Case Series
Volume 13 Issue 9 - 2021
Phantom Limb Pain: Is this a Manifestation of Centralization of Pain of CRPS?
Robert L Knobler*
Department of Neurology, Knobler Institute of Neurologic Disease, United States
*Corresponding Author: Robert L Knobler, Department of Neurology, Knobler Institute of Neurologic Disease, United States.
Received: July 30, 2021; Published: 00-00


Phantom limb pain (PLP) is described as pain localized to a portion of a limb that has been removed. The mechanism of this disorder remains poorly understood, but the pain is similar to that of complex regional pain syndrome (CRPS), i.e. burning, tingling, cramping, aching, shooting, sharp, stabbing and constricting in the “affected” area. Although CRPS can arise in any portion of the body, it most commonly affects limbs and is usually most prominent distally. Spread of CRPS signs to other limbs can occur and several patterns of spread have been identified. Due to distal symptom predominance, it had been suggested that amputation could limit the spread of CRPS to other limbs. The present report addresses findings in four patients, who were seen over the past 18 years. All four had undergone surgical amputation of a CRPS affected lower limb to prevent spread. CRPS persisted in each of the affected limb stumps, along with PLP. One of the four underwent a contralateral leg amputation in an effort to relieve severe CRPS symptoms that spread to the previously uninjured contralateral leg. The second and third, one with a below the knee and the other with an above the knee amputation, had pain and objective hair follicle signs of spread of CRPS in the remaining lower extremity. The fourth developed dramatic spontaneous limb stump movements following an above the knee amputation and recurring skin ulcerations after amputation. These four individuals demonstrate persistent CRPS despite limb amputation, clear evidence of spread of CRPS signs and subsequent PLP. In all four cases CRPS preceded development of PLP. These cases also objectively demonstrate that CRPS spread is mediated through central sensitization of pain mechanisms despite the peripheral origin of the CRPS. It is suggested that CRPS, due to the original insult, is often unrecognized in those subsequently undergoing limb amputation and that PLP is a manifestation of central sensitization and cortical reorganization in CRPS, evident following limb amputation.


Keywords: Phantom Limb Pain (PLP); Complex Regional Pain Syndrome (CRPS); Knee Amputation


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Citation: Robert L Knobler. “Phantom Limb Pain: Is this a Manifestation of Centralization of Pain of CRPS?”. EC Neurology 13.9 (2021): 102-111.

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