PLP - Wina

1. Phantom Limb Pain
Group 2
Wina
Prodpran
Jessica
Ya

2. Phantom limb pain
• Phantom limb pain refers to mild to extreme pain felt in the area
where a limb has been amputated.
• Phantom limb sensations usually will disappear or decrease over
time; when phantom limb pain continues for more than six
months, however, the prognosis for improvement is poor.

3. 
The concept of Phantom
Limb Pain as being in pain
that feels like it's coming
from a body part that's no
longer there.

Doctors once believed this
post-amputation
phenomenon was a
psychological problem, but
experts now recognize that
these real sensations
originate in the spinal cord
and brain.
Introduction

4. What are
the
symptoms?
• In addition to pain in the phantom limb,
some people experience other
sensations such as tingling, cramping,
heat, and cold in the portion of the limb
that was removed. Any sensation that
the limb could have experienced prior to
the amputation may be experienced in
the amputated phantom limb.

5. What causes it?
• Less painkillers during the amputation or the painkillers wasn`t
effective enough.
• Before amputation patient had a really strong traumatic pain.
• Although the limb is no longer there, the nerve endings at the site of the
amputation continue to send pain signals to the brain that makes the brain think th
e limb is still there. Sometimes, the brain’s memory of pain is retained and is interp
reted as pain, regardless of signals from injured nerves

6. Treatments
•
Mirror therapy
•
Relaxation techniques
•
Massage of the amputation area
•
Injections with local anesthetics and/
or steroids
•
Surgery to remove scar tissue entangling a
nerve
•
Physical therapy
•
TENS (transcutaneous electrical nerve
stimulation) of the stump
•
Neurostimulation techniques such as spinal
cord stimulation or deep brain stimulation
•
Medications such as pain-relievers,
neuroleptics,antidepressants, beta-blockers, a
nd sodium channel blockers.
•
Prosthesis

7. Treatment of Phantom pain
• Nonpharmacological treatment
• Transcutaneous Electrical
Never Stimulation (TENS)
- Standard device ,
inexpensive
- Safe and easy to use
- Using battery to
control
- Generates to the
skin to activate the
effected nerves.

8. Prosthesis
-
Help to regain the feeling
of loosing limb
-
An electrical prosthetic
limb moved by signals.

9. Mirror Therapy
•
was first introduced by
Ramachandran in 1996
•
persons with amputated limb use
either a mirror or mirror box to
reflect an image of the intact limb.
It is hypothesized that this works
by preventing cortical
restructuring
•
patients with PLP showed a
decrease in pain at the 6-month
follow-up (Diers, 2010)
•
mechanisms underlying the
effects of mirror training or motor
imagery, are still unclear

10. Mirror box
therapy

12. How to avoid the phantom limb
pain?
• Right operation technics.
• Effective painkillers during the procedure and after it.
• Good stump care and rehabilitation.

14. 1. Christopher V Boudakian, DO PGY-4
Rusk Rehabilitation
NYU Langone Medical Center
2. 2010 Lippincott Williams & Wilkins Volume 16, September
2010
3. http://www.slideshare.net/KksKerst/phantom-limb-pain
4. http://www.webmd.com/pain-management/guide/phantom-
limb-pain
References