Phantom Limb Pain

Phantom Limb Pain (PLP) is a type of pain that localizes to a missing (amputated) limb. Pain that localizes to other missing organs is termed phantom pain. PLP and phantom pain have very similar mechanisms and treatment options.

Types
PLP is categorized according to the reason for the missing limb and the severity of the pain.

Signs and Symptoms
Since examination of the phantom limb is usually impossible, objective and observable signs of PLP are very few. Symptoms of PLP, i.e., what the patient experiences, are of pain that reminds him or her of the missing limb being compressed, distorted, or otherwise injured; adjectives such as "stabbing" and "throbbing" are often used to describe the pain.

Causes
PLP is caused by a injury to peripheral nerves that, under normal circumstances, transmit pain signals to the brain. The injury and subsequent healing process may leave the nerves especially likely to continue transmitting the "pain" signal after the amputation.

Treatment
Treatment options range from as-needed use of nonprescription analgesics to implantable pumps that deliver narcotics straight to the central nervous system. Many pharmacological options are commonly employed to treat PLP, and several choices are supported by at least one controlled study showing a positive effect. These include opioids, calcitonin, gabapentin, ketamine, and dextromethorophan. Intrathecal (IT) drug delivery is sometimes employed to lessen systemic side effects use of drugs such as fentanyl, and combination morphine/bupivicaine for treating PLP has been reported.

Chances of developing
PLP affects as many as 80% of amputees at some time.

History
PLP was first described by a French military surgeon in 1551.