Phantom and Stump Pain

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.

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Inhalt
I. Neurobiological Basis.- On the Origin of Pain Associated with Amputation.- Neurophysiological Analysis of Efferent Sympathetic and Afferent Fibers in Skin Nerves with Experimentally Produced Neuromata.- Somatosensory Evoked Potentials in Above-Knee Amputees with Phantom and Stump Pain.- II. Psychophysiological and Clinical Aspects.- Clinical and Neurophysiological Findings-in Above-knee Amputees: A Synopsis.- The Phenomenology of Postamputation Pain.- Phantom Sensations After Amputation: The Importance of Localization and Prognosis.- Phantom Sensations (Phantom Arm) in Plexus Paralysis.- Phantom Illusions in Spinal Cord Lesions.- Phantom Limb Pain in Arterial Occlusive Disease.- Phantom Tooth Phenomenon: Painless and Painful Sensations.- Phantom Tooth.- The Analysis of Personality Factors in the Prediction of Phantom Limb Pain.- III. Medical Treatment.- Drug Treatment of Phantom and Stump Pain.- Treatment of Phantom Pain by Transcutaneous Stimulation of the Stump, the Limb Contralateral to the Stump, and the Other Extremities.- Transcutaneous Electrical Nerve Stimulation in Postamputation Pain.- Transcutaneous Electrical Nerve Stimulation in the Treatment of Chronic Pain After Peripheral Nerve Lesions.- Contralateral Local Anesthesia for the Treatment of Postamputation Pain.- Rehabilitation of Elderly Amputees: Stump and Phantom Pain.- IV. Surgical Treatment.- Surgical Stump Revision as a Treatment of Stump and Phantom Pains: Results of 100 Cases.- Centrocentral Anastomosis of Peripheral Nerves: A Neurosurgical Treatment of Amputation Neuromas.- The Effects on Pain of Reconstructive Neurosurgery in 160 Patients with Traction and/or Crush Injury to the Brachial Plexus.- Neurosurgical Treatment of Phantom Limb Pain: A Survey of Methods.- Thermocoagulation of the Substantia Gelatinosa for Pain Relief - (Preliminary Report).- Treatment of Phantom and Stump Pain with Controlled Thermocoagulation of Amputation Neuroma.- Spinal Cord Stimulation in Postamputation Pain.- Programmed Transcutaneous and Central Stimulation for Control of Phantom Limb Pain and Causalgia: A New Method for Treatment.

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