Phantom limb: a phenomenological study

Phantom limb phenomena during the post-operative period were studied in 72 amputees. All were right handed. Phantom limb was present in 86.1 per cent of the cases, significantly more commonly amputation of the right arm. Nearly half of the phantoms developed within the first 24 hours and another quarter in the next 24 hours, appearing earlier in lower limb amputees. Movements in the phantom were felt by three-quarters of the cases, an incidence unaffected by site or side of amputation. Telescopy was present in nearly two-thirds and phantom limb pain in over two-thirds, significantly more commonly in the upper limb amputees but uninfluenced by the side of amputation. Thirty-one of the patients dreamed that their limbs were intact.

A psychiatric study of amputees

Psychiatric manifestations were studied in 72 amputees in the post-operative period. All were right handed. Besides phantom limb phenomena, which were observed in nearly four-fifths of the cases and are described in another paper, nearly two-thirds had psychiatric symptoms inthe form of depression (45 patients), anxiety (38), crying spells (38), insomnia (34), loss of appetite (23), suicidal ideas (21) and psychotic behaviour (2). Right arm amputees had phantom phenomena and insomnia significantly more often than left. Nearly one-fifth of the cases were diagnosed as having psychotic depressive reactions, two-fifths as having depressive neurosis and two, both with right upper limb amputations, as schizophrenic.

Persistent phantom limb pain

The role of psychological factors in 10 patients with painful phantom limbs was investigated by means of a questionnaire and interviews. The hypotheses were that the severity of pain would be positively correlated with their present personal problems and attitudes and with experience of pain in the limb before amputation. The first hypothesis was confirmed but the second was not.

Discrimination of phantom hand sensations elicited by afferent electrical nerve stimulation in below-elbow amputees

The necessity for a sensory feedback system that would enhance patient acceptability of motorized hand prostheses is now generally acknowledged. Afferent electrical stimulation of the nerves in the amputation stump can convey sensory feedback from prostheses with the advantage of eliciting sensations in the phantom image of the lost hand. Experiments with percutaneous nerve stimulation of the amputation stump in below-elbow amputees showed that with stable electrode conditions, amplitude modulated stimulation was better than frequency modulated stimulation in terms of accuracy, delay, and transinformation both with intermittent and uninterrupted stimulation. With unstable electrode conditions, different results were noticed, since amplitude modulated stimulation is very sensitive even to minor changes in electrode position. It is concluded that afferent electrical nerve stimulation with adequate training and stable electrodes had characteristics of accuracy, transinformation and delay which are good enough to make it a suitable method of conveying information in a prosthesis feedback system.

Treatment of phantom limb pain with muscular relaxation training to disrupt the pain--anxiety--tension cycle

Sixteen phantom limb pain patients were treated with a combination of (1) progressive muscle relaxation exercise, (2) feedback of stump and forehead muscle tension, and (3) reassurance about normal phantom sensations and the relationship between anxiety and pain. Fourteen of the patients had chronic pain (average of 12 years) and two were recent amputees (5- and 1-week). At the end of treatment, 8 of the chronic patients showed virtually complete relief from pain, 4 showed significant decreases to a point at which they no longer desired treatment and 2 showed no significant change. Both recent amputees showed complete relief from pain. These changes have been sustained for follow-up period of 6 months to 3 years. The 2 unsuccessful patients did not learn to relax and had strong psychological needs for their pain.

Phantom bite syndrome

Despite repeated treatment failures, some individuals seek bite correction from a succession of dentists. Their pathological narcissism focuses on their bite, in a manner reminiscent of phantom limb phenomena. The dentist's diagnosis and treatment are manipulated until the patient claims them a failure and consults another dentist. The author suggests that this behavior represents a defense against paranoia and severe personality disorders.