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Pain Management
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Phantom Limb Pain
 
A phantom limb is the sensation that an amputated or missing limb (even an organ, like the appendix) is still attached to the body and is moving appropriately with other body parts.[1][2][3] Approximately 60 to 80% of individuals with an amputation experience phantom sensations in their amputated limb, and the majority of the sensations are painful.[4] Phantom sensations may also occur after the removal of body parts other than the limbs, e.g. after amputation of the breast, extraction of a tooth (phantom tooth pain) or removal of an eye (phantom eye syndrome). The missing limb often feels shorter and may feel as if it is in a distorted and painful position. Occasionally, the pain can be made worse by stress, anxiety, and weather changes. Phantom limb pain is usually intermittent. The frequency and intensity of attacks usually decline with time. 
 
A slightly different sensation known as phantom pains can also occur in people who are born without limbs and people who are paralyzed.[6][7] Phantom pains occur when nerves that would normally innervate the missing limb cause pain. It is often described as a burning or similarly strange sensation and can be extremely agonizing for some people, but the exact sensation differs widely for individuals. Other induced sensations include warmth, cold, itching, squeezing, tightness, and tingling (Ramachandran & Blakeslee 1998; Ramachandran & Hirstein 1998). 
 
Treatment
 
Some treatments include drugs such as antidepressants. Spinal cord stimulation (SCS) can be effective treatment for phantom pain. An electrical stimulator is implanted under the skin, and an electrode is placed next to the spinal cord. The nerve pathways in the spinal cord are stimulated by an electric current. This interferes with the impulses travelling towards the brain and lessens the pain felt in the phantom limb (Melzack 1992). Instead, amputees feel a tingling sensation in the phantom limb. 
 
Vibration therapy, acupuncture, hypnosis, and biofeedback may all be used to treat phantom pain but are often of little help. The pain can sometimes be helped by keeping busy and focusing attention on something else. Massaging the stump can sometimes help. 
 
For planned amputation, phantom pain can be reduced by preoperative pain management, effective control of pain by analgesic or neuroleptic is required. The brain seems to implant the sensations from the preoperative state. 
 
One particularly novel treatment for phantom limb pain is the mirror box developed by Vilayanur Ramachandran and colleagues (Ramachandran, Rogers-Ramachandran & Cobb 1995). Through the use of artificial visual feedback it becomes possible for the patient to "move" the phantom limb, and to unclench it from potentially painful positions. Repeated training in some subjects has led to long-term improvement, and in one exceptional case, even to the complete elimination of the phantom limb between the hand and the shoulder (so that the phantom hand was dangling from the shoulder). 
 
The success of the mirror method inspired a team of researchers at the University of Manchester in England to experiment a technology of "immersive virtual reality" to combat the discomfort caused by phantom limb syndrome.[8][9] The researchers reported that phantom limb pain can be relieved by attaching the sufferer's real limb to an interface that allows them to see two limbs moving in a computer-generated simulation. This works on the same principle as the mirror box technique in that the somatosensory cortex is being 'tricked', except that the computer created illusion is thought to be stronger. Another virtual reality research was reported in 2009