Phantom Limb Pain
Joel KatzThe Toronto Hospital and Acute Pain Research Unit, Mount Sinai Hospital, and University of Toronto
Many patients awake from the anesthetic after an amputation believing that the operation has not been performed. Their continued sense of the lost limb is so real that not until they lift the bed sheets to see it do they realize it has been cut off. This startling realization has little effect on the reality of the limb they experience, and in some cases may even intensify the sensations that define it. Mitchell ( 1871) coined the term phantom limb to describe the persisting sensory awareness of a limb after amputation.
A distinction is usually made between the painful and nonpainful phantom limb ( Melzack & Wall, 1988). The most salient property of the non- painful phantom is its tingling, "pins and needles" or paresthestic quality, but sensations of temperature, posture, length, volume, and movement are also very common ( T. S. Jensen & Rasmussen, 1994). Recent studies estimate the incidence of the nonpainful phantom at approximately 80% to 100% ( T. S. Jensen & Rasmussen, 1994). For many amputees, however, a distressing problem is phantom limb pain ( R. A. Sherman, 1989). Many patients report a painful intensification of the paresthesias (i.e., dysesthesias) that define the nonpainful phantom limb. Some sufferers describe bouts of paroxysmal shooting pain that travel up and down the limb. Others report the phantom to be in a cramped or otherwise unnatural posture that gives rise to excruciating pain. Many amputees describe the