Phantom sensation

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Phantom sensation is experienced by almost everyone who undergoes limb amputation, but it rarely represents a clinical problem. Immediately after the amputation, the phantom limb often resembles the preamputation limb in shape, size, and volume.11,1922 2354 The sensation can be very vivid and often includes feelings of posture and movement. The phantom sensation may fade over time. Richardsen et al.26 prospectively studied phantom phenomena in 52 lower amputees. At six-months follow up, nonpainful phantom sensations were present in 100 percent, spontaneous movements occurred in 65.4 percent, and 58 percent stated that they were able to move the phantom themselves. In another study, amputees were asked about the frequency of phantom sensations a median time of 19 years after amputation. Twenty-two percent experienced phantom sensations always, another 11 percent had phantom sensations daily, and the rest had sensations with intervals of weeks, months, or

even years.23

In some patients, a phenomenon called telescoping occurs when the distal parts of the phantom are gradually felt to approach the residual limb and eventually they may even be experienced within the residual limb (Figure 31.1). It has been suggested that phantom pain prevents telescoping, but Montoya et al.19 failed to find such a relation: 12 of 16 patients with phantom pain and 5 of 10 patients without pain reported telescoping. The following case illustrates telescoping: A 54-year-old man had his right arm crushed in a machine at work. The arm was subsequently amputated at hospital. Immediately after the operation, the patient had a vivid sensation that the arm was still present. The phantom arm felt as if it had the same size and shape as before the amputation. Gradually, the phantom arm underwent shrinkage, and

Table 31.2 Factors that may modulate the experience of phantom pain. Internal factors External factors

Genetic predisposition Weather change

Anxiety/emotional distress Touching the residual limb

Attention/distraction Use of prosthesis

Urination/defecation Spinal anesthesia

Coping strategies Rehabilitation

Other disease (prolapsed intervertebral disk, spinal neoplasia) Treatment

Phantom Sensation With Amputee
Figure 31.1 Telescoping: a gradual shrinkage of the phantom limb. In upper limb amputees, the hand may eventually become located within the residual limb.

the phantom hand eventually became located within the residual limb. Telescoping may in some cases resolve. The patient reported that the phantom arm resumed its genuine size and shape during the use of an artificial prosthesis.

Phantom pain and phantom sensation are strongly correlated. In a study by Kooijmann et al.,23 phantom pain was present in 36 out of 37 upper limb amputees with phantom sensations, but only in one out of 17 without phantom sensations. Phantom sensations are less frequent in congenital amputees and in patients who underwent amputation before the age of six years.31

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