Phantom Pain In Amputees Research Articles

Targeted Muscle Reinnervation and Regenerative Peripheral Nerve Interfaces for Prophylactic Pain Control in Neurofibromatosis Type 1 Amputees.

Neurofibromatosis type 1 (NF1) is an inherited multisystem disorder that affects one in 2500 to one in 5000 people. Neurofibromas are the second-most common benign peripheral nerve sheath tumors arising from Schwann cells and are associated with neurofibromatosis. Chronic pain and opioid use is elevated in patients with NF1 when neurofibromas are associated with sensory nerves. Surgical excision is the primary treatment of neurofibromas when they become large, malignant, or painful, but they are associated with high rates of recurrence. Targeted muscle reinnervation and regenerative peripheral nerve interfaces are two prophylactic surgical techniques that are used to prevent neuroma-associated residual limb and phantom pain in amputees. Both techniques stimulate physiologic regeneration of the nerve via trophic stimulus from denervated muscle. This case report describes two patients with NF1 who underwent targeted muscle reinnervation and/or regenerative peripheral nerve interfaces at the time of amputation. Despite the abnormality of the peripheral nerves involved, both patients had excellent postoperative outcomes with minimal pain. This experience advocates for the use of prophylactic nerve management techniques in neurofibromatosis patients despite baseline nerve pathology.

The use of mirror therapy in the treatment of phantom limb pain in amputees

Mirror therapy is a non-invasive and inexpensive therapeutic procedure indicated for the treatment of post-amputation phantom limb pain. This technique has proven its effectiveness and consists of bringing into play brain plasticity in order to reshape the central body architecture after amputation. This is a quantitative and descriptive study, which aims to objectify the use of mirror therapy on phantom pain in amputees, by combining the results in order to evaluate its effects, its application and its limits in the management of post-amputation.

Experimental Induction of a Perceived “Telescoped” Limb Using a Full-Body Illusion

Phantom limbs refer to the sensation that an amputated or missing limb is still attached to the body. Phantom limbs may be perceived as continuous with the stump so as to resemble a normal limb, or as “telescoped” with the more distal portion of the phantom being perceived as having withdrawn within the stump. Telescoping tends to be related to increased levels of phantom pain, making it a clinically relevant phenomenon to investigate. In the current study we show that a full-body illusion can be used to induce the sensation of a telescoped limb in healthy individuals. For the induction of the full-body illusion, participants saw the body of a mannequin from a first person perspective while being subjected to synchronized visuo-tactile stimulation through stroking. Crucially, the mannequin was missing its left hand so as to resemble an amputee. By manipulating the positioning of the strokes applied to the mannequin's stump with respect to the participants’ hand we were able to evoke the sensation of the participants’ hand being located either below the stump or, more crucially, “inside” the stump, i.e., telescoped. In three separate experiments these effects were supported by complementary subjective data from questionnaires, verbally reported perceived location of the hand, and manual pointing movements indicating hand position (proprioceptive drift). Taken together our results show that healthy individuals can experience the body of an upper limb amputee as their own, and that this can be associated with telescoping sensations. This is a theoretically important observation as it shows that ownership of an entire body can be evoked in the context of gross anatomical incongruence for a single limb, and that telescoping sensations occur as a consequence of the body representation system trying to reduce this incongruence. Furthermore, the present study might provide a new platform for future studies of the relationship between telescoping and phantom pain in amputees.

PR_238: Sciatica Caused by a Sacroiliac Fixation Screw in a Traumatic Transfemoral Amputee: A Case Report

Setting: University outpatient clinic. Patient: A 32-year-old man with a transfemoral amputation and persisting neuropathic pain. Case Description: This patient recovered from multiple left-sided fractures following a snowmobile versus automobile collision. However, he continued to experience severe neuropathic pain in his amputated left leg and foot during the 2 years since his initial injury. After multiple unsuccessful medication trials, he presented to our amputee clinic for a second opinion. Assessment/Results: He had swelling and tenderness in the distal stump, so an ultrasound was ordered. It showed a hypoechoic mass at the distal sciatic nerve. Magnetic resonance imaging (MRI) confirmed the presence of a neuroma. Subsequent treatments targeted at the neuroma were unsuccessful, including image-guided anesthetic blocks. He had no history of back pain, but the distribution of his pain resembled the S1 dermatome, so a lumbosacral MRI was ordered. This showed a sacroiliac screw, placed to stabilize a pelvic fracture, intruding into the left S1 neuroforamen. A diagnostic S1 nerve block temporarily relieved his pain, and the screw was subsequently removed. Discussion: A handful of cases have reported sciatica in amputees. The symptoms are usually described as a phantom pain or neuropathic pain in the residual limb and are often refractory to conventional treatments. These symptoms typically occur with back pain, and are distinct from the patient’s usual symptoms. Because of this, this case demonstrates that these findings are not universal. Conclusions: Radiculopathy should be included early in the differential diagnosis of refractory phantom pain in amputees with a history of spine or pelvic instrumentation. It should also be considered in those with a change in their usual pain symptoms. As conventional diagnostic tests are limited, including physical exam and electromyography, fluoroscopically guided injection is a useful diagnostic tool in these patients.

A Clinical analysis of Phantom Limb and Phantom Pain in Amputees

A Clinical analysis of Phantom Limb and Phantom Pain in Amputees