F • CLINICAL ASPECTS OF SPINAL CORD INJURIES
259
This is in accordance with Pollock and his colleagues (1951), who also found persist
ence in the character of phantom sensation in paraplegics, following amputation of a
paralysed limb. These authors stressed the point that burning pain which had been
present in both paralysed limbs persisted after amputation. Furthermore, they found
persistence of pain in the paralysed legs following spinal anaesthesia below the level of the
lesion, although all spasms and reflex activity were suppressed. On the other hand, the
burning pain disappeared following spinal anaesthesia above the lesion. In accordance
with this observation I found in such cases permanent disappearance of the painful
phantom sensation following intrathecal alcohol block above the cord or cauda equina
lesion, when the alcohol block below the level of the lesion had been unsuccessful.
From these observations, it can be concluded that painful phantom sensations
localized in the paralysed limbs, experienced by patients with complete cord lesions,
originate from the distal end of the segments proximal to the spinal cord transection and
that this pain sensation is comparable to the pain referred from a neuroma of an injured
peripheral nerve.
3.
Telescoping
Telescoping of phantoms in spinal cord lesions have not been observed in our cases, in
contrast to such development resulting from neuroma formation following amputations
in non-paraplegic patients.
4.
Extinction of phantom limbs
It is well known that a phantom limb following unilateral amputation of a leg or arm is
abolished by a lesion of the parietal lobe of the contralateral side of the brain occurring
later. No observations on this problem are available in complete or incomplete lesions ofthe
spinal cord.
(e) Local and remote sensory disturbances due to visceral hyper-activity in
the paralysed area
The problem of referred pain, in relation to the activity of hollow, muscular walled
viscera, in non-paraplegic individuals has a literature too vast to review here.
Since Sturges' (1883), Ross' (1888), Lennander's (1903) and Mackenzie's (1909)
work, there has been controversy relating to pain and discomfort originating from patho
logical visceral conditions amongst many authors. Sir Thomas Lewis (1941), in his book
Pain,
has given an excellent review about the theories held by various workers in this
field. In more recent years, investigators have been concerned with research on sensations
with specific visceral action pattern, such as hunger, nausea and abdominal dread
('butterflies in the stomach5), in relation to their mediation by afferent pathways (Gross-
mann & Stein, 1948; Wenger, 1950; James, 1957; Wright, 1965). Crawford & Frankel
(1971) compared 60 (42 complete) cervical lesions with 23 thoracic, lumbar and sacral
