Phantom pain is an intriguing mystery that has captured the imagination of health care providers and the public alike. How is it possible to feel pain in a limb or some other body part that has been surgically removed? Phantom pain develops among people who have lost a limb or a breast or have had internal organs removed. It also occurs in people with totally transected spinal cords. Unfortunately, phantom pain is a medical night mare. Many of the people reporting phantom pain make dispropor tionately heavy use of the medical system because their severe pains are usually not treated successfully. The effect on quality of life can be devas tating. Phantom pain has been reported at least since 1545 (Weir Mitchell as related by Nathanson, 1988) and/ or experienced by such diverse people as Admiral Lord Nelson and Ambroise Pare (Melzack & Wall, 1982; Davis, 1993). The folklore surrounding phantom pain is fascinating and mirrors the concepts about how our bodies work that are in vogue at any particu lar time. Most of the stories relate to phantom limbs and date from the mid-1800s. The typical story goes like this: A man who had his leg ampu tated complained about terrible crawling, twitching feelings in his leg. His friends found out where the leg was buried, dug it up, and found maggots eating it. They burned it, and the pain stopped. Another man complained of a swollen feeling with frequent stinging or biting pains.
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Locations Characteristics and Descriptions
Phantom Pain as an Expression of Referred and Neuropathic Pain
Potential Mechanisms of Phantom Tooth Pain
The Role of the Sympathetic Nervous System in Phantom Pain
Central Nervous System Correlates and Mechanisms of Phantom Pain
Psychological Factors Influencing Phantom Pain
History of Treatment Attempts
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activity afferent allodynia ampu amputation anesthesia anesthetic Arena autotomy block blood flow body burning phantom pain central sensitization Chapter chronic pain chronic phantom clinical cognitive correlated cramping phantom pain deafferentation decrease descriptions of phantom Devor dorsal root ganglia dysesthesias ectopia ectopic effective epinephrine episodes experience factors feel fibers Figure finger foot ganglion healing homunculus hyperalgesia injection input intact limb intensity of phantom Katz Marbach mechanism Melzack memory component muscle tension nerve injury neural neuroma neurons nociceptors normal pain memories pain patients peripheral persisted phan phantom limb pain phantom limb paresthesias phantom limb sensation phantom pain phantom sensations phantom tooth pain physiological preamputation pain problems prosthesis prosthetic psychological relationship reporting phantom pain residual limb response saphenous nerve sensory Sherman Sherman & Sherman socket somatosensory memory spinal cord stimulation stress studies stump pain stump skin conductance surgery surgical sympathetic nervous system tion tissue treatment for phantom triggered
Page 261 - Wall PD, Gutnick M: Ongoing activity in peripheral nerves: The physiology and pharmacology of impulses originating from a neuroma. Exp Neurol 45:576-589, 1974.