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Amputation and phantom limb pain

from Medical topics

Published online by Cambridge University Press:  18 December 2014

By
Ronald Melzack  and
Kartz Joel
Edited by
Susan Ayers ,
Andrew Baum ,
Chris McManus ,
Stanton Newman ,
Kenneth Wallston ,
John Weinman  and
Robert West
Ronald Melzack
Affiliation:
McGill University
Kartz Joel
Affiliation:
York University
Susan Ayers
Affiliation:
University of Sussex
Andrew Baum
Affiliation:
University of Pittsburgh
Chris McManus
Affiliation:
St Mary's Hospital Medical School
Stanton Newman
Affiliation:
University College and Middlesex School of Medicine
Kenneth Wallston
Affiliation:
Vanderbilt University School of Nursing
John Weinman
Affiliation:
United Medical and Dental Schools of Guy's and St Thomas's
Robert West
Affiliation:
St George's Hospital Medical School, University of London
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Summary

Phantom limbs occur in 95–100% of amputees who lose an arm or leg. The phantom limb is usually described as having a tingling feeling and a definite shape that resembles the somatosensory experience of the real limb before amputation. It is reported to move through space in much the same way as the normal limb would move when the person walks, sits down, or stretches out on a bed. At first, the phantom limb feels perfectly normal in size and shape, so much so that the amputee may reach out for objects with the phantom hand, or try to step on to the floor with the phantom leg. As time passes, however, the phantom limb begins to change shape. The arm or leg becomes less distinct and may fade away altogether, so that the phantom hand or foot seems to be hanging in mid-air. Sometimes, the limb is slowly ‘telescoped’ into the stump until only the hand or foot remain at the stump tip (Solonen, 1962). However, the neural basis of the phantom does not disappear. Injury of the stump years or decades after fading or telescoping may suddenly produce a phantom as vivid and full-sized as that felt immediately after amputation (Cohen, 1944).

Amputation is not essential for the occurrence of a phantom. After avulsion of the brachial plexus of the arm, without injury to the arm itself, most patients report a phantom arm (the ‘third arm’) which is usually extremely painful (Wynn-Parry, 1980).

Type
Chapter
Information
Cambridge Handbook of Psychology, Health and Medicine , pp. 548 - 550
Publisher: Cambridge University Press
Print publication year: 2007

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