What is Phantom Limb Pain?
Question:
Discuss about thr Psychology for Treatment of Chronic Pain Conditions.
The notion of Phantom pain or the Phantom limb pain refers to the sensations that are perceived as pain that is experienced by an individual associating with an organ or a limb which may not be a physical part of the body (Hanson 2016). This idea has been defined first by Ambrose Pare who was a military surgeon in France in the sixteenth century. Later the term ‘phantom limb pain’ has been coined by Silas Weir Mitchell and he had provided a widespread definition of the situation. However, the concept of phantom pain is still poorly understood in the medical science, therefore in many cases it is complicated to treat. A recent study exhibits that approximately 1.6 million patients with a loss of limb has been projected and some scholars indicate that the numbers may rise to 3.6 million by the year 2050 (Schipper and Maurer 2017). The phantom sensation is generally a sensory phenomenon that can be felt at the absent part of the limb or the entire limb. The past researches have indicated that approximately 80% amputees tend to experience the phantom sensations during some point of their lives. In fact some of the patients tend to experience a little phantom pain and feel the missing limb throughout their lives. Therefore this paper will target the depictions of phantom pain and will discuss the methods that can be utilized for treating it.
Resources suggest that the Phantom limb sensation and Phantom Limb pain both are interlinked but it needs to be differentiated from the other. The Phantom limb sensations are mostly experienced by those people who have an injury in the spinal cord or have a deficiency in congenital limb deficiency whereas the Phantom Limb pain tends to occur only as an outcome of an amputation (Chien and Bolash 2017). Some of the recent reports show that the prevalence of Phantom Limb pain is more common amongst the ones having upper Limb amputation than the ones having lower Limb amputation. Even though some of the researchers think that Gender and age make no difference in such experience of pain the previous reports have shown that Phantom Limb pain 3 to be more common amongst the female patients than the males. Even a recent survey has reported that overall pain interference and intensity is greater in the female patients than the males and it is also observed that women significantly endorsed great catastrophizing usage of few strategies for coping with the pain and believes that are associated to many aspects of the pain which may result in to poor adjustments.
There are several reports about Phantom pain and Phantom sensations after the amputation of the body parts such as Strong Teeth breast bladder eyes nose but Phantom meaning after leave application is most common amongst all. Throbbing, tingling, piercing and needle sensation are the most common pain that has been reported. Recent study has also revealed that there is a chance of a strong association between the residual limb pain and the Phantom Limb pain which may trigger anxiety, stress or depression and other emotional disturbances as well (Khan and Braun 2015). At the initial stage Phantom leaving pain has been considered as a psychiatric illness. However with the evidences from numbers of studies dating place over the past few decades the idea of Phantom pain has been shifted towards the neural axis. There are hypothesis is charges Central neural mechanism and peripheral mechanism that has gained immense population as the potential mechanism for defining Phantom Limb pain (Goldberg 2016). How is none of these theories are capable of explaining the phenomenon independently therefore most of the theorists believe that there are numbers of mechanism then to be responsible for the occurrence of Phantom Limb pain.
Causes of Phantom Limb Pain
There are numbers therapies that are relied on different theories which has been proposed for treating Phantom Limb pain. However according to many theories particular guidelines for treating Phantom Limb pain are yet to be evolved. There are three specific approaches for treating Phantom Limb pain such as pharmacotherapy invasive or surgical procedures and adjuvant therapy.
Over the years researchers have developed few pharmacological approaches for treating this pain. Anaesthesia and pre-emptive and a Glacier is a major approach for treating Phantom Limb pain. It is believed that pre-emptive usage of and aesthetics and analgesics in the preoperative period can prevent the stimulus from the particular imputed please from triggering the central neural sensation and other hyperplasic changes that may prevent future impulses to be amplified from that amputation site. Recent research has reported that following controlled and a Glacier optimised epidural anaesthesia within 48 hours of the amputation tend to decrease Phantom Limb pain. After years of studying the researchers have also settled on specific medications that can be used for treating Phantom Limb pain. A recent cross sectional research has indicated that NSAID and acetaminophen at the most common medications. Is Indore the analgesic mechanism of the lateral wall is not really clear but it is said that different central nervous system ways such as serotonergic tend to be involved here. The former one is believed to be in Hayward the specific enzymes which are required for synthesizing prostaglandin and decreasing nociception centrally and peripherally. Opioids are another renowned method for binding to the central and peripheral Opioid receptors therefore providing analgesia without losing consciousness proprioception or touch (Ortiz-Catalan et al. 2014). These can also diminish the reorganization of cortical therefore it can disrupt one of the potential mechanisms of Phantom Limb pain. For the past decade both controlled and random trials have revealed the call treating any neuropathic pain like Phantom Limb pain. According to Foell et al. (2014) tri-cyclic antidepressants is a commonly utilised medication for different neuropathic pain that was it is also used for treating Phantom Limb pain. The analgesic reaction of this anti depression is attributed mostly to the inhibitions of the serotonin norepinephrine uptake blockages. As stated by Raffin et al. (2016) the tri-cyclic antidepressant is already established for treating several conditions of neuropathic pain, but its reaction for treating phantom limb pain has been mixed. A recent research on the usage of antidepressants reveals that an average dosage of 55mg of amitrypline can control phantom limb pain in an excellent way. There are other pharmacological approaches for treating this pain such as anticonvulsants, Calcitonin or NMDA receptor antagonism. Both the results of Calcitonin and Anticonvulsant treatments have received mixed outcomes for controlling phantom limb pain (Vaso et al. 2014). Previous researches also report that the NMDA receptor antagonism is also unable to provide a clear mechanism for the pain. Some have shown remarkable benefits in some of the cases, whereas the controlled trial has exhibited mixed outcomes.
However the non-pharmacological treatments are also quite popular including Transcutaneous Electrical Nerve Stimulation, Integrative, bio-feedback, behavioural methods, mirror therapy, electroconvulsive therapy etc. According to Philip et al. (2017) Transcutaneous Electrical Nerve Stimulation (TENS) has always been helpful in PLP treatment. There have been several studies exhibiting its effectiveness. Even thought there is still no strong evidences, both high frequency and low frequency TENS are effective for treating PLP than any other methods. The devices for TENS are easily portable; however this therapy has some contradictions as well. Another well-known therapy for treating PLP is Mirror therapy which focuses on determining the visual-proprioceptive dissociation of the brain. In this therapy, the patient sees his or her reflection of their undamaged limb shifting in mirror that is placed between their legs or arms while shifting the phantom foot or hand in a way similar to their observation so that the phantom limb can be replaced by the virtual limb. Several studies have shown the existing mirror neurons can trigger both the times when an action is performed or observed. Random or controlled mirror therapy has been applied on patients who have amputation in their lower leg have exhibited that here is a significant benefit of this therapy as the activated mirror neurons can block the pain awareness within the phantom limb (Foell et al. 2014). On the other hand, even though there have been reports stating that the behavioural methods are helpful in treating the PLP, but there has not been any specific evidence of matching a specific behavioural and bio-feedback techniques matching to a particular type of PLP. However several neurotic pains tend to be treated with the help of hypnosis, relaxation techniques and guided imageries, therefore some case studies have shown that these cognitive behavioural therapies are effectual in treating PLP as well. Ambron et al. (2018) suggest that if no other treatment method is successful, surgical interventions can be employed. Some case studies also reveal that stimulating spinal cord can be helpful for patients who are not being able to obtain sufficient relief with medical procedures.
Conclusion
PLP is a comparatively common entity in the medical arena and psychology. However, there is still no such merging theory that can define the PLP mechanisms. Some treatments based on PLP mechanisms are still developing, however most PLP treatments are still done on the basis of specific suggestions for the neuropathic pains. Therefore it can be said that a combining hypothesis clarifying this phenomenon is still evolving for elucidating the connected between phantom limb pain and the proposed mechanisms.
Reference list
Ambron, E., Miller, A., Kuchenbecker, K.J., Buxbaum, L.J. and Coslett, H., 2018. immersive low-cost Virtual reality Treatment for Phantom limb Pain: evidence from Two cases. Frontiers in Neurology, 9, p.67.
Chien, G.C.C. and Bolash, R., 2017. Phantom Limb Pain. In Treatment of Chronic Pain Conditions (pp. 283-286). Springer, New York, NY.
Foell, J., Bekrater?Bodmann, R., Diers, M. and Flor, H., 2014. Mirror therapy for phantom limb pain: brain changes and the role of body representation. European journal of pain, 18(5), pp.729-739.
Goldberg, D., 2016. “What They Think of the Causes of So Much Suffering”: S. Weir Mitchell, John Kearsley Mitchell, and Ideas about Phantom Limb Pain in Late 19th c. America. Spontaneous Generations: A Journal for the History and Philosophy of Science, 8(1), pp.27-54.
Hanson, E., 2016. Phantom Limb Pain. Anesthesiology: The Journal of the American Society of Anesthesiologists, 124(2), pp.509-509.
Khan, T.W. and Braun, E.E., 2015. Phantom Limb Pain. Encyclopedia of Trauma Care, pp.1235-1240.
Ortiz-Catalan, M., Sander, N., Kristoffersen, M.B., Håkansson, B. and Brånemark, R., 2014. Treatment of phantom limb pain (PLP) based on augmented reality and gaming controlled by myoelectric pattern recognition: a case study of a chronic PLP patient. Frontiers in neuroscience, 8, p.24.
Philip, B., Valyear, K., Cirstea, C. and Frey, S., 2017. Reorganization of Primary Somatosensory Cortex After Upper Limb Amputation May Lack Functional Significance. Archives of Physical Medicine and Rehabilitation, 98(10), p.e103.
Raffin, E., Richard, N., Giraux, P. and Reilly, K.T., 2016. Primary motor cortex changes after amputation correlate with phantom limb pain and the ability to move the phantom limb. NeuroImage, 130, pp.134-144.
Schipper, S. and Maurer, K., 2017. Phantom Limb Pain. In Pain Medicine (pp. 503-505). Springer, Cham.
Stockburger, S., Sadhir, M. and Omar, H.A., 2016. Phantom limb pain. Journal of Pain Management, 9(2), p.161.
Vaso, A., Adahan, H.M., Gjika, A., Zahaj, S., Zhurda, T., Vyshka, G. and Devor, M., 2014. Peripheral nervous system origin of phantom limb pain. PAIN®, 155(7), pp.1384-1391.
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