Phantom pain question Replies

Phantom pain question Replies

Pacific Orthotic Prosthetic Service

7/15/1999

I want to thank all those who responded. Especially those of you on
AMP-L. I recieved more info from them than OandP-L. Here is the original
post followed by the replies
Thank you again
Steve Childs

<original post>
I was given a unique case yesterday. 55 year old male, T-4 para, one
year post-op RBK, one month post-op LAK. Two weeks ago began experiencing
Phantom pain in the RBK. I'm looking for treatment options to control
Phantom limb pain. After 25 yrs this is the first I have ever heard of
this happening.


<replies>


Hi,
I am sorry I cannot be more specific but I think this may interest
you. Approx. 2 weeks ago, there was a progamme on British T.V.
regarding the management of phantom pain. The Dr. involved ( who
incidently was rubbished by the great, white, western male
ideology), found that by using mirrors to reflect the image of the
sound limb, pain relief was very successful. This is thought to be
due to the brain thinking that the reflected image is actually the
missing limb. By moving and exercising the intact limb, the brain
responds and several amputees have said that it feels
like they can unlock the muscular spasms and nerve sensations in the
absent limb.

The results have been very successful and it would appear that more
research is needed in to this therapy. Has anyone else heard of this
treatment ?

Regards,
Vicky

*********

Good Luck!

This is not a problem that a prosthetist can manage with great success.
The
only thing that may help a person with phantom pain, not stump pain,
would be
a well fitting total contact socket. Activity would help but in a para
it's
very difficult. In whatever caused this patient to become a para severed
his
large motor nerves leaving the tiny temperature and pain nerves.

In a fully capable person with phantom pain biofeedback, acupuncture and
pain
meds MAY help. In your para pain meds and it's only slightly possible
that
acupuncture may help. I would suggest you do whatever you can
prosthetically
and then refer the patient to a physiatrist who also has acupuncture
training. The physiatrist will possibly be able to help with the
acupuncture
and pain meds and most probably in tandem.

Ask me directly for more direction.

Evan A. Bader, MD, CPO, FAAOP

**************

Hi Steve Childs - Does sound odd. I would detail it to Dr. V.
Ramachandran,
one of the seminal researchers in the nervous system. I think it's
<Email Address Redacted> The man is very personable and approachable. A
recent
book of his is Phantoms in the Brain. His thought about phantoms is the
only intelligible thing I have encountered, and as an amputee myself I
can
confirm much of what he suggests. It occurs to me to try to distinguish
pain from other sensations. So many amputees seem to define all post
amputation sensations as painful, stubbornly. Cheers, George Boyer.

PS: I'm rather a fan of his. He wrote a single-authorship research
paper
which was published in the prestigious 'Proceedings of the National
Academy
of Science'.....
longish at 80 k but I can email it to you if you have interest. GB.

**********

I have a magazine article that seems to be very helpful on addressing
treatments of phantom pain for amputees. If you would like me to send
you the article-please respond with your mailing address.
I would like to make it clear that I am not a doctor. I work with
amputees on a daily basis through my office position.

Have a nice weekend,

Julia M. Marsh
United Amputee Services Association, Inc.
407-678-2920

*********

I don't know how the drug prescribing laws are in your country, but be
careful how you recommend medicinal treatments, even a recommendation of
product could possibly get you into trouble.

I've been interested in the TENS ( transcutaneous electrical nerve
stimulation ) treatment lately, largely because it can be recommended
easliy due to its noninvasive nature. A recent search of the net
revealed dozens of manufacturers/retailers willing to sell units. There
cost is appealing too !

The most recent of my patients became drug free and pain free in about
three weeks of TENS treatment, though I'd usually expect slightly
longer.

Scott - Prosthetist, New Zealand.

*********

Yep, to my dismay, phantoms and SCI often go together:-( A couple of
questions from the original post come up. First, as Esther mentioned,
the SCI could be incomplete allowing the guy to feel something (or
even everything) in his legs. Second, which came first, the SCI or the
amputations? Last, how long post SCI is he? If he is an old, complete
SCI and a recent amputee, that would raise some tantalizing questions!

Russ
<Email Address Redacted>
Virtual Paraplegia
<URL Redacted> In SCI people have been very well documented in the medical
literature. As Jan suggested, check it out. This is not at all
uncommon,
and is another piece of evidence which points to a central, (brain)
mechanism for the phantoms, which is not fully understood. Several
studies
now being done on possible drug interventions for the phantoms involve
SCI
patients as well as amputees.

The publications of Ramachandran are another piece of evidence to uphold
this theory, and are certainly valid. The only objection I have is the
comment that his mirror therapy has been very successful. This is not
the case, but an example of media hype. It has been mildly to moderately
helpful for some individuals, a few arm amps. As I have stated before on
many occasions, there are many treatments for the phantoms, but not one
has been 100% successful for 100% of the time. However, I see no reason
not to try this , it may work for you, is non-invasive and won't cost a
fortune. Can't hurt, might help.

Christina HPMD

***********

FYI, I believe one of those articles dealt specifically with
phantom pain in SCI patients and proposed hypothetical mechanisms
for the pain perception. I don't have the list with me, but I would
guess the article appeared in Pain 1995 or, more probably, more recently
than that. A Medline search at one of the free sites, like the National
Library of Medicine, should turn up abstract.

Jill McMahon < <Email Address Redacted> >

***************

Paraplegics can be complete paraplegics and incomplete paraplegics.
Complete means zero sensation or control past the injured place on the
spinal cord. Incomplete means that there is sensation or control or both
past the injury point.

One of my ex-roommates has an incomplete spinal cord injury. To wit, she
cannot drive a car without hand controls, uses a catheter, has a little
bit of bladder sensation, and can walk (within limits). She cannot climb
ladders.

As for the Ramachandran research about mirrors helping this patient with
phantom pain, I don't know. Maybe if he has phantom pain in one limb
but not the other?

Esther

**************

I always believed that Phantom Pain exists completely in the mind (brain)
and not be dependent upon nerve conections to the affected area. Indeed,
the
nerves are severed in an amputee, and just severed a little bit higher in
a
SCI. Be aware that something that is in the mind does not make it any
less real.

Regards
Greg

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