[So-called initial description of phantom pain by Ambroise Paré. "Chose digne d'admiration et quasi incredible": the "douleur ès parties mortes et amputées"]

Abstract

In his (1552 (1554?) "Harquebusses and other guns" tractate the French surgeon, Ambroise Paré (1510-1590) described the post-amputation syndrome-considered to be the first description of this syndrome--which, on hermaneutic analysis, proves surprisingly complete: Paré differentiated pre-amputation pain ("la douleur ès parties mortes") from post-operative symptoms; he differentiated stump pain from phantom-limb sensations ("faux sentiments"), and he succeeded in distinguishing pain-free exteroceptive sensations--the so-called phantom-limb sensation--from phantom-limb pain proper ("la douleur ès parties amputées"). He characterised the psychogenic pain syndrome ("se plaigner fort"), described protracted, intermittent and delayed courses, as also exogenous modulating factors which--e.g. the weather ("les causes froides")--exacerbate the situation, or--e.g. massage--can also ameliorate it. Furthermore, he made use of psychological factors to combat pain, and rejected the use of multiple peripheral surgery to treat pain. He proposed two neurological models to explain the etiology of phantom-limb pain, one postulating peripheral changes in stump nerves, the other, involving memory, suggesting a cerebral origin, and locating algogenesis in the brain.