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INTRODUCTION

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Phantom pain is described as a painful sensation that an individual experiences relating to a limb or an organ that is not physically present. Weir Mitchell is credited with coining the term during the American Civil War even though earlier physicians had reported the phenomena of abnormal sensations and pain in amputated limbs. Amputation of a limb can lead to both painful and nonpainful sensations: phantom pain, phantom sensations, telescoping, and stump pain.

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CLASSIFICATION

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Phantom Pain

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Phantom pain is the perception of a noxious sensation in the distribution of the missing body part. The incidence of phantom pain is reported to range between 60% and 80%. Phantom pain can resolve spontaneously; however, pain persisting 6 months or longer can become chronic and recalcitrant to treatment. The occurrence of phantom pain is independent of the patient’s age, sex, or cause of amputation. The presence of pre-amputation pain is said to be the greatest predictor of whether pain will develop in the amputated limb.

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Phantom Sensations

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Phantom sensations are nonpainful sensations that are perceived as originating from the missing body part. The incidence of phantom sensations is almost 90%, especially during the first 6 months after amputation. Phantom sensations are more common in the distal portions of the limbs due to the disproportionately large cortical reservation for these structures.

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Telescoping

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Telescoping is the perception of progressive shortening of the amputated limb so that the patient perceives the distal part of the limb is becoming more proximal. Telescoping is a common phenomenon and occurs in about 70% of amputations.

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Stump Pain

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Stump pain usually develops due to local factors such as infection, lesions of the skin, ischemia, improper fitting prostheses, which places undue pressure on pre-existing neuromas. Stump pain is easily differentiated from phantom limb pain, as the associated pain is located only at the residual stump.

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Phantom Breast Syndrome

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Phantom breast syndrome occurs after mastectomy has a lower incidence of approximately 20%–30% compared to limb amputation. The lower prevalence is related to the minor cortical representation. It seriously affects quality of life through the combined impact of physical disability and emotional distress. There are a number of assumed factors causing or perpetuating persistent neuropathic pain after breast cancer surgery. Most well-established risk factors for developing phantom breast pain and other related neuropathic pain syndromes are severe acute postoperative pain and greater postoperative use of analgesics.

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PATHOPHYSIOLOGY

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The exact pathophysiology for the development of phantom pain is not known. The mechanisms for the development of phantom pain are mostly experimental theories and observations. There is evidence to suggest that phantom pain is the consequence of altered interactions between peripheral, spinal, and cortical pathways. Peripheral mechanisms suggest evidence demonstrating spontaneous ...

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