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The phenomenon of phantom limb was described in medical literature at least as early as 1545 by Ambroise Pare, according to the notes in the translation of Lemos' dissertation, "On the Continuing Pain of an Amputated Limb", by Price and Twombly [9]. This strange experience was brought to public attention by a popular essay anonymously published 1866 by Mitchell concerning the story of George Dedlow, a quadriamputee who described his invisible limbs [7]. In 1871 Mitchell wrote under his own name, and was the. first to use the term "phantom limb" [8]. In this work, he also corrected some erroneous beliefs that had arisen from his 1866 essay [13]. Most amputees report feeling a phantom limb almost immediately after amputation of an arm or a leg [11]. It is a positive sensation, usually described as tingling or numbness, which is not painful. The most distal parts of the limb, particulary the digits, thumb, and index, are the strongest and most persisting phantom sites, and may be the only parts to appear even after removal of a whole limb. The elbow or knee is sometimes involved, the forearm or lower leg rarely, and the upper arm and thigh almost never [5]. The phantom thus appears to consist predominantly of those parts which have the most extensive representa tion in the thalamus and in the cerebral cortex.
1 101 kr
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Pain is unfortunately not an early symptom in neoplastic diseases. When it occurs, however, as it so often does in the advanced stages of the disease, then it can be particularly severe. Many physicians are not able to treat such pain efficiently with the standard methods familiar to them. Even in the oncological clinic, it is common for cancer patients not to receive adequate treatment of their pain; the therapeutic efforts are directed principally at the cancer, the pain often being neglected. This book fills a gap in the literature and should enhance the awareness of pain of all those who deal with cancer patients. For the patient, the symptoms of the disease are usually the direct cause of suffering, and pain is often the most severe symptom. The pain may be potentiated by knowledge of the threat posed by the cancer, or may itself considerably increase the patients existing anxiety. Thus there is a vicious circle of pain and psychological factors which will reduce the patient to a state of despair and distress. It is, therefore, obvious that efficient pain therapy is of utmost signi ficance to the patient, who will judge the doctor's ability to provide medical assistance according to the degree of pain relief achieved. The patient's quality of life will also depend critically on the relief obtained.