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With the range of unique individual experiences, finding a single effective treatment option presents a significant challenge to PLP researchers.Īs with the experience of PLP, treatment options and success can vary. The authors described a particular patient who felt he was pulling the trigger on his rifle but unable to move his hand to a different position. Some patients feel volitional control over their phantom, and some feel that the limb is fixed in a specific position. Tsao’s article,¹ there are variations in onset, duration, description, and location of phantoms sensations and PLP. Individual experiences range greatly, especially among patients at Walter Reed. “Whether it is a nocturnal phenomenon or related to a lack of distractions is unclear,” Dr.
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Individuals are typically busy with activities during the day, so the experience of PLP is more pronounced when they are sitting quietly at home at night. With regard to triggers, PLP “appears in our patients to be most often seen at the end of the day,” explained Dr. Tsao and his colleagues proposed that proprioceptive memories remain in an individual even after a limb has been amputated.¹ The brain mechanisms that sense proprioception remain intact, as do memories of limb position, and may be reactivated, thus giving rise to the phantom the realization that a limb is missing arises then through the visual system, a relevant point for the upcoming discussion on treatment options. Proprioceptive memory refers to memory of specific limb positions.ĭr. Tsao’s theory takes on a “multifactorial approach,” incorporating “proprioceptive memory” and Ramachandran and Hirstein’s model.⁵ Their model describes five sources involved in PLP: 1) residual limb neuromas, 2) remapping, 3) monitoring of corollary discharge from motor commands to the limb, 4) a primordial, internal “body” image, and 5) vivid somatic memories of painful sensations or posture of the original limb being “carried” over into the phantom. Several theories have been proposed to describe the origins of PLP, including cortical reorganization, body schema, and neuromatrix theory (see Weeks et al for a review).¹ Dr. Attempts also have been made to characterize PLP,³˒⁴ but the pathophysiology and etiology are unclear. There are also kinetic sensations, which are the perceptions of movement, and kinesthetic components, which describe size, shape, and position of the missing limb. Naturally, PLP is of stronger intensity than phantom sensations. PLP is actually one of three phenomena associated with what have been termed “phantom sensations” by Weinstein.² He proposed that PLP fell under the category of “exteroceptive perceptions,” which include sensations such as touch, pressure, temperature, and itch.
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Phantom limb pain can occur in many regions of the body, but limbs are the most common sites. Tsao to gain additional insight into recent developments regarding research in PLP. Tsao and his colleagues at Walter Reed Army Medical Center recently published a review article describing the various theories and therapies associated with PLP.¹ Practical Pain Management spoke with Dr. At the forefront of this research is CDR Jack Tsao, MD, DPhil, Director of Traumatic Brain Injury Programs for the US Navy Bureau of Medicine and Surgery in Washington, DC, and Associate Professor of Neurology and Neuroscience at the Uniformed Services University of the Health Sciences in Bethesda, MD. There are numerous theories behind the mechanisms of PLP and many treatment options.