Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Journal of Medical Case Reports
Published in: Journal of Medical Case Reports 1/2023

Open Access 21-05-2023 | Nerve Stimulation | Case report

Managing acute phantom limb pain with transcutaneous electrical nerve stimulation: a case report

Author: Katleho Limakatso

Published in: Journal of Medical Case Reports | Issue 1/2023

Login to get access

Abstract

Introduction

Phantom limb pain is characterized by painful sensations in the amputated limb. The clinical presentation of acute phantom limb pain may differ from that of patients with chronic phantom limb pain. The variation observed implies that acute phantom limb pain may be driven by peripheral mechanisms, indicating that therapies focused on the peripheral nervous system might be successful in reducing pain.

Case presentation

A 36-year-old African male with acute phantom limb pain in the left lower limb, was treated with transcutaneous electrical nerve stimulation.

Conclusion

The assessment results of the presented case and the evidence on acute phantom limb pain mechanisms contribute to the current body of literature, indicating that acute phantom limb pain presents differently to chronic phantom limb pain. These findings emphasize the importance of testing treatments that target the peripheral mechanisms responsible for phantom limb pain in relevant individuals with acquired amputations.
Literature
1.
Padovani MT, Martins MR, Venancio A, Forni JE. Anxiety, depression and quality of life in individuals with phantom limb pain. Acta Ortop Bras. 2015;23(2):107–10.PubMedPubMedCentralCrossRef
2.
Ahmed A, Bhatnagar S, Mishra S, Khurana D, Joshi S, Ahmad S. Prevalence of phantom limb pain, stump pain, and phantom limb sensation among the amputated cancer patients in India: a prospective, observational study. Indian J Palliat Care. 2017;23(1):24–35.PubMedPubMedCentralCrossRef
3.
Clark RL, Bowling FL, Fergus J, Rajbhandari S. Phantom limb pain after amputation in diabetic patients does not differ from that after amputation in nondiabetic patients. Pain. 2013;154(5):729–32.PubMedCrossRef
4.
5.
Bornemann-Cimenti H, Dorn C, Rumpold-Seitlinger G. Early onset and treatment of phantom limb pain following surgical amputation. Pain Med. 2017;18(12):2510–2.PubMedCrossRef
6.
7.
Ehde DM, Wegener ST. Management of chronic pain after limb loss. In: Gallagher P, Desmond D, MacLachlan M, editors. Psychoprosthetics. London: Springer; 2008. p. 33–51.CrossRef
8.
Diers M, Christmann C, Koeppe C, Ruf M, Flor H. Mirrored, imagined and executed movements differentially activate sensorimotor cortex in amputees with and without phantom limb pain. Pain. 2010;149(2):296–304.
9.
Flor H. Cortical reorganisation and chronic pain: Implications for rehabilitation. J Rehabil Med. 2003;35:66–72.CrossRef
10.
Flor H, Elbert T, Knecht S, Wienbruch C, Pantev C, Birbaumers N, et al. Phantom-limb pain as a perceptual correlate of cortical reorganization following arm amputation. Nature. 1995;375(6531):482–4.PubMedCrossRef
11.
Foell J, Bekrater-Bodmann R, Diers M, Flor H. Mirror therapy for phantom limb pain: brain changes and the role of body representation. Eur J Pain. 2014;18(5):729–39.PubMedCrossRef
12.
Gruesser SM, Winter C, Schaefer M, Fritzsche K, Benhidjeb T, Tunn P-U, et al. Perceptual phenomena after unilateral arm amputation: a pre-post-surgical comparison. Neurosci Lett. 2001;302(1):13–6.CrossRef
13.
Guo X, Lin Z, Lyu Y, Bekrater-Bodmann R, Flor H, Tong S. The effect of prosthesis use on hand mental rotation after unilateral upper-limb amputation. IEEE Trans Neural Syst Rehabilitation Eng. 2017;25(11):2046–53.CrossRef
14.
Karl A, Birbaumer N, Lutzenberger W, Cohen LG, Flor H. Reorganization of motor and somatosensory cortex in upper extremity amputees with phantom limb pain. J Neurosci. 2001;21(10):3609–18.PubMedPubMedCentralCrossRef
15.
Vaso A, Adahan H-M, Gjika A, Zahaj S, Zhurda T, Vyshka G, et al. Peripheral nervous system origin of phantom limb pain. Pain. 2014;155(7):1384–91.PubMedCrossRef
16.
17.
Wong CK, Wong CK. Limb laterality recognition score: a reliable clinical measure related to phantom limb pain. Pain Med. 2018;19(4):753–6.PubMedCrossRef
18.
Margarita Cadavid Puentes A, Castañeda Marin EM. Very early phantom limb pain following amputation of a lower extremity: case report. Colomb J Anesthesiol. 2013;41:236.
19.
Reinersmann A, Haarmeyer GS, Blankenburg M, Frettlöh J, Krumova EK, Ocklenburg S, et al. Left is where the L is right. Significantly delayed reaction time in limb laterality recognition in both CRPS and phantom limb pain patients. Neurosci Lett. 2010;486(3):240–5.PubMedCrossRef
20.
21.
Hall N, Eldabe S. Phantom limb pain: a review of pharmacological management. Br J Pain. 2018;12(4):202–7.PubMedCrossRef
22.
Turan Z, Topaloğlu M, Özyemişçi-Taşkıran Ö. What is the effectiveness and adverse event data of transcutaneous electrical nerve stimulation (TENS) in reducing pain in adults with chronic pain? An overview of Cochrane Reviews summary with commentary. Turkish J Phys Med Rehabil. 2020;66(2):210–3.CrossRef
23.
Mulvey MR, Radford HE, Fawkner HJ, Hirst L, Neumann V, Johnson MI. Transcutaneous electrical nerve stimulation for phantom pain and stump pain in adult amputees. Pain Pract. 2013;13(4):289–96.CrossRef
24.
Giuffrida O, Simpson L, Halligan PW. Contralateral stimulation, using TENS, of phantom limb pain: two confirmatory cases. Pain Med. 2010;11(1):133–41.PubMedCrossRef
25.
Tilak M, Isaac SA, Fletcher J, Vasanthan LT, Subbaiah RS, Babu A, et al. Mirror therapy and transcutaneous electrical nerve stimulation for management of phantom limb pain in amputees—a single blinded randomized controlled trial. Physiother Res Int. 2016;21(2):109–15.PubMedCrossRef
26.
Vance CG, Dailey DL, Rakel BA, Sluka KA. Using TENS for pain control: the state of the evidence. Pain Manag. 2014;4(3):197–209.PubMedCrossRef
27.
Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J, et al. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain. 2005;114(1–2):29–36.PubMedCrossRef
28.
Cleeland C, Ryan K. Pain assessment: global use of the brief pain inventory. Ann Acad Med Singap; 1994.
29.
Chan BL, Witt R, Charrow AP, Magee A, Howard R, Pasquina PF, et al. Mirror therapy for phantom limb pain. N Engl J Med. 2007;357(21):2206–7.PubMedCrossRef
30.
Moseley GL. Graded motor imagery for pathologic pain: a randomized controlled trial. Neurology. 2006;67(12):2129–34.PubMedCrossRef
31.
Barbin J, Seetha V, Casillas JM, Paysant J, Perennou D. The effects of mirror therapy on pain and motor control of phantom limb in amputees: a systematic review. Ann Phys Rehabil Med. 2016;59(4):270–5.PubMedCrossRef
32.
Bowering KJ, O’Connell NE, Tabor A, Catley MJ, Leake HB, Moseley GL, et al. The effects of graded motor imagery and its components on chronic pain: a systematic review and meta-analysis. J Pain. 2013;14(1):3–13.PubMedCrossRef
33.
Thieme H, Morkisch N, Rietz C, Dohle C, Borgetto B. The efficacy of movement representation techniques for treatment of limb pain—a systematic review and meta-analysis. J Pain. 2016;17(2):167–80.PubMedCrossRef
34.
Flor H, Elbert T. Phantom-limb pain as a perceptual correlate of cortical reorganization following arm amputation. Nature. 1995;375(6531):482.PubMedCrossRef
35.
36.
Parsons LM, Fox PT. The neural basis of implicit movements used in recognising hand shape. Cogn Neuropsychol. 1998;15:583–616.
37.
Moseley GL. Imagined movements cause pain and swelling in a patient with complex regional pain syndrome. Neurology. 2004;62(9):1644.PubMedCrossRef
38.
Makin TR, Scholz J, Filippini N, Henderson Slater D, Tracey I, Johansen-Berg H. Phantom pain is associated with preserved structure and function in the former hand area. Nat Commun. 2013;4:1570.PubMedCrossRef
39.
McCormick Z, Chang-Chien G, Marshall B, Huang M, Harden RN. Phantom limb pain: a systematic neuroanatomical-based review of pharmacologic treatment. Pain Med. 2014;15(2):292–305.PubMedCrossRef
40.
Flor H, Nikolajsen L, Jensen TS. Phantom limb pain: a case of maladaptive CNS plasticity? Nat Rev Neurosci. 2006;7(11):873.PubMedCrossRef
41.
Rokugo T, Takeuchi T, Ito H. A histochemical study of substance P in the rat spinal cord: effect of transcutaneous electrical nerve stimulation. J Nippon Med Sch. 2002;69(5):428–33.PubMedCrossRef
42.
Palmer ST, Martin DJ, Steedman WM, Ravey J. Effects of electric stimulation on C and A delta fiber-mediated thermal perception thresholds. Arch Phys Med Rehabil. 2004;85(1):119–28.PubMedCrossRef
43.
Hu X, Trevelyan E, Yang G, Lee MS, Lorenc A, Liu J, et al. The effectiveness of acupuncture/TENS for phantom limb syndrome. I: A systematic review of controlled clinical trials. Eur J Integr Med. 2014;6(3):355–64.CrossRef
44.
Johnson MI, Mulvey MR, Bagnall AM. Transcutaneous electrical nerve stimulation (TENS) for phantom pain and stump pain following amputation in adults. Cochrane Database Syst Rev. 2015;8(8):7264.
Metadata
Title
Managing acute phantom limb pain with transcutaneous electrical nerve stimulation: a case report
Author
Katleho Limakatso
Publication date
21-05-2023
Publisher
BioMed Central
Published in
Journal of Medical Case Reports / Issue 1/2023
Electronic ISSN: 1752-1947
DOI
https://doi.org/10.1186/s13256-023-03915-z

Other articles of this Issue 1/2023

Journal of Medical Case Reports 1/2023 Go to the issue

Case report

Eggshell calcified hydrocele sac: a case report

Case report

Whole lung lavage decreases physiological dead space in patients with pulmonary alveolar proteinosis: two case reports 

Case report

Percutaneous pedicle screw fixation was effective for bone regeneration after a huge vertebral defect due to intractable pyogenic spondylitis caused by methicillin-resistant Staphylococcus aureus: a case report

Case report

Cauda equina syndrome caused by secondary CNS lymphoma

Case report

Vasculitis presenting as carpal tunnel syndrome: a case report

Case Report

Spinal nerve root sleeve cysticercosis: a case report and  review of the literature
Image Credits