Phantom Limb Pain: Causes and Cures

摘要

Phantom limb pain is a frequent sequel of amputation. Peripheral factors such as local changes in the residual limb and alterations in severed nerves and associated dorsal root ganglia (DRG), as well as central changes such as synaptic reorganization at spinal, brainstem, thalamic, and cortical levels all contribute to phantom pain. To date, few mechanism-based treatments for phantom limb pain have been proposed and so most of the literature on treatment is based on anecdotes. Interventions targeting central and peripheral changes hold out some promise. Attempts to prevent phantom limb pain by peripheral analgesia have not yielded consistent results, but other approaches to the reversal or prevention of pain memory formation may be effective. The amputation of a limb is usually followed by the sensation that the deafferented body part is still present. Nonpainful phantom sensations may include a specific position, shape, or movement of the missing limb, and feelings of warmth or cold, itching, tingling, or electric sensations, and other paresthesias. "Phantom limb pain" is pain in a body part that is no longer present. Phantom pain occurs to some degree in 50-80% of all amputees (Jensen and Nikolajsen 1999; Kooijman et al. 2000; Nikolajsen and Jensen 2001).