abnormal sensation is a real issue for the amputees and is linked to the PLP. Phantom limb pain refers to painful sensation in the portion of the limb that has been amputated, whereas RLP refers to painful sensation in the residual portion of the limb which is still physically present following amputation. Non-amputated limb pain is defined as painful sensation on the contralateral side of amputation, while BP indicates the painful sensation at the back. These definitions were explained by the trained researchers prior to each survey to facilitate the understanding of the difference among the above-mentioned amputation-related pain.
Managing limb pain using virtual reality: a systematic review of clinical and experimental studies
Published in Disability and Rehabilitation, 2019
Priscilla G. Wittkopf, Donna M. Lloyd, Mark I. Johnson
Recently, Dunn et al. [8] have reviewed the use of virtual representation of body parts in the treatment of phantom limb pain and concluded that there is only limited evidence to show that the technique may offer some immediate relief of pain, and insufficient data to establish a clear protocol for these interventions. Dunn et al. [8] did not evaluate the effect of virtual representation of body parts in other painful conditions known to produce disrupted perceptions, such as complex regional pain syndrome, or the outcome of studies that induced experimental pain in healthy pain-free participants. The findings of experimental studies are valuable because they enable investigators to control many of the confounding variables that influence pain experience in the clinical setting, and are often used as a precursor to clinical trials and to investigate the factors that influence treatment response [9]. For example, Nierula et al. [10] found that healthy pain-free participants reported higher pain thresholds and a stronger sense of embodiment towards a virtual arm collocated with their real arm compared with displacing the virtual arm 30 cm away from the body midline.
Stepping forward following lower limb amputation
Published in Physical Therapy Reviews, 2018
Prasath Jayakaran, Natalie Vanicek
In this special issue we have compiled five expert reviews to inform individuals who are involved in the rehabilitation process following limb loss. One review explores how prosthetic prescription is an integral component of the rehabilitation phase and for user outcomes. Phantom limb pain is a common impairment, often debilitating for many individuals and impacts their physical function and quality of life. Therefore, one review explores the non-pharmacological management of this condition. Patient education about the prevention of limb loss through modifiable lifestyle risk factors is critical, especially in individuals with diabetes and/or peripheral vascular disease, and one review explores how physical therapy plays an important role for individuals at high risk of amputation. While regular physical activity is recommended for the prevention of other health comorbidities, individuals with a lower limb amputation may encounter a number of barriers preventing them from regular participation. One review discusses the importance of physical fitness, and factors that impact physical activity in those with a lower limb amputation. Finally, the last review summarises some of the available physical therapy interventions to improve balance and walking ability.