PHANTOM OF AMPUTATED

From Big Medical Encyclopedia

The PHANTOM AMPUTATED

(fr. fantome, from Greek phantasma the ghost, imagination) — false sensation, illusion of presence of the lost part of a body.

For the first time this phenomenon was described in 16 century by A. Paré. After amputation or a separation of an extremity F. and. it is observed at 95 — 98% of victims.

Pathogeny F. and. it is difficult and finally it is not found out. It is considered that in emergence of phantom feelings the large role is played by a flow of the irritations which are arriving from the periphery and turning on the difficult mechanism in action maintenance in consciousness of idea of a body scheme depends on functioning to-rogo, in particular, (see). As confirmation of a cortical origin of phantom feelings serves the known fact that at small children, and also at mentally sick these feelings after amputation of an extremity often are absent. However there are data on phantom feelings and persons with inborn absence have extremities; it was the basis for the assumption that the structural basis of this phenomenon is genetically caused. Peripheral irritations are necessary for emergence of stump neuralgias; as a rule, they are connected with patol. condition of tissues of stump (hems, neuromas). If this impulsation is rather intensive and long, then pains can gain the «central» character due to emergence of the resistant centers of irritation in these or those sites of c. N of the page creating perception of pain (see). There is an idea of generating mechanisms F. and. According to it as a result of the deafferentation arising at amputation of an extremity sensitivity of neurons increases and there is an insufficiency of the central mechanisms braking pain caused by loss of the peripheral impulsapiya stimulating these mechanisms. As a result the deafferentation conducts to patol. activities of cells of a head and spinal cord, to-rye begin to be excited spontaneously and generate patholologically the strengthened excitement.

Distinguish phantom feelings (bezbolevy the phantom), stump neuralgias and amputating pains.

Phantom feelings arise at most of patients, and in 80% of cases at once after loss of an extremity. Most clearly distal departments of the absent part of an extremity, especially the fingers of hands or legs rich with sensitive nerve terminations are felt. More highly located parts of an extremity are usually felt indistinctly. The absent hand most often is represented to the patient bent, and a leg — unbent, however «pose» of the phantom can significantly change over time. The feeling of the absent hand usually is expressed much more brightly, than legs. It is noticed that phantom feelings of subjects are more distinct, than the level of the made amputation is higher. Disorders, negative emotions, pain promote their aggravation. At most of victims illusion of a possibility of autokinesias of the absent extremity remains, but the attempt of implementation of movements can cause sharp pain. Duration of existence of phantom feelings is estimated several months or years, but sometimes they with firmness remain for decades. Their disappearance happens usually at gradual fading of brightness of illusions. Sometimes eventually the phenomenon of «shortening» of the phantom when it is represented to the patient that the brush or foot gradually approaches a stump is observed, eventually as if merging with it.

Stump neuralgias, i.e. pains felt in the absent parts of a body are observed not at all patients. Their frequency is estimated differently — from 11 to 80% that is connected with unequal understanding of this phenomenon. According to E. V. Schmidt, stump neuralgias meet approximately in half of cases, and they reach considerable intensity only at 10% of the patients who underwent amputation of an extremity. Stump neuralgias arise more often not right after loss of an extremity, and several months later or even in several years. In cases when loss of an extremity was accompanied by especially sharp pain (e.g., at its separation), stump neuralgias appear early. Sometimes patients can characterize and accurately localize these pains in details; in other cases of their description are very not certain. The nature of pain and its expressiveness can change for days; in some cases pain disturbs hl. obr.

at night, depriving of patients of a dream. The physical and mental condition of the patient, a weather changing, ambient temperature, etc. have significant effect on intensity of a pain syndrome. Allocate four basic groups of pain: the localized pains

which are felt in a certain place (a finger, a heel, a palm, etc.) sometimes irradiating on the course of a nervous trunk, these pains carry the cutting, pricking, tearing, shooting or pulsing character; kinaesthetic pains, i.e. feeling of the painful movement, compression, a prelum, stretching or twisting of the absent part of a body; pains of kau-zalgichesky type (see Kauzalgiya); pains of the uncertain or mixed character.

Amputating pains differ from stump neuralgias first of all in the fact that are felt in a stump of an extremity. Stump pains are observed very often and carry various coloring: they can be stupid, acute, burning, pricking, can diffuzno extend on a stump or be limited to its certain point.

As phantom feelings represent almost inevitable and natural consequence of the amputation which is not reflected significantly in the general state and not influencing working capacity, special treatment about it is not required. Fight against stump neuralgias fairly is considered one of the most difficult medical tasks. The main place in their treatment belongs to surgical methods, to-rye, however, shall be combined with conservative actions. At emergence F. and. appoint prolonged drug treatment (analgetics, sedatives, tranquilizers), physiotherapeutic influences, including reflexotherapy (see); use also novocainic blockade of nervous formations of a stump (as futlyarny or conduction anesthesia). For the purpose of elimination of the peripheral center of excitement stump operations are shown: excision of hems and neuromas, sometimes — reamputation (see). If pains have kauzalgichesky character, and novocainic blockade of the corresponding nodes of a sympathetic trunk at least temporarily reduces pain, the sympathectomy is reasonable (see).

However the listed actions seldom are really effective. Did not equal the hopes which were originally laid on them and such operations as section of sensory nerves of a stump (see the Neurotomy) or back roots of spinal nerves (see the Radicotomy). It is possible to achieve success during the crossing of boleprovodyashchy ways of a spinal cord in the field of a front commissure much more often (see the Commissurotomy of a spinal cord) or a spinotalamichesky path (see the Tractotomy). In isolated cases, at very expressed pain syndrome, resort to operation of removal of certain sites of a cerebral cortex — a topectomy (see), gyrectomies. In a crust, time the increasing distribution is got by operations of the destruction of underlying cerebral structures which is carried out in the stereotaxic way (see. Stereotaxic neurosurgery, Talamotomiya). Encouraging also there were results of more sparing ways of fight with F. and. by long electrostimulation of back columns of a spinal cord or nek-ry cerebral educations by means of the implanted electrodes.

PHARYNGITIS 191


Forecast is doubtful, depends on level and the nature of amputation and the chosen method of treatment.

Bibliography: Burdenko H. H. With

brany compositions, t. 3, page 246, M., 1951; Vasinn.Ya. i'grokhovskiyn.p. A stereotaxic talamotomiya at a phantom pain syndrome, Vopr. neyrokhir., Nb 5, page 16, 1980; Vasin N. Ya. and P and c and V. I. Stereotaxic destruction of a relay sensitive kernel of a thalamus as method of surgical treatment of unsatiable pains, in the same place, No. 3, page 3, 1971; Kandel E. I. Functional and stereotaxic neurosurgery, M., 1981; Kryzhanovsky G. N. Generating mechanisms of the central pain syndromes and anesthesia, Vestn. USSR Academy of Medical Sciences, No. 9, page 33, 1980;

Schmidt E. B. The phantom amputated, M., 1948; Abramson A. S. a. F e i-b e 1 A. The fantom phenomenon, its use and disuse, Bull. N. Y. Acad. Med., v. 57, p. 99, 1981; To r an i n i with k J. U., T h o-den U. Riechert T. Pain reduction of amputees by long-term spinal cord stimulation, J. Neurosurg., v. 52, p. 346, 1980; Leri che R. La chirurgie de la douleur, P., 1937; Melzack R. a.

L o e s e r J. D. Phantom body pain in paraplegics, evidence for a central «pattern generating mechanism» for pain, Pain, v. 4, p. 195, 1978; Nielson K. D., Adams J. E. a. Hosobuchi Y. Phantom limb pain, Treatment with dorsal column stimulation, J. Neurosurg., v. 42, p. 301, 1975; Pare A. Selections from the works of Ambroise Pare, L., 1924.

Jl. Ya. Livshits.

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