ABSTRACT

RELEVANCE. Mine-blast injury is one of the most severe types of combat-related injury, frequently leading to limb amputations and the development of postamputation pain. Traditionally, research and clinical practice have primarily focused on the phenomenon of phantom limb pain. However, an equally important manifestation among phantom sensory phenomena is phantom limb sensations — non-painful experiences that include the feeling of the presence of the lost limb, its movement, temperature changes, and paresthesias. Although phantom limb sensations are not accompanied by pronounced nociceptive qualities, they have a significant impact on patients’ quality of life, complicate prosthetic rehabilitation, and may precede the onset of phantom limb pain.

AIM. To present a clinical case of a patient with isolated phantom limb sensations after amputation due to high-energy mine-blast injury, and to discuss the pathogenetic mechanisms of this condition along with current therapeutic approaches.

MATERIALS AND METHODS. Based on the analysis of medical records, we provide a clinical description of the disease course in a patient who sustained a mine-blast injury with subsequent above-knee amputation. The report includes medical history, timing of hospitalization, complaints, results of laboratory and instrumental examinations, details of therapy administered, and clinical dynamics.

RESULTS. The patient experienced phantom limb sensations described as a feeling of a “cold shin” in the absent limb. Phantom limb pain was not reported. Despite comprehensive pharmacotherapy (anticonvulsants, antidepressants at medium therapeutic doses), physiotherapy, and psychotherapeutic support, the phantom limb sensations persisted, demonstrating their resistance to standard approaches.

CONCLUSION. This clinical case highlights the need to distinguish phantom limb sensations as a separate subtype of phantom sensory phenomena. Their diagnosis and treatment require a multidisciplinary approach, including pharmacological management, psychotherapy, and modern rehabilitation strategies. Phantom limb sensations should be regarded as a clinically significant factor affecting rehabilitation and prosthetic adaptation, as well as a potential predictor of phantom limb pain.

KEYWORDS: phantom limb sensations, phantom limb pain, high-energy injuries, mine-blast injuries

For citation: Rachin S.A., Melkonyan G.G., Lytkina K.A., Topolyanskaya S.V. Phantom Limb Sensations after Mine-Blast Injury: A Clinical Case Report. Comorbidity Neurology. 2025; 2 (3): 80-85. https://doi.org/10.62505/3034-185x-2025-2-3-80-85

*For correspondence: Sergei A. Rachin, Neurologist, Executive Director, National Association of Experts in Comorbid Neurology, Moscow, Russia; Russian Medical Academy of Continuous Professional Education, Moscow, Russia, e-mail: rachin.sergei@gmail.com

REFERENCES

1.Limakatso K., Bedwell G.J., Madden V.J., Parker R. The prevalence and Risk Factors for Phantom Limb Pain in People with Amputations: a Systematic Review and Meta-Analysis. PLoS One. 2020; 15 (10): e0240431. https://doi.org/10.1371/journal.pone.0240431

2.Makin T.R., Flor H. Brain (re)organisation Following Amputation: Implications for Phantom Limb Pain. NeuroImage. 2020; 218: 116943. https://doi.org/10.1016/j.neuroimage.2020.116943

3.Schöne H.R. Making Sense of Phantom Limb Pain. J Neurol Neurosurg Psychiatry. 2022;93(8):833–843. https://doi.org/10.1136/jnnp-2021-328428

4.Lendaro E., Ortiz-Catalan M., Reinkensmeyer D.J., et al. Phantom Motor Execution as a Treatment for Phantom Limb Pain: Protocol for a Multicenter, Double-Blind, Randomised Controlled Trial. BMJ Open. 2018; 8 (7): e021039. https://doi.org/10.1136/bmjopen-2017-021039

5.Kumar A., Soliman N., Gan Z., Cullinan P., Vollert J., Rice A.S.C., Kemp H. A Systematic Review of the Prevalence of Postamputation and Chronic Neuropathic Pain Associated with Combat Injury in Military Personnel. PAIN. 2024; 165 (4): 727–740. https://doi.org/10.1097/j.pain.0000000000003094

6.Erlenwein J., Diers M., Ernst J., Schulз .F, Petzke F. Clinical updates on phantom limb pain. Pain Reports. 2021; 6 (1): e888. https://doi.org/10.1097/PR9.0000000000000888

7.Kaur A., Guan Y. Phantom Limb Pain: A Literature Review. Chin J Traumatol. 2018;21(6):366–368. https://doi.org/10.1016/j.cjtee.2018.05.011

8.Limakatso K., Bedwell G.J., Madden V.J., Parker R. The Prevalence and Risk Factors for Phantom Limb Pain: A Cross-Sectional Survey. BMC Neurol. 2024; 24: 57. https://doi.org/10.1186/s12883-024-03547-w

9.Zagorulko OI, Medvedeva LA. Treatment and Prevention Phantom Pain Syndrome in Mine-Explosive Injuries. Pirogov Russian Journal of Surgery. 2023;(12): 83‑88. https://doi.org/10.17116/hirurgia202312183 (In Russ.)

10.Vladimirova E.S., Chernousov F.A., Ivanov P.A., Badygov S.A., Popova I.E. The Specifics of Mine and Explosive Damage, the Provision of Specialized Assistance and Rehabilitation of Victims Who Were in the Zone of Terrorist Operations. Bulletin of the Medical Institute "REAVIZ". 2024; 14 (6): 47-58. https://doi.org/10.20340/vmi-rvz.2024.6.CLIN.1 (In Russ.)

11.Пономаренко Г.Н. Боевая травма: медико-социальная реабилитация. Практическое руководство. М., 2023. 304 с. (In Russ.)

12.Richardson C., Kulkarni J. A Review of the Management of Phantom Limb Pain: Challenges and Solutions. J Pain Res. 2017; 10: 1861-1870. https://doi.org/10.2147/JPR.S124713

13. Flor H. Maladaptive Plasticity, Memory for Pain and Phantom Limb Pain: Review and Suggestions for New Therapies. Expert Rev Neurother. 2008; 8 (5): 809-818. https://doi.org/10.1586/14737175.8.5.809

ADDITIONAL INFORMATION

Sergei A. Rachin, Neurologist, Executive Director, National Association of Experts in Comorbid Neurology, Moscow, Russia; Russian Medical Academy of Continuous Professional Education, Moscow, Russia. E-mail:rachin.sergei@gmail.com. ORCID: https://orcid.org/0000-0001-9771-4621

Georgiy G. Melkonyan, Dr. of Sci. (Med.), Prof. Department of Combined and Combined Injuries, Russian Medical Academy of Continuous Professional Education, Moscow, Russia; Chief Physician, Hospital for War Veterans No. 3. Moscow, Russia. E-mail: gvv3@zdrav.mos.ru. ORCID: https://orcid.org/0000-0002-4021-5044

Karina A. Lytkina, Ph.D. of Sci. (Med.), Deputy Chief Physician for Therapeutic Care, Hospital for War Veterans No. 3. Moscow, Russia. E-mail: lytkina.k@mail.ru. ORCID: https://orcid.org/0000-0001-9647-7492

Svetlana V. Topolyanskaya, Dr. of Sci. (Med.), Prof. Department of Hospital Therapy №2, I.M. Sechenov First Moscow State Medical University. Moscow, Russia. E-mail: sshekshina@yahoo.com.  ORCID: https://orcid.org/0000-0002-4131-8432

Author contributions. All authors confirm their authorship in accordance with the international ICMJE criteria (all authors made a significant contribution to the study conception, research design, and article preparation, read and approved the final version prior to publication). Special contributions: Rachin S.A., Lytkina K.A., Melkonyan G.G. – conceptualization, methodology, writing review & editing; Rachin S.A., Topolyanskaya S.V. – formal analysis, writing original draft.

Funding. This study was not supported by any external sources of funding.

Disclosure. The authors declare no apparent or potential conflicts of interest related to the publication of this article.

The content is available under the Creative Commons Attribution 4.0 License.

©2025. Sergei A. Rachin, Georgiy G. Melkonyan, Karina A. Lytkina, Svetlana V. Topolyanskaya