Phantom Limb - Treatment

Treatment

Most approaches to treatment over the past two decades have not shown consistent symptom improvement. Treatment approaches have included drugs such as antidepressants, Spinal cord stimulation, Vibration therapy, acupuncture, hypnosis, and biofeedback.

In 2006 Hera Flor, at the Department of Clinical Neuroscience, University of Heidelberg, stated that "Several studies, including large surveys of amputees, have shown that most currently available treatments for phantom limb pain, which range from analgesic and antidepressant medication to stimulation, are ineffective and fail to consider the mechanisms that underlie production of the pain".

One approach that has gained a great deal of public attention is the mirror box developed by Vilayanur Ramachandran and colleagues. Through the use of artificial visual feedback it becomes possible for the patient to "move" the phantom limb, and to unclench it from potentially painful positions. Repeated training in some subjects has led to long-term improvement, and in one exceptional case, even to the complete elimination of the phantom limb between the hand and the shoulder (so that the phantom hand was dangling from the shoulder).

Recently, graded motor imagery (which may incorporate mirror therapy) and sensory discrimination training have emerged as promising therapeutic tools in dealing with pathologic pain problems such as phantom limb pain and complex regional pain syndrome. However, Lorimer Mosely, who developed graded motor imagery, cautions "Although evidence is emerging that treatments such as graded motor imagery and sensory discrimination training can be effective for pathologic pain, further studies are needed to replicate the current data and elucidate the mechanisms involved."

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