Psychology Research

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Phantom Limb Pain (PLP) is a Real Pain
The medical phenomenon “Physiopathosynesthesia”
PSCY 310 Sensation & Perception
Term Paper
Professor: Antonio V Laverghetta, PhD
Student: Modupe O. Sarratt
University of Maryland University College
First edition: April 24, 2012
Revised: May 02, 2012

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Phantom Limb Pain (PLP) is a Real Pain
Introduction
Today, the prevailing assumption for phantom limb pain was delusion or an illusion
because the phantom limb does not have physical substance to associate with pain in the body.
This research showed that phantom limb pain is real and there is an evidence of physical
substance that cause the awareness of the pain in the body. The dynamic phenomenon pattern of
medical words when combined “physiopathosynesthesia” explained that there is a real pain
associated with phantom limb. The study of human anatomy and functions in health and in
sickness in association with the sensation and perception of pain provided the evidence that
phantom limb pain is real.
Phantom limb phenomenon is real pain; persons who lost limbs experience masking,
kinesthetic sense, and intersensory integration. Masking according to Foley and Maltin is a
“general phenomenon in which one stimulus interferes with the process of second stimulus”. In
“backward masking” a later stimuli can mask an earlier stimuli, for an amputee perception to use
a limb that was amputated can mask the pain signal for damage to the tissues before the
amputation. (Foley & Maltin p146) According to Foley and Maltin, “kinesthesia derives from
Greek word meaning ‘perception of movement,’” (Foley & Maltin p348) for lost limb, the
movement sensations remain inactive as damage tissue in the sensory stimuli for limb fixed
position. An amputee feels the pain for stagnation when the need to use the limb occurs.
The fact is human developed intersensory integration during infant. According to Foley
and Maltin, “intersensory integration allows the abilities to perceive the object as the source of
stimulation of multiple senses,” (Foley & Maltin p391) suggest that an amputee can sense a pain

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in other part of body that corresponds with the amputated limb. Currently, there is no cure for
phantom limb except interventions. The three types of interventions available are physical,
pharmacological, and psychological.
What is a pain?
A pain “is perception of unpleasant sensory and emotional experience associated with
actual or potential tissues damage” that threatened well being. Pain serve to “protect the body
from further damage” by heightened our awareness for survival according to Foley and Maltin
with the belief that pain receptors is in the skin that conjugate with Gate-theory that pain is a
“top-down process of neural fibers in the central nervous system (CNS) interaction with the
extremity or the limb”(Foley & Maltin p340). The top-down process shows a pain perception
cannot be felt until the brain sense and interpret the signal. Therefore, pain signal is real and
there is no phantom pain.
What is phantom limb?
According to World English Dictionary, phantom limb is “the illusion that a limb still
exists following its amputation, sometimes with pain” (Phantom limb n.d. Collins) that agree
with the Medical Dictionary that phantom limb is “the sensation that an amputated limb is still
attached, often associated with painful paresthesia known as pseudesthesia” (Phantom limb n.d.
Stedman). Pseudo is prefix that means “bogus” that can also means replica, imitation or
simulated and esthesia is the suffix that means feeling causes the feeling of pain from non-
existing limb to be view as phantom feeling, then, what do we mean by phantom pain? An
abnormal sensation of pain that associated with amputated limb, base on the fact that a pain is a

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result of damage tissue or non-function tissues, pain can never be abnormal. Pain is real
sensations.
Phantom Limb Pain (PLP) “physiopathosynesthesia”
The phenomenal “physiopathosynesthesia” are the biology, medical, and the cognitive of
human structures in relationship to tissues damages or illness that embraced human belief or the
philosophy that the mind and the body is one. The physical structures (anatomy) and the
functioning process (physiology) together with thinking and perception process (psychology) are
the instruments that made the body and mind complete and be able to function as one body
(philosophy).
Physio is related to physical structures and their function in the body. Today an amputee
struggle to convince anyone, include the healthcare profession, the scientists, and the physicians
that he or she feels the pain in the limb that was removed from his body by amputation because
the limb was association with physical structure and little bit about the function.
The human anatomy and physiology shows the associated of amputated limb and its
function in the body was sense as damage tissue not it was lost that need to be found but as
damage part that the body recognized. Nervous system in the brain functions from the center of
the brain to the edge or nonessential part. Everything that made a human is in the brain. Pain is
the signal of the brain indicating damage tissue in where.
According to online article about the brain top down published by Canada Institutes of
health research suggested that there are “many different structures in the brain involved in motor
functions that some people even say that practically the entire brain contributes to body
movements” (The Brain).

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The most basic structure of the nervous system is a neuron, which bundle together to
form nerve fibers. Affective neuron fiber is the complex stimulation initiated by a central process
in the CNS to PNS, as result of internal or external causes. It manifests as a change in the CNS
releasing reflex or impulse of the CNS in the PNS. The CNS consists of the brain and the spinal
cord and is known to be the control center, which initiates the simulation or the reproduction
feature in the PNS, PNS consists of all nerves and ganglion outside of the brain. PNS relate CNS
information in the nonessential part of the body such as, the pain receptor in the skin felt around
the location of amputated limb. (The Brain)
Pathos is prefix for disease, condition of deviation from normal structure because of
damage tissues that cause pain. The study of pain indicated that pain is a signal for damage
tissue. The pathos for phantom limb is the absent body part, the deviation from the body
structure that all amputee experienced “immediately after amputation as soon as the anesthetic
wears off and the patient is conscious that associated with both peripheral and central factors”.
There is no “physical explanations that the irritation of severed nerves causes phantom feelings
and no psychological explanations that feeling a phantom limb is a form of mental denial” (Flor
2002).
Therefore, the perception for the pain in the brain is from the amputated limb that
experts now recognize that the sensations originate in the spinal cord and brain. Foley and Maltin
suggested that phantom limbs pain could be explained by “notion of the neuromatrix”. Because
in the reorganization or neural connections after amputation is an indication that physical
appearance of body part do not need to be present to feel the pain, “the brain does more than
detect and analyze inputs and it generates perceptual experience even when no external inputs
occur” (Foley & Matlin p344).

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Synesthesiae, a Greek word for “together sensation” explain the pain associated with
amputated limb. Thinking of doing something requires the element to have it done is a together
process. “Synesthesiae” according to Etymology Dictionary is organize in three ways, one way
is physiology, a sensation experienced in a part of the body other than the stimulated felt
elsewhere in the body, e.g. when you feel hungry and perceive food, you feel the stimulation in
your hand reaching to grab the food. Second to physiology is psychology, the subjective
sensation of a sense other than the one being stimulated, according to dictionary, the psychology
“is the stimulation of one sense alongside another” e.g., a sensation of color when a sound is
heard. The third is the philosophy as a rhetorical device for belief or symbolic thinking for the
description of sense perception in relationship to a symbol or a figure, e.g., waving your hand
instead of saying goodbye. (Synaethesia 2012)
Psychology, there is little evident to suggest that psychological play a role in phantom
limb pain. However, there are some factors that suggesting increase risk for phantom pain
includes pain before the amputation. Some researchers have found that people who had pain in a
limb before the amputation are likely to have it afterward and that may be due to the brain holds
on to the memory of the pain and keeps sending pain signals.
The scientific study of the mental states or the mind of amputee indicated that there might
be many mechanisms underlying phantom limb pain. An article published by the Pain Clinic
about “damage to nerve endings” suggested, “subsequent erroneous regrowth can lead to
abnormal and painful discharge of neurons in the stump, and may change the way that nerves
from the amputated limb connect to neurons within the spinal cord” (The Pain Clinic 2002-11).
The difference in the psychology analysis of amputee phantom pain and birth defect
phantom pain was the amputee pain is associated trauma while birth defect is associated with

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behavior and personal interest. According to Herta Flor, “Empirical studies on psychological
characteristics of patients with phantom-limb pain show that these patients tend to have normal
psychological profiles.” (Flor 2002)
Further study with Electromyography by Dr. Sherman for psychophysiology analysis
suggested that the awareness of amputated limb or the trauma is not the cause for the pain. Pain
“can occur anytime, just after an amputation and years later. Its occurrence is not related to
psychological factors”. Therefore, it is the sensory stimuli or the perception to use limb when the
need for limb arises in the brain that generates the sensation of pain at the location or in the
remains nerve paths for indicating stagnant. Because the paths do not change much after
amputation and the brain has no way to know that the limb is not present. (Sherman 1997)
Treatment, as of today, there is no cure for phantom limb pain. There are three types of
interventions. The pharmacological intervention used “analgesic medication” to alleviate the
pain for short duration because long use can cause kidney damage. Physical intervention
involves using “counterirritants” that stimulate one area to diminish pain in another, a technique
called “acupuncture”. Psychological interventions use “cognitive-behavioral approaches” that
involves developing adaptive thinking and behavior responses to the pain. (Foley & Maltin p345-
47)
Besides the three interventions aforementioned, the new findings from “neuroelectric and
neuromagnetic imaging” suggested that the restoration of the original cortical organization” may
provide a “New treatments for phantom pain” by “seek to make cortical reorganization regress
toward normal” (Flor 2002).
Furthermore, the brain has the ability to change according to Foley and Maltin, “given
what we know about brain plasticity, ‘there are certain area of the brain whose role seems to be

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to integrate information from various senses e.g. superior colliculus and the superior temporal
sulcus” (Foley & Maltin 238).
This diagram of brain showed the motor cortex triggered by messages from other cortical
areas suggests that the sensation of pain could be from any sensory perception within the brain.
Example, thinking about food in the sensory area required the coordination of the motor cortex to
use the hand but due to stagnation in the sensory cortex for the amputated hand, the amputee
sense pain in the area where the hand used to be or in the stumps of the hand that was amputated.
(The Brain)

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Reference
Flor, Herta PhD (June 2002) Phantom-limb pain: characteristics, causes, and treatment
Department of Clinical and Cognitive Neuroscience, Central Institute of Mental Health.
THE LANCET Neurology Vol 1 July 2002 http://neurology.thelancet.com
Foley, H.J. & Matlin, M.W. (2012) Sensation and perception (5th Ed) Upper Saddle River, NJ.
Phantom limb (n.d.). Collins English Dictionary - Complete & Unabridged 10th Edition.
Retrieved April 27, 2012, from Dictionary.com website:
http://dictionary.reference.com/browse/phantom limb
Phantom limb. (n.d.). Stedman's Medical Dictionary. The American Heritage Retrieved April 27,
2012, from Dictionary.com website: http://dictionary.reference.com/browse/phantom
limb
Synaesthesia. (n.d.). Online Etymology Dictionary Retrieved April 19, 2012, from
Dictionary.com website: http://dictionary.reference.com/browse/synaesthesia
Sherman, Richard A, PhD (1997) Electromyography Phantom Limb Pain Biofeedback
Foundation of Europe http://www.bfe.org/protocol/pro05eng1.htm
The Pain Clinic (2002-2011) Nerve Pain Phantom Limb http://www.painclinic.org/nervepain-
phantomlimbpain.htm
The Brain from Top to Bottom, Canada Institutes of Health Research of Neurosciences, mental
health and addiction.
http://thebrain.mcgill.ca/flash/i/i_06/i_06_cr/i_06_cr_mou/i_06_cr_mou.html