Phantom Limb Pain Severe injury leading to amputation Pain sensations experienced not necessarily cease after amputation Most (in excess of two-thirds) experienced by patients who have lost a limb at least occasionally

What is the “Phantom Limb” VS Ramachandran begin at 3:15-minutes http://www.youtube.com/watch?v=sq6u4XVrr58&feature=video_response

What is the Phantom Limb phenomenon? After amputation still feels like limb is there, attached to body, moving appropriately with other body parts Can also happen when born without a limb or when paralyzed?! Constant pain for some Not all phantom limb experience is painful feel gesturing, itches, twitch or even attempts to pick things up Not gender biased

What is the Phantom Limb phenomenon? Phantom arms will swing while a woman walks Phantom fingers will grasp for a cup as a man aims his stump toward the table A man reported falling out of bed in the morning when he tried to bear weight on his phantom leg Sensation of a watch or ring can often be felt

The Process of Neural (cortical) “plasticity” When a limb is lost, the cells of the area in the somatosensory cortex that responded to the missing limb begin to respond to other stimuli. Newly recruited cells begin to respond to the body part represented by the new reorganization. Response is very likely stronger in younger individuals, but is believed to occur at all ages.

Neural/cortical plasticity Encroachment actually takes place on either side of the deafferented location in the brain so that the two receptive fields actually enlarge to fill in the area. Stimulation to corresponding body part which is encroaching on deafferented location results in feeling sensations in your phantom limb.

One theory about why pain is experienced Ramachandran et. al. (1993; 2000) Cortical reorganization correlates with the pain felt in the phantom limb Phantom limb sensations are due to the “cross-wiring” of the somatosensory cortex Sensory “confusion” experienced as pain Pain results from “mis-match” between an absence of an anticipated motor output historically paired with the sensory information processed in the somatosensory cortex

Psychological Interventions Medication Psychotherapy Behavioral Therapy Hypnosis Ramachandran Mirror Box Therapy: re-create a match between sensory experience and motor output to resolve the mis-match confusion

Classic mirror treatment phantom limb pain - Ramachandran (1993) If the patient gets visual feedback that the phantom is obeying the brain’s commands, the learned paralysis is sometimes unlearned. Mirror imaging of limbs using a mirror box

Classic mirror treatment phantom limb pain - Ramachandran (1993) If the patient gets visual feedback that the phantom is obeying the brain’s commands, the learned paralysis is sometimes unlearned. Mirror imaging of limbs using a mirror box “Look into side of the mirror so that you see the reflection of your intact hand superimposed on the felt location of your phantom hand.” “Then try to make symmetrical motions using both hands (e.g., conducting an orchestra).”

Classic mirror treatment phantom limb pain - Ramachandran (1993) This method has positive therapeutic value for some patients – it “unlocks” the tight feeling In some patients, the procedure animates the phantom as never before, allowing it to “move.” The sudden sense of voluntary control and movement reduces and sometimes permanently removes phantom pain.

Psychological Interventions Medication Psychotherapy Behavioral Therapy Hypnosis Ramachandran Mirror Box Virtual Reality training Virtual Reality developed off of Mirror Box

What is the “Phantom Limb” http://www.youtube.com/watch?v=PpEpj-JgGDI&feature=related

Soldiers get virtual reality therapy for burn pain http://www.youtube.com/watch?v=jNIqyyypojg

60-Minutes “Brain Power” http://www.cbsnews.com/video/watch/?id=5228109n