Painful phantom limb treated by high cervical chordotomy report of two cases

Falconer, Murray A.; Lindsay, J. S. B.

doi:10.1002/bjs.18003313202

Cited by 18 publications

(1 citation statement)

References 11 publications

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“…But these sensations may still arise from the activity of nerve cells intermediate between the cortex and the peripheral neurone. In an earlier paper (Falconer and Lindsay, 1945) it was pointed out that, in cases with intractable pain, antero-lateral chordotomy renders a phantom painless, whereas posterior rhizotomy does not, and consequently that the neurones presumably responsible for the pain are the cells of the substantia gelatinosa of Rolando. I would like to develop this hypothesis further in the light of more recent evidence, both theoretical and experimental.…”

Section: Frontal Lobotomymentioning

confidence: 99%

Surgical Treatment of Intractable Phantom-limb Pain

Falconer¹

1953

BMJ

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Section: Frontal Lobotomymentioning

confidence: 99%

Surgical Treatment of Intractable Phantom-limb Pain

Falconer¹

1953

BMJ

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Phantom Limb Pain and Central Pain

Stone¹

1950

Arch NeurPsych

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CHICAGO PHANTOM limb pain was first described by Ambroise Par\l=e'\1 in 1551, and many theories have since been advanced to explain it. The present study was made with the thought of developing a form of therapy for this extremely painful entity. A review of the literature revealed an unusual variation in types of therapy. Among such procedures are removal or resection of a painful neuroma at the stump, further reamputation, sympathectomy, ganglionectomy, chordotomy, posterior rhizotomy, leukotomy and, in some cases, focal ablation of the cortex in the posterior central convolution.In 1871 Weir Mitchell 2 published his work and gave the term by which this condition is known\p=m-\phantom limb pain. He stated that a person with this condition is haunted, as it were, by a constant or an inconstant fractional phantom of so much of himself as has been lopped away. He was the first to faradize the track of the nerves in or above the stump. As a result of this stimulation, the patient felt as though he had the limb or hand or foot that had been amputated. Weir Mitchell stated the belief that this phenomenon was due to irritation of sensory trunks, which occasioned impressions of muscular motion in the sensorium. He found that 95 per cent of patients experience phantom limb after amputa¬ tion, albeit no pain.Henderson and Smyth's 3 study of .300 cases revealed that phantom limb was a natural, and almost universal, sequel to amputation. They reported three kinds of sensory phenomena : ( 1 ) mild tingling, which forms the basic part of the phantom in nearly every case and probably

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Observations on Phantom-Limb Phenomena

Haber¹

1956

Arch NeurPsych

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Loss of limb, in man, is often followed by an illusion\p=m-\the conviction that the limb, or parts of it, continues to be present. Wier Mitchell30 coined the term "phantom limb" to designate this phenomenon, but descriptions can be found for centuries before him.* The more recent literature has assumed forbidding proportions,\s=d\yet the phenomenon itself remains puzzling. Perhaps all attempts at explanation are premature until we know more about the phenomenon itself, for the great mass of studies tells us little about such simple questions as the incidence of phantom limbs after amputation, the relative frequency of different phantom sensations, or the changes in the illusion with time.To answer these questions, one needs systematic surveys of groups of cases; most of the available accounts are based, instead, on particularly striking aspects found in selected instances. Thus, for obvious reasons, painful phantoms (first described by Par\l=e'\ in 1552) have been discussed at the expense of "natural" painless phantoms, which are actually much more frequent.:}:A good deal of the literature on phantom limbs is concerned with theories about their origin. These theories are based on conjec¬ tures but are nevertheless useful in guiding one's observations. There are essentially three views on etiology: a peripheral view, a central view, and a third approach, com¬ bining the other two. theories Peripheral Theory.-This theory ascribes phantom limbs to sensations arising from nerve endings in the stump. § Impulses are said to be triggered off by irritants, such as neuromata, mechanical defects, scar tissue, or anoxia. Sensations due to the propagated impulses are assigned to parts originally in¬ nervated. Thus the phantom is "projected" to those areas which had been supplied by the nerve trunk, even though the distal fibers were lost with the amputation.Attempts at direct confirmation of the peripheral theory have been made by claim¬ ing that presence of neuromata or excessive scarring of the stump are associated with especially persistent and painful phantoms; by claiming beneficial effects of peripheral surgery, and by claiming that phantom sensa¬ tions are readily influenced by stimulation of the stump or its nerves.Evidence on all these points is far from convincing. The impression of association between neuroma and persistent phantom is based on unsystematic observations and is rejected by many neurosurgeons.|| Similarly, there are few that accept without question the claims for beneficial effects on phantoms of corrective surgery on the stump, removal of neuroma, proximal cutting of sensory nerves, dorsal root sections, or blocking or \ s=s\ References 10 11, 23, and 34. \ m= p a r \ References 9, 23, 27, 28, and 43.

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Painful phantom limb treated by high cervical chordotomy report of two cases

Cited by 18 publications

References 11 publications

Surgical Treatment of Intractable Phantom-limb Pain

Surgical Treatment of Intractable Phantom-limb Pain

Phantom Limb Pain and Central Pain

Observations on Phantom-Limb Phenomena

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