Phantom Limb Pain Research Paper

Gawande wrote about a woman named M. who scratched through her skull to her brain in her sleep. The scratching only gave her momentary relief before the urge to scratch just grew bigger making the annoyance worse. Since pain was thought to be so closely linked to itching through nerves, M’s doctors thought that the only way to get rid of the itch was to cut off the function to the nerves where the itch was present. After losing the feeling in her face and after taking anesthetics and antibiotics the urge to scratch still came back, becoming more of a chronic itch. Fueling Gawande's theories about the itch, he theorized that maybe there is nothing wrong with the nerves at all. He thought that there was something going wrong in the brain when it tells your body that you need to scratch, when clearly you do not. After becoming more in depth with M’s case, Gawande then introduced a man named H.. H. suffered from strange symptoms of phantom limbs. Phantom limb sensations were described as, “... far too varied and rich to be explained by the random firings of a bruised nerve” (Gawande, 2008). Gawande's theory expanded by theorizing that the brain can't visually see that the person/self is healed when the nerve transmissions are shut off due to

When a body part is lost the corresponding part of the brain is not able to handle the loss and rewires its circuitry to make up for the signals it was no longer receiving from the missing digit. The rewiring might occur in one of two ways. Perhaps nerve impulses in the sensory cortex begin to course down previously untraveled pathways. The second theory is that neighboring neurons in the cortex may actually invade the territory left fallow because sensations are no longer received from the missing limb.

Numbness and tingling of the limbs are also common symptoms. Since Multiple Sclerosis targets the central nervous system, no signals are dispatched down the spine creating numbness is multiple parts of the body. Healthline Editorial Team, George Krucik, MD, MBA Early Signs of Multiple Sclerosis, January 25, 2013, states that “the spinal column (the body’s message center), it can send conflicting signals around the body. Sometimes, no signals are sent, which results in the most common symptom, numbness.”

The phantom limb pain the woman is experiencing is described as a painful condition of the amputated limb after the stump has completely healed. It is a chronic pain that occurs in more than 80% of amputees especially those who suffered pain in the limb before the amputation. Theories suggest that phantom limb pain results from redevelopment or hyperactivity of cut peripheral nerves, scar tissue or neuroma formation in the cut peripheral nerves, spinal cord deafferentation, and alterations in the thalamus and cortex. More so, the CNS integration, which involves reorganization and plastic modifications of the somatosensory cortex, effects the receptors in perceiving the pain of the amputated limb despite of the limb itself being absent. In addition,

For my final paper topic, I have chosen to discuss phantom limb pain. I was inspired to write about phantom limb pain after a recent visit to the Veterans Affairs hospital. I will be explaining the physiological aspects, including involvements of nerves, spinal cord, and the brain, as well as the psychological aspects, including grief, stress, depression and anxiety of phantom limb pain. According to Goldstein (2010), phantom limb pain is a phenomenon that a person whose limb has been amputated continues to experience the sensation of the limb (p.344). Along with the sensation of the amputated limb, patients can also experience pain, tingling, numbness, and temperature changes. People who were born without a limb can also experience phantom

Furthermore phantom limb pain is simply a sensation of pain. A patient experiences the pain in an affected extremity that no longer exists (McCance & Huether). Although nerve fibers have the capability to regenerate this is a time consuming process that does not always yield a fully functional nerve (Subedi & Grossberg, 2011).

With conflicting research and hardly valid data, to say that phantom limb syndrome is solely caused based on psychogenic mechanism of the patient is inaccurate. More recent research has strongly suggested peripheral mechanism to also be a factor in phantom limb syndrome. Once amputation of a limb or part of a limb is performed, a neuroma is created. Neuromas result from a trauma to the nerve and are typically formed on the site of an inquired sensory nerve, forming a knot in the area. The knot is mainly composed of axons that can no longer reconnect to the rest of the nerve cells due to amputation . These neuromas are the site where increased excitability due to an increased accumulation of molecules (recent research, scientist are not quite

Data indicated that PLP is related to, and may be a consequence of, plastic changes in the primary somatosensory cortex, and that the shift of the cortical map following amputation might be a potential neurophysiological basis of PLP (6).

To prevent the risk of developing phantom limb pain, doctors suggest the use of regional anesthesia through spinal or epidural few hours or days leading to the amputation. By doing this procedure, it might help to reduce the pain before the surgery hence reducing the risk of lasting phantom limb pain. Most amputees that have phantom pain, often feels to them as if they’re stuck in their last action with that limb. The mirror clears and retained memories of limb position from the brain. It is also helps neurons start making new connections in the brain.

Body Integrity Identity Disorder (BIID, also known as apotemnophilia and xenomelia) is a rare condition in which the person experiences a strong feeling of ‘overcompleteness’ with four limbs, causing an intense desire for amputation (1,2). Instead of a wish for amputation there may also be a desire to paralysis (3). These individuals do not suffer from delusions or psychosis, and fully understand the bizarre nature of their desire (2,4). At this time BIID is not included in the ICD-11 or DSM-5, causing this condition to be unknown by psychiatrists, neurologist and surgeons. Therefore there is no effective pharmacological or psychotherapeutic treatment option available (2). Only the requested amputation itself seems effective, but for ethical reasons those amputations are not preformed in regular healthcare (3). As a result BIID individuals often avoid healthcare and express their desire by pretending to be disabled or, in extreme cases, by eventually performing self-amputation (4–7).

The so-called "I-function" which describes the brain's sense of self takes on interesting connotations when discussing phantom limbs and associated phantom pain. The loss of an arm or leg through amputation is not an easy experience to endure, and is even more difficult when the patient begins to feel sensations in their now missing limb. These feelings, sometimes referred to as "stump hallucination", is the subjective sensation, not arising from an external stimulus, that an amputated limb is still present (1). Although they no longer exist, patients perceive these limbs as still being essential components of their body-image, and continues to move in sync with their torso and other

Sensory neuropathy can affect the hands, feet, legs and arms, symptoms may range from mild to severe, such as numbness, reduced ability to sense pain or extreme temperatures, tingling feeling, unexplained burning sensations, sharp stabbing pains, often symptoms are more noticeable at night. People with sensory neuropathy may experience dysesthesia (abnormal sensation) symptoms of dysesthesia include a burning feeling under the skin and extremely sensitive skin to the extent where clothes and bedding can cause intense pain (Diabetes UK,

Sacks discussed the ideas behind the phantom limb and how they affected many peoples live. The most interesting story was about a sailor that accidentally cut off his index finger. For forty years he thought he would poke himself in the eye whenever he moved his hand to his face. One day he lost the feeling in his entire hand including his phantom finger and his problem was cured (Sacks 66-67). Up to 70 percent of amputees confirmed that they still feel or still thought a missing limb was there. They often feel that they can reach out and grab something. Some won't sleep in a certain way because they feel the missing limb between them and the mattress. The sensations felt stem from the activity of the sensory axons

An extensive matrix of neurons in the brain gives us the sense of our own bodies and body parts. Pain results when this matrix produces an abnormal pattern of activity, as a result of memories, emotions, expectations or signals from various brain centres and not just from signals from peripheral nerves. Because of the lack of sensory stimulation or a person’s efforts to move a nonexistent limb, abnormal patterns may arise, resulting in phantom pain.

A therapeutic approach that has the potential to temporarily resolve the visuo-proprioceptive dissociation described in phantom limb pain is mirror therapy.(4) Mirror therapy was exposed by Ramachandran and Rogers-Ramachandran in 1996.(3) When doing mirror therapy, a patient is allowed to feel the imaginary movement of the amputated limb as normal body movement through a mirror by moving their intact limb while watching the reflection in a mirror. This induces the illusory perception of movement of their phantom limb. (3) (4) (6) The mirror image of the normal limb is believed to help reorganize and integrate the difference between proprioception and visual feedback and representations of the amputated limb, thus enhancing the treatment effect for phantom limb pain through the illusion or imagery of movement of the