{"id":8250,"date":"2023-03-09T17:34:31","date_gmt":"2023-03-09T17:34:31","guid":{"rendered":"https:\/\/generic.wordpress.soton.ac.uk\/uosm2031\/?p=8250"},"modified":"2023-03-09T17:34:31","modified_gmt":"2023-03-09T17:34:31","slug":"treating-the-invisible-pain-prosthetics-and-phantom-limb-pain","status":"publish","type":"post","link":"https:\/\/generic.wordpress.soton.ac.uk\/uosm2031\/2023\/03\/09\/treating-the-invisible-pain-prosthetics-and-phantom-limb-pain\/","title":{"rendered":"Treating the Invisible Pain: Prosthetics and Phantom Limb Pain"},"content":{"rendered":"\n<p>I was initially intrigued by the concept of Phantom Limb Pain (PLP) because I was fascinated by how someone could experience pain in a body part they no longer possessed. The depiction of PLP in the sci-fi movies I watched when I was younger seemed to be a figment of the imagination; it appeared to be a mysterious occurrence, somewhat fantastical and an element of creative licence adding dramatic effect.<\/p>\n\n\n\n<p>After further research, I discovered that this perplexing phenomenon is\u00a0<strong>real, not make-believe!<\/strong>\u00a0The basis of PLP although unclear, is suggested to be due to changes in an amputee&#8217;s brain organisation; more specifically, alterations in\u00a0<a rel=\"noreferrer noopener\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3198614\/\" target=\"_blank\">the somatosensory cortex\u00a0<\/a>responsible for processing sensory information such as sight and touch, thus affecting the perception of pain sensitivity.<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"2-Minute Neuroscience: Phantom Limb\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/GYxksqaLBxc?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"alignright size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/generic.wordpress.soton.ac.uk\/uosm2031\/wp-content\/uploads\/sites\/458\/2023\/03\/Phantom-limb-pain-somatosensory-cortex-imaging.jpg\" alt=\"\" class=\"wp-image-8435\" width=\"490\" height=\"208\" srcset=\"https:\/\/generic.wordpress.soton.ac.uk\/uosm2031\/wp-content\/uploads\/sites\/458\/2023\/03\/Phantom-limb-pain-somatosensory-cortex-imaging.jpg 704w, https:\/\/generic.wordpress.soton.ac.uk\/uosm2031\/wp-content\/uploads\/sites\/458\/2023\/03\/Phantom-limb-pain-somatosensory-cortex-imaging-300x127.jpg 300w\" sizes=\"auto, (max-width: 490px) 100vw, 490px\" \/><\/figure><\/div>\n\n\n<p>For those who are unaware, PLP can occur within the first few days after amputation; and can persist without intervention. The symptoms vary from the perceived ability to voluntarily move the phantom limbs to intense pain and tingling sensations.&nbsp;<a rel=\"noreferrer noopener\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3198614\/\" target=\"_blank\">PLP treatment&nbsp;<\/a>is usually with pharmacotherapy, and prosthetic use is considered an adjuvant therapy.<\/p>\n\n\n\n<p><\/p>\n\n\n\n<p style=\"font-size:25px\"><strong>So where do prosthetics come in? <\/strong><\/p>\n\n\n\n<p>A prosthesis is an artificial device that substitutes for part of the body that is absent due to amputation as a result of a disease or traumatic injury.<\/p>\n\n\n\n<p><a rel=\"noreferrer noopener\" href=\"https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0304394099005959?via%3Dihub\" target=\"_blank\">Weiss et al. (1999)<\/a>&nbsp;investigated how increased use of the residual limb by a prosthetic could alleviate PLP by comparing the amount of PLP experienced by upper extremity amputees who wore either the Sauerbruch prosthesis or a cosmetic prosthesis. The Sauerbruch prosthesis allows for the performance of several activities by being connected to one of the muscles of the arm through a surgically created tunnel with cables that operate a rod inserted into the arm, allowing for the contraction and relaxation of the muscle connected to the prosthesis and therefore promotes substantial use of the residual limb. Contrastingly, a cosmetic prosthesis has little functional value and usually leads to the non-use of the affected limb in most individuals who use one. The study concluded that individuals using the Sauerbruch prosthesis have substantially less PLP due to direct motor control of and somatosensory feedback from the prosthetic hand originating in the muscle of the residual limb than those using a cosmetic prosthesis.<\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"alignleft size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/generic.wordpress.soton.ac.uk\/uosm2031\/wp-content\/uploads\/sites\/458\/2023\/03\/Sauerbruch-arm.jpg\" alt=\"\" class=\"wp-image-8252\" width=\"362\" height=\"237\" srcset=\"https:\/\/generic.wordpress.soton.ac.uk\/uosm2031\/wp-content\/uploads\/sites\/458\/2023\/03\/Sauerbruch-arm.jpg 1000w, https:\/\/generic.wordpress.soton.ac.uk\/uosm2031\/wp-content\/uploads\/sites\/458\/2023\/03\/Sauerbruch-arm-300x197.jpg 300w, https:\/\/generic.wordpress.soton.ac.uk\/uosm2031\/wp-content\/uploads\/sites\/458\/2023\/03\/Sauerbruch-arm-768x505.jpg 768w\" sizes=\"auto, (max-width: 362px) 100vw, 362px\" \/><figcaption>The original Sauerbruch arm                                                                                                                       <\/figcaption><\/figure><\/div>\n\n\n<figure class=\"wp-block-image size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/generic.wordpress.soton.ac.uk\/uosm2031\/wp-content\/uploads\/sites\/458\/2023\/03\/image-12.png\" alt=\"\" class=\"wp-image-8258\" width=\"272\" height=\"272\" srcset=\"https:\/\/generic.wordpress.soton.ac.uk\/uosm2031\/wp-content\/uploads\/sites\/458\/2023\/03\/image-12.png 350w, https:\/\/generic.wordpress.soton.ac.uk\/uosm2031\/wp-content\/uploads\/sites\/458\/2023\/03\/image-12-300x300.png 300w, https:\/\/generic.wordpress.soton.ac.uk\/uosm2031\/wp-content\/uploads\/sites\/458\/2023\/03\/image-12-150x150.png 150w\" sizes=\"auto, (max-width: 272px) 100vw, 272px\" \/><figcaption>                           Cosmetic Prosthesis                                                                                                                                                                                                                                        <\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-video\"><video controls src=\"https:\/\/generic.wordpress.soton.ac.uk\/uosm2031\/wp-content\/uploads\/sites\/458\/2023\/03\/mov70-2.mp4\"><\/video><figcaption>Depiction of the functionality of the Sauerbruch Prosthesis<\/figcaption><\/figure>\n\n\n\n<p>Modern <a href=\"https:\/\/www.armdynamics.com\/upper-limb-library\/introduction-to-myoelectric-prostheses\">myoelectric prostheses<\/a> function like the Sauerbruch prosthesis, however, they utilise electrodes in the prosthesis to detect nerve and muscle activity along the residual limb musculature, which triggers motors in the prosthetic to control and produce the movement intended.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/generic.wordpress.soton.ac.uk\/uosm2031\/wp-content\/uploads\/sites\/458\/2023\/03\/image-14.png\" alt=\"\" class=\"wp-image-8260\" width=\"409\" height=\"153\" srcset=\"https:\/\/generic.wordpress.soton.ac.uk\/uosm2031\/wp-content\/uploads\/sites\/458\/2023\/03\/image-14.png 938w, https:\/\/generic.wordpress.soton.ac.uk\/uosm2031\/wp-content\/uploads\/sites\/458\/2023\/03\/image-14-300x113.png 300w, https:\/\/generic.wordpress.soton.ac.uk\/uosm2031\/wp-content\/uploads\/sites\/458\/2023\/03\/image-14-768x288.png 768w\" sizes=\"auto, (max-width: 409px) 100vw, 409px\" \/><figcaption>Basic Diagram of a myoelectric limb                                                                                            <\/figcaption><\/figure>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"alignleft size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/generic.wordpress.soton.ac.uk\/uosm2031\/wp-content\/uploads\/sites\/458\/2023\/03\/Taska-Precision-Grip.2021-01-15-11_57_26.gif\" alt=\"\" class=\"wp-image-8283\" width=\"307\" height=\"172\" \/><\/figure><\/div>\n\n\n<p style=\"font-size:25px\"><strong>Final Thoughts: <\/strong><\/p>\n\n\n\n<p>The understanding of PLP and prosthetics as an adjuvant treatment allowed me to consider further; whether cosmesis of prosthetics(making artificial limbs look lifelike, similar to the original missing limb) aids the alleviation of PLP, as the somatosensory cortex also processes visual information.<\/p>\n\n\n\n<p>My learning extended to another study suggesting that the correction of body perception may modulate PLP. This hypothesis stems from the&nbsp;<a target=\"_blank\" href=\"https:\/\/journals.lww.com\/pain\/Abstract\/2021\/02000\/Relationship_of_prosthesis_ownership_and_phantom.28.aspx\" rel=\"noreferrer noopener\">prosthetic ownership concept,<\/a>&nbsp;whereby prosthetic use is experienced as part of the body rather than an attached device foreign to it. This added to my insight into the prosthetic treatment of PLP as the brain combines&nbsp;<a target=\"_blank\" href=\"https:\/\/www.pnas.org\/doi\/10.1073\/pnas.1616305114\" rel=\"noreferrer noopener\">visual input and direct cortical-somatosensory&nbsp;<\/a>electrical stimulation by the prosthetic, creating a multisensory illusion that an artificial limb actually belongs to the body, thereby reverting the somatosensory cortex to a healthy state.<\/p>\n\n\n\n<p>Overall, PLP accounts for a significant reduction in the quality of life of amputees; thus, the development of prostheses with somatosensory feedback and a cosmesis effect is a promising therapeutic tool to reduce PLP.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>I was initially intrigued by the concept of Phantom Limb Pain (PLP) because I was fascinated by how someone could experience pain in a body part they no longer possessed. The depiction of PLP in the sci-fi movies I watched when I was younger seemed to be a figment of the imagination; it appeared to [&hellip;]<\/p>\n","protected":false},"author":5517,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[163,167],"class_list":["post-8250","post","type-post","status-publish","format-standard","hentry","category-uncategorised","tag-prosthesis","tag-replacement-body-parts"],"jetpack_featured_media_url":"","_links":{"self":[{"href":"https:\/\/generic.wordpress.soton.ac.uk\/uosm2031\/wp-json\/wp\/v2\/posts\/8250","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/generic.wordpress.soton.ac.uk\/uosm2031\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/generic.wordpress.soton.ac.uk\/uosm2031\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/generic.wordpress.soton.ac.uk\/uosm2031\/wp-json\/wp\/v2\/users\/5517"}],"replies":[{"embeddable":true,"href":"https:\/\/generic.wordpress.soton.ac.uk\/uosm2031\/wp-json\/wp\/v2\/comments?post=8250"}],"version-history":[{"count":19,"href":"https:\/\/generic.wordpress.soton.ac.uk\/uosm2031\/wp-json\/wp\/v2\/posts\/8250\/revisions"}],"predecessor-version":[{"id":8445,"href":"https:\/\/generic.wordpress.soton.ac.uk\/uosm2031\/wp-json\/wp\/v2\/posts\/8250\/revisions\/8445"}],"wp:attachment":[{"href":"https:\/\/generic.wordpress.soton.ac.uk\/uosm2031\/wp-json\/wp\/v2\/media?parent=8250"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/generic.wordpress.soton.ac.uk\/uosm2031\/wp-json\/wp\/v2\/categories?post=8250"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/generic.wordpress.soton.ac.uk\/uosm2031\/wp-json\/wp\/v2\/tags?post=8250"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}