Phantom Limb Pain

As the scope of care and responsibilities of Physician Assistants’ expands, so does the range of medical conditions to diagnose and treat grow. One medical condition that has become more prevalent in the past decade due to the wars in Afghanistan and Iraq is Phantom Limb Pain (PLP). With reported rates of PLP in 50% to 85% of amputees (Weeks, Anderson-Barnes, & Tsao, 2010, p. 278) and over 900 amputees as a result alone from the conflicts in Iraq and Afghanistan (Weeks et al., 2010, p. 284), the need for understanding and evaluating the best treatment options in managing PLP in patients has increased. This paper will explain what PLP is, establish the most common treatments for managing and reducing PLP by comparing and contrasting recent studies
PLP is described as pain in a limb that has been amputated ranging from hands, arms, feet, legs and more. Patients with PLP have described the sensation as, “burning, cramping, and tingling, as well as lancinating electrical socks, itching, stabbing, throbbing, and even a feeling or ‘pins and needles’” (Weeks et al., 2010, p. 278-279). Others have distinct sensations of PLP such as, “cramping resulting from clutching a grenade, firing a rifle, or boots compressing toes too tightly” (Weeks et al., 2010, p. 279). While anyone who has had a limb amputated may experience PLP, factors that may affect prevalence in PLP include, “women… upper extremity amputation, presence of pre-amputation pain, residual pain in remaining limb… stress, anxiety, depression and other emotional triggers” (Knotkova, Cruciani, Tronnier, & Rasche, 2012, p.
Dr. V. S. Ramachandran was a one of the first to propose the popular theory of PLP being due to neural plasticity; the brain essentially rewiring its somatosensory system. In Dr. Ramachandran’s breakthrough article, “Behavioral and magnetoencephalographic correlates of plasticity in the adult human brain,” he describes his experiment in which he blindfolded arm amputees and stroked a Q tip on various skin surfaces and each subject described where they felt sensation from the Q tip on their body. Dr. Ramachandran’s subjects both felt sensations on very specific regions on their face as well as a, “ ‘tingling’ sensation in an individual digit” (Ramachandran, 1993, p. 10415) of the amputated arm. Dr. Ramachandran compared the location of senses to the Penfield homunculus and noticed that areas that amputees felt sensations from the Q tip (face and upper arm) are sandwiched between sensations for the hand. With this information, Dr. Ramachandran proposed the theory that the brain is capable of “remapping” sensations with nearby areas, “rewiring” itself so that “sensory input from the face and from around the stump were to ‘invade’ the cortical territory of the hand, “ (Ramachandran, 1993, p. 10417). Dr. Ramachandran further explains a theory for the pain associated with phantom limbs as being due to, “a slight error in the remapping-a sort of ‘cross-wiring’ –so that