By: Areeba, Cheyne, Ahmed Phantom Limb Pain (PLP)

What is PLP? Phantom Limb Pain (PLP) is the feeling of pain in an absent limb or a portion of a limb. The pain sensation varies from individual to individual. Phantom limb sensation is the term given to any sensory phenomenon (except pain) which is felt in an absent limb or a portion of the limb.

Grey’s Anatomy

History First described in 1552 by French surgeon Ambroise Paré Weir Mitchell sparked the interest of Hughling Jackson towards the end of the 19th century. He discovered that the “movements” of the lost limb were the result of excitation of motor centers roused into activity by incoming currents from the sensory nerves in the limb stump Was not generally recognized by the medical profession until Riddock demonstrated that anterolateral cordotomy could relieve phantom limb pain and agreed that no relief could be expected when the pain had become permanently stamped on the cerebral cortex.

Cause and Risk Factors Cause: Nerve endings at the site of the amputation continue to send pain signals to the brain Brain memory of pain is retained and is interpreted as pain, regardless of signals from injured nerves. Risk Factors: Preamputation pain A blood clot in the amputated limb Preamputation infection Previous damage to spinal cord or peripheral nerves that supplied the affected limb Traumatic amputation Type of anesthesia used during the amputation

Diagnosis There is currently no official medical test to diagnose PLP However, doctors are able to detect the condition by focusing on the patient’s symptoms and circumstances (Ex. if the patient has recently suffered an amputation or surgery)

Symptoms Symptoms may occur in people who have had a limb removed as well as people who are born without a limb. Include feelings/illusions of: - Shooting, stabbing, piercing, or burning pain - An article of clothing or jewelry - The limb still being attached and functioning normally - Numbness, tickling, or cramping - Pleasure

Treatment Treatment of phantom limb pain is difficult. Treatment is usually determined based on the person's level of pain, and multiple treatments may be combined. Methods include… Heat application Biofeedback to reduce muscle tension Relaxation techniques Massage of the amputation area 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, anticonvulsants, antidepressants, beta-blockers, and sodium channel blockers. Prosthetic Limbs

Connection to the Brain PLP and phantom sensations are created from the re-organization of sensory pathways. The parts of the brain responsible for PLP are mainly the somatosensory cortex and the motor cortex. These cortices (plural of cortex) contain a map of the body (left side of brain contains map of right side of body, and vice-versa); every point on this map corresponds with a point on your body.

Connection to the Brain When a limb is amputated, the part of the brain corresponding to the limb loses sensory input and begins craving new sensory input The sensory signals of another body part (i.e. the face, which is located next to the hand/arm signal on the brain map) invades this newly vacated area connected to the missing limb (i.e. the hand). So, the illusion that the hand is moving or being touched is created because the signals from the face are misinterpreted as coming from the missing hand.

Video Summary

Comparison to “Normal” Brain The yellow is only on one side because it represents the signals connected to the missing limb. The right side has no yellow because there is no limb sending impulses to the brain, so the red (representing signals from a non-missing part, most likely the face) is taking over the empty space. The normal brain has yellow on both sides because there are no missing limbs, and therefore no empty spaces for the other sections to invade. The sensory signals are all being used by the proper limbs, so the sections are equal colour and size.

Comparison to “Normal” Brain The PLP is asymmetrical A “normal” brain would be much more evenly coloured on both sides. The PLP brain is missing a section that would receive signals/impulses from the missing limb, and therefore one section of signals is taking up twice the room in order to use up this empty area On a “normal” brain, the amount/size of sections would be even as there is no need for one section to invade another since there is no space being left unused The “normal” brain still has signals from each section corresponding with the designated limb. The “normal” brain does not feel phantom sensations because all the signals in the somatosensory cortex/motor cortex are organized properly.

Interactive portion

Christian Bagge American soldier whose legs were blown off after a two-bomb explosion in Iraq Felt as though his legs were being crushed by hammers He allows us to better understand PLP because… - His feelings of pain better explain the symptoms of PLP. - His high severity of pain shows the range of symptoms felt among PLP patients since he shows signs of high level pain as opposed to the simple warm or cold/numbing sensations felt by 20-40% of patients. -His difficulty of finding an effective treatment plan enforces the notion that treatment plans vary depending on the person and the severity -His optimism and positive attitude display the rarely discussed emotional factors of PLP

Fun Facts PLP is mentioned in the famous classic novel Moby Dick. Apart from limbs, phantom pain can be felt in the eyes, nose, teeth, tongue, breasts, bladder, and genital organs. “Phantom Limb” is the name of a popular song by The Shins. Phantom Limb is also the name of a supervillain on the show The Venture Bros.

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