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. 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. Tsao and his colleagues proposed that proprioceptive memories remain in an individual even after a limb has been amputated. Proprioceptive memory refers to memory of specific limb positions.ĭr. 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. Tsao’s theory takes on a “multifactorial approach,” incorporating “proprioceptive memory” and Ramachandran and Hirstein’s model. 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).
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. 2 He proposed that PLP fell under the category of “exteroceptive perceptions,” which include sensations such as touch, pressure, temperature, and itch. PLP is actually one of three phenomena associated with what have been termed “phantom sensations” by Weinstein. 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. 1 Practical Pain Management spoke with Dr. Tsao and his colleagues at Walter Reed Army Medical Center recently published a review article describing the various theories and therapies associated with PLP. 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. For many of these individuals, pain from their injuries does not cease following amputation many suffer from phantom limb pain (PLP), or pain that is perceived in an area of the body that no longer exists. Over the past few years, military conflicts in Iraq and Afghanistan have resulted in a dramatic increase in the number of service members returning home with single- and multiple-limb amputations.
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