Abstract
The direct, and much of the indirect, evidence supporting the existence psychophysiological mechanisms for phantom limb pain is reviewed. Phantom pain is shown to be a symptom class composed of different, but similarly described problems, each having its own underlying mechanisms. At least some descriptive types of phantom pain probably have mainly peripheral, as opposed to only central, origins. Although much of the direct data are preliminary, burning phantom pain is probably related to decreased blood flow in the residual limb, while cramping phantom pain is mainly related to spikelike muscle spasms in the major muscles of the residual limb. Little support is provided for psychological causes for phantom pain, but the expression of phantom pain does appear to be influenced by psychological mechanisms similarly to the ways other chronic pain conditions are influenced. The importance of a careful psychophysiological assessment of patients to treatment success is discussed. Because several different mechanisms are involved, no one treatment is likely to be effective for all of the different types of phantom pain. Appropriate combinations of self-regulation strategies aimed at controlling the underlying physiological problems are likely to be effective in reducing the incidence and severity of burning and cramping types of phantom pain.
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References
Alexander, F. (1950).Psychosomatic medicine. New York: Norton Press.
Allen, M., & Moretz, W. (1982). Sympathectomy. In J. Youmans (Eds.),Neurological surgery. Philadelphia: W. B. Saunders.
Appenzeller, O., & Bicknell, J. (1969). Effects of nervous system lesions on phantom experience in amputees.Neurology, 19 141–146.
Arena, J. G., Sherman, R. A., Bruno, G. M., & Smith, J. (1988a). The relationship between situational stress and phantom limb pain.Proceedings of the 19th Annual meeting of the Biofeedback Society of America, Colorado Springs (p. 12).
Arena, J. G., Sherman, R. A., Bruno, G. M., & Smith, J. (1988b). The relationship between physical activity and phantom limb pain: Preliminary analysis.Proceedings of the Annual Meeting of the American Association for Behavioral Therapy.
Feringa, E., & Vahlsing, H. (1985). Labeled cortico-spinal neurones one year after spinal cord transection.Neuroscience Letters, 58 283–286.
Hess, C. W., Mills, K. R., & Murray, N. M. (1986). Magnetic stimulation of the human brain: Facilitation of motor responses by voluntary contraction of muscles with additional observation on an amputee.Neuroscience Letters, 71 235–240.
Kaas, J., Merzenich, M., & Killackey, H. (1983). The reorganization of the somatosensory cortex following peripheral nerve damage in adult and developing mammals.Annual Review of Neuroscience, 6 325–356.
Kolb, L. (1952). Psychiatric aspects of treatment of painful phantom limb.Medical Record and Annals, 46 370–374.
Kolb, L. (1954).The painful phantom: Psychology, physiology and treatment. Springfield, IL: Charles C. Thomas.
Marsland, A., Weeks, J., Atkinson, R., & Leong, M. (1982). Phantom limb pain: A case for beta blockers?Pain, 12 295–297.
Matzner, O., & Devor, M. (1987). Contrasting thermal sensitivity of spontaneously active A and C fibers in experimental nerve-end neuromas.Pain, 30 373–384.
Melzack, R., & Wall, P. (1982).The challenge of pain. New York: Basic Books.
Melzack, R. (1971). Phantom limb pain: Implications for treatment of pathological pain.Anesthesiology, 35 409–419.
Mihic, D., & Pinkert, E. (1981). Phantom limb pain during peridural anaesthesia.Pain, 11 269–272.
Nathanson, M. (1988). Phantom limbs as reported by S. Weir Mitchell.Neurology, 38 504–505.
Nystrom, B., & Hagbarth, K. (1981). Microelectrode recordings from transected nerves in amputees with phantom limb pain.Neuroscience Letters, 27 211–216.
Parks, C. (1973). Factors determining the persistence of phantom pain in the amputee.Journal of Psychosomatic Research, 17 97–108.
Riddoch, G. (1941). Phantom limbs and body shape.Brain, 64 197–222.
Sellick, B. (1985). Phantom limb pain and spinal anesthesia.Anesthesiology, 62 801–802.
Sherman, R. A. (1980). Special review: Published treatments of phantom limb pain.American Journal of Physical Medicine, 59 232–244.
Sherman, R. A. (1984). Direct evidence of a link between burning phantom limb pain and stump blood circulation.Orthopedics, 7 1319–1320.
Sherman, R. A. (1989). Stump and phantom limb pain. In R. Portenoy (Ed.),Neurologic Clinics: Pain. Philadelphia: W. B. Saunders.
Sherman, R. A., & Barja, R. J. (1989). Treatment of post-amputation and phantom limb pain. In K. Foley & R. Payne (Eds.),Current therapy of pain. Grand Junction, CO: B. C. Decker.
Sherman, R. A., Barja, R. J., & Bruno, G. M. (1987). Thermographic correlates of chronic pain: Analysis of 125 sequential subjects incorporating evaluations by a blind panel.Archives of Physical Medicine and Rehabilitation, 68 273–279.
Sherman, R. A., & Bruno, G. M. (1980). Concurrent variation of burning phantom limb and stump pain with near surface blood flow in the stump.Orthopedics, 10 1395–1402.
Sherman, R. A., Bruno, G. M., Sherman, C. J., Arena, J. G., & Grana, A. (1989).Relationships between muscle contraction patterns in the residual limb and phantom limb pain: An initial evaluation. Manuscript submitted for publication.
Sherman, R. A., Ernst, J., Barja, R., & Bruno, G. M. (1988). Phantom pain: A lesson in the necessity for carrying out careful clinical research in chronic pain problems.Rehabilitation Research and Development, 25(2), vii-x.
Sherman, R. A., Ernst, J., & Markowski, J. (1986). Relationships between near surface blood flow and altered sensations among spinal cord injured veterans.American Journal of Physical Medicine, 66(6), 281–297.
Sherman, R. A., Gall, N., & Gormly, J. (1979). Treatment of phantom limb pain with muscular relaxation training to disrupt the pain-anxiety-tension cycle.Pain, 6 47–55.
Sherman, R. A., & Sherman, C. J. (1983). Prevalence and characteristics of chronic phantom limb pain among American veterans.American Journal of Physical Medicine, 62 227–238.
Sherman, R. A., & Sherman, C. J. (1985). A comparison of phantom sensations among amputees whose amputations were of civilian and military origins.Pain, 21 91–97.
Sherman, R. A., Sherman, C. J., & Bruno, G. M. (1987). Psychological factors influencing phantom limb pain: An analysis of the literature.Pain, 28 285–295.
Sherman, C. J., Sherman, R. A., Bruno, G. M., & Arena, J. G. (1989).A survey of locus of control among amputees. Manuscript submitted for publication.
Sherman, R. A., Sherman, C. J., & Parker, L. (1984). Chronic phantom and stump pain among American veterans: Results of a survey.Pain, 18 83–95.
Sternbach, R. (1968).Pain: A psychophysiological analysis. New York: Academic Press.
Sturgis, E. T., & Arena, J. G. (1984). Psychophysiological assessment. In M. Hersen, P. Miller, & R. M. Eisler (Eds.),Progress in behavior modification (Vol. 17, pp. 1–30). New York: Academic Press.
Sumner, A. (1980).The physiology of peripheral nerve disease. Philadelphia: W. B. Saunders.
Sweet, W. (1975). Phantom sensations following intraspinal injury.Neurochirurgia, 18 139–154.
Wall, P. (1981). On the origin of pain associated with amputation. In J. Siegfried & M. Zimmermann (Eds.),Phantom and stump pain (pp. 2–14). Berlin: Springer.
Wall, P., and Gutnick, M. (1974). Ongoing activity in peripheral nerves: The physiology and pharmacology of impulses originating from a neuroma.Experimental Neurology, 43 580–593.
Yarnitsky, D. Barron, S., & Bental, E. (1988). Disappearance of phantom pain after focal brain infarction.Pain, 3 285–287.
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Many of the recordings were performed by Anna Cocilovo, P.A. of the Psychophysiology Laboratory at Fitzsimons Army Medical Center (FAMC). The figure was finalized by Karen Wyatt (medical illustrator at FAMC) from a sketch by Dr. Sherman and a drawing finalized by Wayne Timmerman (medical illustrator at Eisenhower AMC). This research was entirely supported by the Rehabilitation Research section of the Veterans Administration and by the U.S. Army. The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the United States Departments of the Army, Defense, or Veterans Affairs.
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Sherman, R.A., Arena, J.G., Sherman, C.J. et al. The mystery of phantom pain: Growing evidence for psychophysiological mechanisms. Biofeedback and Self-Regulation 14, 267–280 (1989). https://doi.org/10.1007/BF00999118
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DOI: https://doi.org/10.1007/BF00999118