Which Treatment for Phantom Limb Pain Based on Central Mechanisms is Most Effective? Abstract
Phantom limb pain is a common symptom experienced by over 90% of amputees. It’s defined as a painful sensation from a part of the body that no longer exists. There are a variety of methods for treating this neuropathic pain, but at the moment there is no specific treatment to tackle the pain completely. A mixture of medications and therapies has been proposed and trialed including drugs, surgical treatment and neuromodulation. Nonetheless, it is essential that a specific mechanism is targeted to in order to achieve the best therapeutic method.
From central stimulation to mirror therapy, the development of a wide range of treatments available today is due to central mechanisms of phantom limb pain that provide major grounds for research. Other treatments, aside from those related to the central mechanism, are also worth considering in order to improve our understanding. Results of these trials currently suggest that mirror therapy seems to be the most effective treatment based on central mechanisms, with the remaining therapies giving rise to a range of positive to negative outcomes.
Phantom limb pain first arose during the sixteenth century by a French military surgeon, Ambrose Pare (Weinstein, 1998). He described this as pain being perceived from a part of the body which no longer exists, therefore belonging to neuropathic pain syndromes. The phantom limb is generally described to have a tingling sensation and a definite shape that resembles the limb pre amputation. Moreover, some claim to feel it move through space in the same way that the normal limb would have, for example, walking, sitting and stretched out (Melzack, 1973). Almost all amputees would report these non painful sensations immediately after surgery (Nikolajsen et al, 2005). Initially, the phantom limb feels normal causing the amputee to use the limb for its would be usual purposes such as reaching out for objects. However, eventually sometimes the limb begins to change shape resulting to a change in type of pain and sensation reflecting the extent of neurological damage this causes (Melzack, 1973). The spectrum of pain from a phantom limb ranges from rare, short lasting painful shocks to a continuous, excruciating pain where the subject feels intense perception of the absent limb (Flor et al, 2006). It seems to be more severe and vivid in the distal compartments of the limb sharing a variety of characteristics such as throbbing, stabbing, cramping or burning (Hill, 1999). Blakeslee and Ramachandran have stated that some people misidentify a limb for representing another, for example, one patient described her phantom arm of being "6 inches too short" (Ramachandran et al, 1998). Similarly. the onset of pain varies between individuals ranging from immediately to many years after the amputation (Nikolajsen et al, 2005). Some experience the limb to be telescoped into the stump until only the foot or hand could be felt (Melzack, 1973). These variants of the pain has lead to a broader definition where phantom limb pain is now also applied to describe pain in regions which have been completely denervated but not amputated (Portenoy et al, 1996).
These findings provided the root of extensive research encouraging scientists around the world to experiment and understand this condition. However, it still remains as a poorly understood and challenging to tackle pain syndrome. Recently, a review in 2005 has approximated that there were about 1.6 million individuals suffering from limb loss in the USA with this amount set to double by the year 2050 (Ziegler-Graham et al, 2008). This emphasises the importance of trying to establish a certified treatment or therapy in order to improve the quality of lives of those suffering. Currently, scientists and researchers have proven that there are a variety of ways to approach phantom limb pain in terms of...
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