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NeuroRehabilitation 2017Phantom limb pain (PLP), the perception of discomfort in a limb no longer present, commonly occurs following amputation. A variety of interventions have been employed... (Review)
Review
BACKGROUND
Phantom limb pain (PLP), the perception of discomfort in a limb no longer present, commonly occurs following amputation. A variety of interventions have been employed for PLP, including mirror therapy. Virtual Reality (VR) and augmented reality (AR) mirror therapy treatments have also been utilized and have the potential to provide an even greater immersive experience for the amputee. However, there is not currently a consensus on the efficacy of VR and AR therapy.
OBJECTIVE
The aim of this review is to evaluate and summarize the current research on the effect of immersive VR and AR in the treatment of PLP.
METHODS
A comprehensive literature search was conducted utilizing PubMed and Google Scholar in order to collect all available studies concerning the use of VR and/or AR in the treatment of PLP using the search terms "virtual reality," "augmented reality," and "phantom limb pain." Eight studies in total were evaluated, with six of those reporting quantitative data and the other two reporting qualitative findings.
RESULTS
All studies located were of low-level evidence. Each noted improved pain with VR and AR treatment for phantom limb pain, through quantitative or qualitative reporting. Additionally, adverse effects were limited only to simulator sickness occurring in one trial for one patient.
CONCLUSIONS
Despite the positive findings, all of the studies were confined purely to case studies and case report series. No studies of higher evidence have been conducted, thus considerably limiting the strength of the findings. As such, the current use of VR and AR for PLP management, while attractive due to the increasing levels of immersion, customizable environments, and decreasing cost, is yet to be fully proven and continues to need further research with higher quality studies to fully explore its benefits.
Topics: Humans; Neurological Rehabilitation; Phantom Limb; Reality Therapy; Virtual Reality
PubMed: 28211829
DOI: 10.3233/NRE-171447 -
Scandinavian Journal of Pain Oct 2018
Topics: Amputation Stumps; Amputees; Cambodia; Humans; Phantom Limb
PubMed: 30169329
DOI: 10.1515/sjpain-2018-0115 -
Brain and Behavior Mar 2022Phantom limb pain (PLP) is a complicated condition with diverse clinical challenges. It consists of pain perception of a previously amputated limb. The exact pain... (Review)
Review
Phantom limb pain (PLP) is a complicated condition with diverse clinical challenges. It consists of pain perception of a previously amputated limb. The exact pain mechanism is disputed and includes mechanisms involving cerebral, peripheral, and spinal origins. Such controversy limits researchers' and clinicians' ability to develop consistent therapeutics or management. Neuroimaging is an essential tool that can address this problem. This review explores diffusion tensor imaging, functional magnetic resonance imaging, electroencephalography, and magnetoencephalography in the context of PLP. These imaging modalities have distinct mechanisms, implications, applications, and limitations. Diffusion tensor imaging can outline structural changes and has surgical applications. Functional magnetic resonance imaging captures functional changes with spatial resolution and has therapeutic applications. Electroencephalography and magnetoencephalography can identify functional changes with a strong temporal resolution. Each imaging technique provides a unique perspective and they can be used in concert to reveal the true nature of PLP. Furthermore, researchers can utilize the respective strengths of each neuroimaging technique to support the development of innovative therapies. PLP exemplifies how neuroimaging and clinical management are intricately connected. This review can assist clinicians and researchers seeking a foundation for applications and understanding the limitations of neuroimaging techniques in the context of PLP.
Topics: Amputees; Brain Mapping; Diffusion Tensor Imaging; Humans; Neuroimaging; Phantom Limb
PubMed: 35218308
DOI: 10.1002/brb3.2509 -
Cognitive Neuroscience 2015Mirror-touch synesthesia (MTS) is the conscious experience of tactile sensations induced by seeing someone else touched. This paper considers two different, although not...
Mirror-touch synesthesia (MTS) is the conscious experience of tactile sensations induced by seeing someone else touched. This paper considers two different, although not mutually exclusive, theoretical explanations and, in the final section, considers the relation between MTS and other forms of synesthesia and also other kinds of vicarious perception (e.g., contagious yawning). The Threshold Theory explains MTS in terms of hyper-activity within a mirror system for touch and/or pain. This offers a good account for some of the evidence (e.g., from fMRI) but fails to explain the whole pattern (e.g., structural brain differences outside of this system; performance on some tests of social cognition). The Self-Other Theory explains MTS in terms of disturbances in the ability to distinguish the self from others. This can be construed in terms of over-extension of the bodily self in to others, or as difficulties in the control of body-based self-other representations. In this account, MTS is a symptom of a broader cognitive profile. We suggest this meets the criteria for synesthesia, despite the proximal causal mechanisms remaining largely unknown, and that the tendency to localize vicarious sensory experiences distinguishes it from other kinds of seemingly related phenomena (e.g., non-localized affective responses to observing pain).
Topics: Humans; Illusions; Perceptual Disorders; Phantom Limb; Photic Stimulation; Synesthesia; Touch Perception
PubMed: 25893437
DOI: 10.1080/17588928.2015.1042444 -
European Journal of Paediatric... Jul 2022Phantom limb pain is a rare cause of chronic pain in children but it is associated with extremely refractory pain and disability. The reason for limb amputation is often...
Phantom limb pain is a rare cause of chronic pain in children but it is associated with extremely refractory pain and disability. The reason for limb amputation is often due to treatment for cancer or trauma and it has a lower incidence compared to adults. The mechanism of why phantom pain exists remains uncertain and may be a result of cortical reorganisation as well as ectopic peripheral input. Treatment is aimed at reducing both symptoms as well as managing pain related disability and functional restoration. Neuromodulatory approaches using deep brain stimulation for phantom limb pain is reserved for only the most refractory cases. The targets for brain stimulation include the thalamic nuclei and motor cortex. Novel targets such as the anterior cingulate cortex remain experimental as cases of serious adverse effects such as seziures have limited their widespread uptake. A multidisciplinary approach is crucial to successful rehabilitation using a biopsychosocial pain management approach.
Topics: Adult; Child; Deep Brain Stimulation; Humans; Motor Cortex; Pain Management; Phantom Limb
PubMed: 35728428
DOI: 10.1016/j.ejpn.2022.05.009 -
Neuroscience Letters May 2019Phantom limb (PLP) as well as residual limb pain (RLP) are still a very significant problem after amputation and their causes are only partially known. Here we tested...
Phantom limb (PLP) as well as residual limb pain (RLP) are still a very significant problem after amputation and their causes are only partially known. Here we tested whether the predisposition for the frequency, duration and intensity of PLP and RLP is shared with other prior chronic pains and/or the presence of postamputation subacute pain. A week preoperatively we collected data using validated questionnaires, a pain diary and interviews on past chronic pain conditions, acute pain, depression, anxiety, pain interference, life control, social support and affective distress and pain ratings one day before the amputation in 52 patients scheduled for limb amputation. In the week postamputation and again three and 12 months thereafter, we collected data on postoperative wound pain, PLP, RLP and non-painful phantom sensation (PLS). Phantom and residual limb pain indices were calculated per patient, integrating the intensity, frequency and duration of past chronic pain, PLP, RLP and PLS into a single value to index the overall burden of pain. We report that acute and chronic pain long before but not on the day before the amputation and subacute pain postamputation significantly predicted up to half of the variance in the incidence and severity of PLP, RLP and PLS 12 months postamputation. Moreover, the severity of these painful sensations at 12 months postamputation was partially predicted by preamputation scores of depression and anxiety. These findings corroborate the hypothesis that chronic pain and non-painful sensations following limb amputation are strongly related to longstanding preoperative chronic pain and to subacute postoperative pain as well as to psychological factors before the amputation that may be inherited and/or acquired (learning- and memory-related). Furthermore, we also confirm that subacute pain postamputation comprises an additional risk factor for long-term painful sensations postamputation. Our results suggest that timely interventions might prevent the development of chronic pain.
Topics: Acute Disease; Aged; Analgesics; Chronic Disease; Female; Humans; Male; Middle Aged; Pain Management; Pain Measurement; Phantom Limb; Postoperative Period; Preoperative Period
PubMed: 30503915
DOI: 10.1016/j.neulet.2018.11.044 -
Pain Medicine (Malden, Mass.) Oct 2020
Topics: Amputation, Surgical; Humans; Pain Management; Pain Measurement; Phantom Limb
PubMed: 33118599
DOI: 10.1093/pm/pnaa307 -
Physical Medicine and Rehabilitation... Feb 2015Congenital limb differences are uncommon birth defects that may go undetected even with prenatal screening ultrasound scans and often go undetected until birth. For... (Review)
Review
Congenital limb differences are uncommon birth defects that may go undetected even with prenatal screening ultrasound scans and often go undetected until birth. For children with congenital limb differences, a diagnostic evaluation should be done to rule out syndromes involving other organ systems or known associations. The most common etiology of acquired amputation is trauma. Postamputation complications include pain and terminal bony overgrowth. A multidisciplinary approach to management with the child and family can lead to a successful, functional, and fulfilling life.
Topics: Amputation, Surgical; Amputation, Traumatic; Artificial Limbs; Child; Humans; Lower Extremity Deformities, Congenital; Medical History Taking; Neoplasms; Phantom Limb; Physical Examination; Prosthesis Design; Upper Extremity Deformities, Congenital
PubMed: 25479783
DOI: 10.1016/j.pmr.2014.09.006 -
Somatosensory & Motor Research Dec 2021This study aims to investigate phantom limb pain (PLP), PLP-related factors, and the effect of PLP on quality of life in patients who had undergone upper or lower...
AIMS
This study aims to investigate phantom limb pain (PLP), PLP-related factors, and the effect of PLP on quality of life in patients who had undergone upper or lower extremity amputation.
METHODS
One hundred four patients with unilateral amputation of the upper or lower extremity were included in this cross-sectional study. The patients were divided into two groups as patients with PLP and without PLP. Patients' demographic (age, gender, marital status, education level, employment status) and clinical information (date of amputation, amputated limb, the side, level and cause of amputation, phantom limb sensation and pain, sleep disorder) and quality of life (Nottingham extended activities of daily living index) were compared between the groups. In addition, factors associated with PLP were analysed.
RESULTS
Of the 104 patients, 47 patients (45.19%) had PLP. In the group with PLP, phantom sensation and sleep disturbance were significantly higher, whereas the time elapsed after amputation and Nottingham extended activities of daily living index score were significantly lower ( < 0.05). The relationship between PLP and sleep disorder and between PLP and marital status was significant ( < 0.05).
CONCLUSIONS
Our study results showed that PLP was associated with sleep disorder and marital status, and the quality of life was low in the group with PLP. Therefore, PLP evaluation should not be disregarded in amputees; PLP should be treated to increase quality of life.
Topics: Activities of Daily Living; Amputees; Cross-Sectional Studies; Humans; Phantom Limb; Quality of Life
PubMed: 34482809
DOI: 10.1080/08990220.2021.1973405 -
Der Orthopade May 2020An amputation around, through or below the knee joint constitutes a "huge" change in a patient's life. In Orthopaedics, amputations are most frequently performed in...
An amputation around, through or below the knee joint constitutes a "huge" change in a patient's life. In Orthopaedics, amputations are most frequently performed in cases with musculoskeletal tumours or failed total knee arthroplasty. A multidisciplinary team approach (surgeon, anaesthetist, pain specialists, orthotist, psychologist etc.) and patient-specific treatment regime from the outset as well as a meticulous surgical technique are of the outmost importance. Nowadays, prosthetic legs can be fitted for nearly any amputation level. The functional outcome of amputations below the knee is usually superior to amputations above or through the knee joint. Postoperative stump conditioning is paramount and the final prosthetic leg should not be fitted earlier than 4-6 months postoperatively. Problems with wound healing, muscle contractures and phantom limb pain represent common complications which might adversely affect patient outcomes.
Topics: Amputation, Surgical; Amputation Stumps; Arthroplasty, Replacement, Knee; Humans; Knee; Knee Joint; Leg; Phantom Limb; Wound Healing
PubMed: 32266433
DOI: 10.1007/s00132-020-03906-8