Today, author and Christy Award nominee (two nominations!) Jocelyn Green concludes her two-part series on phantom limb pain. You can find Part I here.
As an added bonus, Jocelyn has graciously offered to give away a personalized copy of her latest novel, Widow of Gettysburg, to one commentor. To enter, leave a comment on any of her posts WITH your e-mail address. Must live in the USA. Winner drawn midnight, Saturday, May 11th, 2013 and announced here at Redwood’s on May 12th, 2013.
Jocelyn has also graciously said she’ll send you a signed bookplate if you have any of her novels and would like one. Again, MUST have your e-mail.
You can view Jocelyn’s previous posts at Redwood’s here and here.
Welcome back, Jocelyn!
What We Know Today
The study of PLP continues with today’s generation of amputee veterans. Most contemporary studies confirm what Mitchell found, but add to it some new information. Most recent studies report PLP at rates of 50% to 80%. A few of these are in constant pain, but for most, the episodes can last a few seconds or one to two hours.
Since the beginning of the conflicts in Iraq and Afghanistan more than 1000 amputees have been treated at Walter Reed Army Medical Center in Washington, DC. Almost all experience PLP, either within the first 24 hours of amputation, or within two weeks. The following insight comes from an article in a 2010 issue of The Neurologist:
“As part of routine treatment efforts, the patients are asked to describe their experience with phantom sensation and phantom pain. There have been a plethora of responses regarding the onset, duration, description, and location of phantom sensations and phantom pains from those queried. Furthermore, some explain they have volitional control over their phantom, and can move their phantom at will, while others report their phantoms being fixed in a specific position. Some even report the inability to make movements with the phantom, despite the presence of a strong sensation or pain emanating from their residual limb. For example, one service member reported that his phantom hand was in a distinct position: he felt he was pulling the trigger on his rifle with his index finger, and was unable to move his hand to a different position. He also felt cramping pains in his hand muscles. Another service member, a bilateral, above knee amputee, described the feeling of heavy legs, asserting that the feeling was similar to weights attached to his calf muscles. He also described that it felt as though his combat boots were on too tightly.”
The most successful treatments have been with opioids and mirror therapy, the latter considered the most promising treatment plan.
In this treatment, the patient views the reflection of their intact limb moving in a mirror placed between the arms or legs while simultaneously moving the phantom hand or foot in a manner similar to what they are observing. The virtual limb in the mirror appears to be the missing limb.
Patients have reported a relief of cramping and “frozen limb” phantom pains as a result of even one session with the mirror. In one study in which patients used mirror therapy for 15 minutes each weekday for four weeks, significant decreases in pain were reported. More about mirror therapy can also be found in the online article hyperlinked above.
For further reading:
Mitchell, Silas Weir. The Case of George Dedlow. (fictional account of quad amputee) New York: The Century Co., 1900. Read it online at Google Books here, and begin on page 115. http://bit.ly/ZixtJd
Gunshot Wounds and other Injuries of Nerves. Philadelphia: J.B. Lippincott, & Co., 1864. Read it online at Google Books here: http://bit.ly/17hhuvf