Pain Management Phantom limb pain

Darcy_A._Umphred]_Umphred_s_neurological rehabilitation 
SECTION  III  Neurological  Disorders  and  Applications  Issues
CHAPTER 32 pag1003,1004 

ANNIE  BURKE-DOE,  PT,  MPT,  PhD

There are two theories of the cause for phantom limb pain. At one time it was thought that it occurred as the result of the formation of a terminal neuroma at the site of the amputation11; however, this theory did not explain phantom phenomena in  individuals with congenital amputations or individuals with complete spinal cord injuries who also experience painful and nonpainful sensations in their missing or anaesthetic limbs.  This led researchers to look at the role of the CNS in phantom phenomena, and the latest theories suggest the previously described changes in the dorsal horn neurons and changes in the spinal cord caused by the sudden loss of afferent impulses after amputation.157 These theories are supported by the effectiveness of interventions that stimulate the large nerve fibres and provide inhibitory input through the gating mechanism. Phantom limb pain is relieved by stroking, vibration, TENS, ultrasound, heat applications, and the use of a prosthesis. The patients can be taught a progressive desensitization program. He should be encouraged to wear the shrinker both to prepare his stump for a prosthesis and to decrease pain. Because phantom limb pain is adversely affected by emotional stress, exposure to cold, and local irritants, he should be taught to avoid these factors as much as possible. The patience’s adjustment to a changed body image, a changed lifestyle, and the use of a prosthesis can be aided with any of the cognitive strategies described previously. He might also benefit from referral to an amputee support group. It is important for the patient to be aware of his abilities and limitations so that he remains safe when he returns to work. If appropriate, the therapist should accompany the patient to his job and perform a job task analysis, making suggestions for necessary modifications. If this is not possible, the therapist could discuss needed modifications with the patience based on his descriptions of his job tasks. 

11 FinePG,AshburnMA:Functionalneuroanatomyand nociception.InAshburnMA,editor:The  management of  pain,NewYork,1998,ChurchillLivingstone.

157 HillA: Phantom limb pain:are view of the literature on attributes and potential mechanisms.
J  Pain  Symptom  Manage17:125–142,1999.