Elsevier

The Lancet Neurology

Volume 1, Issue 3, July 2002, Pages 182-189
The Lancet Neurology

Review
Phantom-limb pain: characteristics, causes, and treatment

https://doi.org/10.1016/S1474-4422(02)00074-1Get rights and content

Summary

Phantom-limb pain is a common sequela of amputation, occurring in up to 80% of people who undergo the procedure. It must be differentiated from non-painful phantom phenomena, residual-limb pain, and non-painful residual-limb phenomena. Central changes seem to be a major determinant of phantom-limb pain; however, peripheral and psychological factors may contribute to it. A comprehensive model of phantom-limb pain is presented that assigns major roles to pain occurring before the amputation and to central as well as peripheral changes related to it. So far, few mechanism-based treatments for phantom-limb pain have been proposed. Most published reports are based on anecdotal evidence. Interventions targeting central changes seem promising. The prevention of phantom-limb pain by peripheral analgesia has not yielded consistent results. Additional measures that reverse or prevent the formation of central memory processes might be more effective.

Section snippets

Clinical characteristics

Phantom-limb pain is commonly classified as neuropathic, and it is assumed to be related to damage of central or peripheral neurons. Although such pain is most common after the amputation of an arm or leg, it can also occur after the surgical removal of other body parts such as breast, rectum, penis, testicles, eye, tongue, or teeth. Lesions of the peripheral nerves or the central nervous system (eg, brachial-plexus avulsion or paraplegia) can also cause phantom-limb pain. It seems to be more

Aetiology of phantom-limb pain

Both peripheral and central factors have been discussed as determinants of phantom-limb pain. Psychological factors do not seem to contribute to the causation but may instead affect the course and the severity of the pain.5, 22 The general view now is that many changes along the neuraxis contribute to the experience of phantom-limb pain.

References (80)

  • RA Sherman et al.

    Psychological factors influencing chronic phantom limb pain: an analysis of the literature

    Pain

    (1987)
  • J Sandkuhler

    Learning and memory in pain pathways

    Pain

    (2000)
  • CJ Woolf et al.

    Neuropathic pain: aetiology, symptoms, and treatment

    Lancet

    (1999)
  • RA Melzack

    Phantom limbs and the concept of a neuromatrix

    Trends Neurossci

    (1990)
  • PD Wall et al.

    Ongoing activity in peripheral nerves: the physiology and pharmacology of impulses originating from a neuroma

    Exp Neural

    (1974)
  • B Nystrom et al.

    Microelectrode recordings from transsected nerves in amputees with phantom limb pain

    Neurosci Lett

    (1981)
  • Z Seltzer et al.

    Mapping a gene for neuropathic pain-related behavior following peripheral neurectomy in the mouse

    Pain

    (2001)
  • R Inbal et al.

    Autotomy following nerve injury: genetic factors in the development of chronic pain

    Pain

    (1980)
  • GD Schott

    Pain and its absence in an unfortunate family of amputees

    Pain

    (1986)
  • E Torebjork et al.

    Noradrenaline-evoked pain in neuralgia

    Pain

    (1995)
  • RA Sherman et al.

    Temporal relationships between changes in phantom limb pain intensity and changes in surface electromyogram of the residual limb

    Int J Psychophysiol

    (1992)
  • JG Arena et al.

    The relationship between situational stress and phantom limb pain: cross-lagged correlational data from six-month pain logs

    J Psychosom Med

    (1990)
  • A Hill et al.

    The role of coping in adjustment to phantom limb pain

    Pain

    (1995)
  • H Flor et al.

    Extensive reorganization of primary somatosensory cortex in chronic back pain patients

    Neurosci Lett

    (1997)
  • P Soros et al.

    Functional reorganization of the human primary somatosensory cortex after acute pain demonstrated by magnetoencephalography

    Neurosci Lett

    (2001)
  • RD Treede et al.

    The cortical representation of pain

    Pain

    (1999)
  • L Nikolajsen et al.

    Relationship between mechanical sensitivity and post-amputation pain: a perspective study

    Eur J Pain

    (2000)
  • RA Sherman et al.

    A survey of current phantom limb pain treatment in the United States

    Pain

    (1980)
  • SH Sindrup et al.

    Efficacy of pharmacological treatments of neuropathic pain: an update and effect related to mechanism of drug action

    Pain

    (1999)
  • E Huse et al.

    The effect of opioids on phantom limb pain and cortical reorganization

    Pain

    (2001)
  • H Jaeger et al.

    Calcitonin in phantom limb pain: a double-blind study

    Pain

    (1992)
  • L Nikolajsen et al.

    The effect of ketamine on phantom limb pain: a central neuropathic disorder maintained by peripheral input

    Pain

    (1996)
  • C Chabal et al.

    Pain response to perineuromal injection of normal saline, epinephrine, and lidocaine in humans

    Pain

    (1992)
  • C Chabal et al.

    Pain responses to perineuromal injection of normal saline, gallamine, and lidocaine in humans

    Pain

    (1989)
  • RA Sherman

    Stump and phantom limb pain

    Neurol Clin

    (1989)
  • E Huse et al.

    Phantom limb pain

    Lancet

    (2001)
  • L Nikolajsen et al.

    Randomised trials of epidural bupivacaine and morphine in prevention of stump and phantom pain in lower-limb amputation

    Lancet

    (1997)
  • TS Jensen et al.

    Phantom pain and other phenomena after amputation

  • SW Mitchell

    Injuries of nerves and their consequences

    (1872)
  • G Keil

    So called initial description of phantom pain by Ambroise Pare. “Chose digne dadmiration et quasi incredible”: the “douleur es parties mortes et amputees”

    Fortschr Med

    (1990)
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