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Phantom limbs and related phenomena in recent traumatic amputations

Neurobiology Unit, Hebrew University, Jerusalem, Israel (Drs. Carlen and Wall), and the Rehabilitation Center, Tel Hashomer Hospital, Tel Aviv. Israel (Drs. Nadvorna and Steinbach), the Department of Medicine, Division of Neurology, University of Toronto, Addiction Research Foundation and Toronto Western Hospital, Toronto, Ontario (Dr. Carlen), and the Department of Anatomy, University College, London, England (Dr. Wall).

Seventy-three soldiers who had traumatic amputations were examined from 1 to 6 months after limb loss. All experienced phantom limb sensations and 67 percent experienced phantom limb pains, usually transient. Stump pain occurred in 43 percent and was associated with phantom pain in 54 percent of these. Of the 23 percent of the entire group who had evident stump pathology, 33 percent had phantom pains only, 20 percent had stump pains only, 40 percent had both, and 7 percent were pain-free. All stump ends exhibited an area of hyperpathia with hypoesthesia. Phantom pain probably results from peripheral or spinal cord mechanisms, or both, rather than from more rostra1 mechanisms.

Dr. Carlen's address is 33 Russell Street, Toronto, Ontario M5S 2S1, Canada.

Supported in part by the Thyssen Foundation and the Canadian Multiple Sclerosis Society.

Presented in part at the twenty-eighth annual meeting of the American Academy of Neurology, Toronto, Canada, April 1976.

Accepted for publication June 24, 1977.

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