Phantom And Stump Pain

Phantom pain is an intriguing mystery that has captured the imagination of health care providers and the public alike. How is it possible to feel pain in a limb or some other body part that has been surgically removed? Phantom pain develops among people who have lost a limb or a breast or have had internal organs removed. It also occurs in people with totally transected spinal cords. Unfortunately, phantom pain is a medical night mare. Many of the people reporting phantom pain make dispropor tionately heavy use of the medical system because their severe pains are usually not treated successfully. The effect on quality of life can be devas tating. Phantom pain has been reported at least since 1545 (Weir Mitchell as related by Nathanson, 1988) and/ or experienced by such diverse people as Admiral Lord Nelson and Ambroise Pare (Melzack & Wall, 1982; Davis, 1993). The folklore surrounding phantom pain is fascinating and mirrors the concepts about how our bodies work that are in vogue at any particu lar time. Most of the stories relate to phantom limbs and date from the mid-1800s. The typical story goes like this: A man who had his leg ampu tated complained about terrible crawling, twitching feelings in his leg. His friends found out where the leg was buried, dug it up, and found maggots eating it. They burned it, and the pain stopped. Another man complained of a swollen feeling with frequent stinging or biting pains.

The phenomenon of phantom limb was described in medical literature at least as early as 1545 by Ambroise Pare, according to the notes in the translation of Lemos' dissertation, "On the Continuing Pain of an Amputated Limb", by Price and Twombly [9]. This strange experience was brought to public attention by a popular essay anonymously published 1866 by Mitchell concerning the story of George Dedlow, a quadriamputee who described his invisible limbs [7]. In 1871 Mitchell wrote under his own name, and was the. first to use the term "phantom limb" [8]. In this work, he also corrected some erroneous beliefs that had arisen from his 1866 essay [13]. Most amputees report feeling a phantom limb almost immediately after amputation of an arm or a leg [11]. It is a positive sensation, usually described as tingling or numbness, which is not painful. The most distal parts of the limb, particulary the digits, thumb, and index, are the strongest and most persisting phantom sites, and may be the only parts to appear even after removal of a whole limb. The elbow or knee is sometimes involved, the forearm or lower leg rarely, and the upper arm and thigh almost never [5]. The phantom thus appears to consist predominantly of those parts which have the most extensive representa tion in the thalamus and in the cerebral cortex.

This is a Pageburst digital textbook; The most comprehensive physical therapy text available on this topic, Orthotics and Prosthetics in Rehabilitation, 2nd Edition provides clinically relevant information in a reader-friendly format. It provides essential information about orthotic/prosthetic prescription and fabrication to give readers a foundation for gait assessment, both pre- and post-intervention. Separate chapters cover each type of orthotic followed by clinical applications for typical and special populations, while the section on prosthetics provides an overview of the epidemiology of amputation and the criteria the physical therapist needs in order to determine the necessity for prosthetic limbs. Instructor resources available; contact your sales representative for details. Includes guidelines for pre-prosthetic training programs Presents case vignettes as models of evidence-based practice and clinical decision making Uses a multidisciplinary approach to demonstrate how physical therapists can best work with the rest of the health care team References the Guide to Physical Therapist Practice, 2nd Edition to keep readers up to date with the recognized standard in the field Coverage of the latest equipment and technology helps readers understand current options for their patients Additional case studies show the application of various situations leading to amputation New information on the WHO disablement model, showing how it applies to orthotics and prosthetics New chapters on orthotics in the management of neuromuscular impairment, orthotics in the management of musculoskeletal impairment, adaptive seating (unique!), and advanced training and athletics for persons with lower extremity amputation

Pain is one of the most common symptoms of neurological disease and its appropriate management is essential to the effective care of patients. Neurological disorders differ in their specific pain phenotype, mechanisms and therapy. Case Studies in Neurological Pain addresses the specific pain issues, treatment and pathophysiology in patients with a wide spectrum of neurological disease. Clinical case studies have long been recognized as a useful adjunct to problem-based learning and continuing professional development. They emphasize the need for clinical reasoning, integrative thinking, problem-solving, communication, teamwork and self-directed learning – all desirable generic skills for health care professionals. Presenting real-life cases – covering conditions including diabetic and idiopathic polyneuropathies, focal neuropathies, multiple sclerosis and headache disorders – this book provides neurologists, neurosurgeons, pain clinic specialists and primary care physicians with an understanding of problems encountered in neurological practice. There are also chapters on mechanisms of neurological pain and new treatment guidelines.

Obtain all the core knowledge in pain management you need from one of the most trusted resources in the field. The new edition of Practical Management of Pain gives you completely updated, multidisciplinary overview of every aspect of pain medicine, including evaluation, diagnosis of pain syndromes, rationales for management, treatment modalities, and much more. In print and online, it is all the expert guidance necessary to offer your patients the best possible relief. "In summary, this is the best explanation of what lies behind MRI that I have read, taking what can be a dry subject and making it readily understandable and really interesting. I would recommend it to anyone starting their MRI training and anyone trying to teach MRI to others." Reviewed by RAD Magazine, June 2015 Understand and apply the latest developments in pain medicine with brand-new chapters covering disability assessment, central post-stroke pain, chronic widespread pain, and burn pain. Effectively ease your patients' pain with today's best management techniques, including joint injections, ultrasound-guided therapies, and new pharmacologic agents (such as topical analgesics). Access up-to-the-minute knowledge on all aspects of pain management, from general principles to specific management techniques, with contributions from renowned experts in the field. Read the full text and view all the images online at expertconsult.com. Understand and apply the latest developments in pain management with brand-new chapters covering disability assessment, central post-stroke pain, widespread chronic pain, and burn pain. Effectively ease your patients' pain with today's best management techniques, including joint injections, ultrasound-guided therapies, and new pharmacologic agents (such as topical analgesics).

Edited by internationally recognized pain experts, this book offers 73 clinically relevant cases, accompanied by discussion in a question-and-answer format.

Easy to read and easy to use, Pain Review, 2nd Edition provides you with the most up-to-date, comprehensive review of pain medicine available. Written by Steven Waldman, MD, a leading author in the specialty of pain medicine, this book gives you exactly what you need – an easily understandable, targeted review of the essential basic science; beautifully illustrated, full-color anatomic figures; and a comprehensive review of common and uncommon pain syndromes, as well as how-to-do-it explanations of all of the pain management injection and nerve block techniques that every practitioner needs to know. Pain Review, 2nd Edition is an excellent tool for reviewing the specialty and for preparing for your pain medicine board review, recertification, or for the practice of pain medicine. Provides the reader with clearly written review of the signs, symptoms and physical findings of 95 defined pain syndromes classified by body region. Presents an easy-to-follow, generously illustrated, step-by step roadmap of how to perform 113 individual nerve blocks and injection techniques, as well as a review of associated pitfalls and complications. Follows an easy-to-read templated format throughout for quick mastery and retrieval of information, closely matching the format and content of the American Board of Anesthesiology pain medicine board certification exam. Maintains a consistent approach and editorial style as a single-authored text by noted authority Steven D. Waldman, MD. NEW! Conceptual illustrations are now in full color to help you better visualize injection techniques. Hundreds of NEW full color tables and figures simplify learning. NEW, updated design offers visual appeal and ease of use. Updated references throughout direct you to the most up-to-date source material.

Implement TMR with Your Patients and Improve Their Quality of Life Developed by Dr. Todd A. Kuiken and Dr. Gregory A. Dumanian, targeted muscle reinnervation (TMR) is a new approach to accessing motor control signals from peripheral nerves after amputation and providing sensory feedback to prosthesis users. This practical approach has many advantages over other neural-machine interfaces for the improved control of artificial limbs. Targeted Muscle Reinnervation: A Neural Interface for Artificial Limbs provides a template for the clinical implementation of TMR and a resource for further research in this new area of science. After describing the basic scientific concepts and key principles underlying TMR, the book presents surgical approaches to transhumeral and shoulder disarticulation amputations. It explores the possible role of TMR in the prevention and treatment of end-neuromas and details the principles of rehabilitation, prosthetic fitting, and occupational therapy for TMR patients. The book also describes transfer sensation and discusses the surgical and functional outcomes of the first several TMR patients. It concludes with emerging research on using TMR to further improve the function and quality of life for people with limb loss. With contributions from renowned leaders in the field, including Drs. Kuiken and Dumanian, this book is a useful guide to implementing TMR in patients with high-level upper limb amputations. It also supplies the foundation to enable improvements in TMR techniques and advances in prosthetic technology.