Phantom Limb Pain

Learning Targets:Discuss and analyze the occurrence of phantom limb phenomenonAnalyze the theories that explain phantom limb pain.

Think about it…

You are driving on a remote road during a blizzard. Your car hits an icy patch and you skid into an embankment. You are not seriously injured but your right leg is trapped. After 24 hours pass you realize that no one is going to find you. Would you…

JUST A THOUGHT!!

• Cut off your own leg with a pocket knife?

Phantom Limb – A Case Study

• In 1993, Donald Wyman was in the forest driving a bulldozer.

• A giant oak tree suddenly fell and pinned him to the ground.

• He was all alone and no one could hear his shouts for help.

• Donald knew what he had to do.• He took out his 3 inch pocket knife and cut off his leg,

just below the knee.

More about Donald

• He was bleeding badly, but was able to drag himself to his truck and drive a mile and a half down the road to get help.

• His limb was too badly damaged to be reattached. (they recovered the part of his leg he sawed off)

• Donald now has an artificial limb that is fitted to the stump of his leg.

Additional Facts

• Only few patient’s are in constant pain.

• Pain is primarily located in parts of the missing limb.

• Few case reports suggest that pre-amputation pain may persist as PLP, but this is not the case in most patients.

• Phantom pain is more frequent in patients with long-term stump pain.

By the Numbers

• An estimated 1.7 million people in the US are living with limb loss.

• Each year 158,000 persons undergo an amputation

• The incidence of phantom pain is 60-80% among amputees.

• Independent of adult age, gender or location or side of amputation (less common in children or congenital amputees)

His Recovery

• His recovery went well, though he does have a problem.• “The toughest part since the accident is dealing with

phantom pain. It feels like somebody’s holding an electrical shock to your foot that’s not there. It makes you jump around.”

• We are now going to discuss the strange phenomenon of the phantom limb.

Phantom Limbs

• Doctors have been puzzled by the phantom limb since they were first reported in 1866.

• Phantom limb – Feeling sensations or movements coming from a limb that has been amputated.

• These sensations are felt as if the limb were still present.

Does this happen frequently?

• The vast majority of individuals claim to feel sensations or intense pain coming from their removed limb.

• They often refer to it as “pins and needles”• They insist that it is “real” pain, not memories of previous

pain.• Some individuals claim that their phantom limb was still

present and that it was stuck in certain positions. (straight out from their bodies)

• Some felt that they had to be very careful not to hit their phantom limb when going through doorways!

Answers: #1:

• Sensations come from cut nerves in the stump.

• Early research thought that when nerves were cut near the spinal cord, phantom limb should have been prevented.

• The sensations still remained though.

• This early answer has been rejected.

Answer #2:

• Sensations come from the spinal cord.

• If sensations from phantom limbs do not come from the stump, perhaps they originate in the spinal cord.

• Well…Even individuals whose spinal cords have been severed above the stump report phantom limb sensations.

• A severed spinal cord prevents sensations.

• This theory doesn’t work either.

Answer #3:

• Sensations come from the brain itself.

• Researchers have enough data now to indicate that the origin of phantom limb sensations must be the brain itself.

• They are still puzzled however, how the brain generates sensations from phantom limbs.

Answer #4:

• Sensations come from a body image stored in the brain.

• This theory states that we are all programmed with a system of sensations that show us where are body parts are.

• Based on sensations from body parts, the brain pieces together a complete body image.

• Having this “body image”, the brain can generate sensations coming from any body part, even if that part is a phantom limb.

Between a Rock and a Hard Place: The Story of Aron Ralston

• Aron was forced

• to cut off his own

• arm when he became

• trapped while rock climbing.

• Let’s hear his story!

How do people cope with Phantom Limb Pain?

1. Using a mirror to reflect a limb that is not present

How do people cope with Phantom Limb Pain?

2. Training your brain.

How do people cope with Phantom Limb Pain?

3. Some will even resort to causing “pain” to the prosthetic limb.

How do people cope with Phantom Limb Pain?

4. Medication, massage, physical therapy, deep brain stimulation, etc.