ICPLP2021 - Prof. Tsao: Changing Notions of Phantom Limb Pain

Abstract: This talk will review historical theories about phantom limb pain and present more recent evidence about the nature of this medical condition and discuss contributions of both the peripheral and central nervous system.

Biography: Professor of Neurology, Pediatrics, and Anatomy & Neurobiology at the University of Tennessee Health Science Center, Memphis, TN, USA and Director of the Polytrauma/OIF/OEF Clinic at the Memphis Veterans Affairs Medical Center, a researcher at the Children’s Foundation Research Institute at Le Bonheur Children’s Hospital, and Fellow of both the American Academy of Neurology and American Neurological Association. Dr. Tsao received his undergraduate degree in biochemistry from Harvard College, a master’s degree in biochemistry from the University of Cambridge, England, a doctorate in physiology/pharmacology from the University of Oxford, England, and medical degree from Harvard Medical School. Prior to finishing his medical degree, he was a postdoctoral fellow in the Department of Neurology at Johns Hopkins Hospital. He completed internal medicine internship and neurology residency at the University of California-San Francisco and then began 14 years of active duty service in the United States Navy, where he was first stationed at Naval Hospital Jacksonville, Florida as neurology department head. While there, Dr. Tsao completed a behavioral neurology fellowship at the University of Florida. He was then assigned to the Uniformed Services University of the Health Sciences in Bethesda, MD for 4 years before being selected to become the inaugural Director of Traumatic Brain Injury (TBI) Programs for the United States Navy Bureau of Medicine and Surgery, Falls Church, VA, where he managed Navy and Marine Corps TBI policy and programs for 6.5 years prior to his transfer to the Navy Reserve in 2015. He has published over 100 peer-reviewed articles and book chapters and edited books on TBI and teleneurology. His clinical research is focused on treatments for phantom limb pain in amputees (his research team conducted
the first randomized, controlled trial which demonstrated the utility of mirror therapy for treating phantom limb pain), for which he was awarded the 2014 United States Navy Hero of Military Medicine by the Center for Public-Private Partnerships at the Henry M. Jackson Foundation for the Advancement of Military Medicine, and the clinical effects of blast exposure and concussion. He is also a past chairman of both the Government Services Section and the Practice Committee Telemedicine Work Group of the American Academy of Neurology.

00:00:00 Introduction
00:00:38 Outline
00:00:51 Definition of Phantom Limb Pain
00:02:06 Historical Background
00:03:00 Phantom Limb Pain through Historical Writings
00:04:01 The case of George Dedlow by Silas Weir Mitchell in July 1866
00:04:56 First Description of Telescoping
00:06:16 Theories for Why Phantom Limb Pain Occurs
00:07:50 Cortical Reorganization
00:09:36 Clinical Implications
00:12:04 Treatments
00:15:23 fMRI Study of Unilateral Lower Limb Amputees
00:17:04 Case Example
00:18:08 Phantom sensations change with changes in the position of the phantom limb
00:19:00 Methods, Demographics and Results
00:21:05 New Physical Sensations
00:22:03 Modeling of phantom limb pain characteristics
00:23:22 Pain Characteristics
00:25:07 Clinical Correlations
00:26:30 Questions