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[book review] phantom limb by lucinda berry.
July 21, 2019 Erica Robyn 12 Comments
Phantom Limb by Lucinda Berry is a heartbreaking tale about twin sisters who survive a horrible childhood just to experience a major loss in their teenage years.
This book was so difficult to read because of the content. So major trigger warnings for child abuse, self harm, and suicide.
Let’s dive into my quick review.
My Thoughts on Phantom Limb by Lucinda Berry
I’m glad I read this. Lucinda did an amazing job writing it. It’s certainly very powerful!
From the psychological thriller standpoint, the ending was quite intense! I had guessed at a few things throughout the book, but didn’t see the ending coming.
If you enjoy psychological thrillers, then I would recommend this to you! Just be warned that it’s difficult and very dark.
Snag a copy through Bookshop to help support local indie bookshops:
- Appetite for Innocence by Lucinda Berry
July 21, 2019 at 10:56 am
Sounds like an intense book! I love not knowing how it will end though.
July 21, 2019 at 11:24 am
It sure was!!
July 21, 2019 at 12:32 pm
This sounds kind of depressing to me, not sure I’d want to pick it up right now.
July 21, 2019 at 2:39 pm
It definitely had a lot of tough sections. I had to skim some.
July 21, 2019 at 1:23 pm
I’m sure it’s an intense book, but I’m not sure if I want to pick it up during my upcoming holiday, since I want just fluffy and unicorns and rainbows, lol!
I do see myself reading this during winter, at night next to the fireplace…
July 21, 2019 at 2:40 pm
Yeah, definitely not a book for a holiday! Phew! haha I’d love to hear your thoughts on it if you do read it this winter.
July 21, 2019 at 2:17 pm
Thank you for the trigger warnings!
Of course! This one really needs it at the beginning of the book! Phew…
July 22, 2019 at 9:37 am
This sounds like a good read but I don’t know if I’m up to the subject matter. I investigated child abuse/neglect for 14 years and I find it hard sometimes to go back and read about it. It’s not really a trigger or anything for me, but I had enough of that when I did it everyday. I am glad you enjoyed this one though.
July 22, 2019 at 8:54 pm
Oofh yeah, this would be too much for you I think! It wasn’t too dark or graphic, but it was definitely difficult.
July 29, 2019 at 4:14 pm
Ohh great review Erica, I do love dark books and this one looks and sounds absolutely great and right up my alley as well. Thank you so much for sharing your awesome post and review and for putting this book on my radar my friend.
July 29, 2019 at 5:20 pm
It was SO dark!!
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Contemporary Reviews: Phantom Limbs & The Year We Fell Down
October 19, 2016 by Jenna | 4 stars , ARC Reviews , Double Reviews , Mini Reviews , Reviews
How do you move on from an irreplaceable loss? In a poignant debut, a sixteen-year-old boy must learn to swim against an undercurrent of grief—or be swept away by it. Otis and Meg were inseparable until her family abruptly moved away after the terrible accident that left Otis’s little brother dead and both of their families changed forever. Since then, it’s been three years of radio silence, during which time Otis has become the unlikely protégé of eighteen-year-old Dara—part drill sergeant, part friend—who’s hell-bent on transforming Otis into the Olympic swimmer she can no longer be. But when Otis learns that Meg is coming back to town, he must face some difficult truths about the girl he’s never forgotten and the brother he’s never stopped grieving. As it becomes achingly clear that he and Meg are not the same people they were, Otis must decide what to hold on to and what to leave behind. Quietly affecting, this compulsively readable debut novel captures all the confusion, heartbreak, and fragile hope of three teens struggling to accept profound absences in their lives.
I love a book that deals with grief and Phantom Limbs delivers a wonderful story about grief. What I really loved about it was that it wasn’t dark and heavy, but instead was relatively lighthearted and charming. Rather than solely focusing on grief as a theme, this book also explores friendship and first love and how these things are affected by grief or tragic things that happen in life. It was a novel that was written with great sensitivity and I was able to completely connect with it because of how honest the emotions were.
Phantom Limbs is written from the perspective of Otis, and I was pleasantly surprised by how much I enjoyed reading from his perspective. I’m always extremely wary when it comes to male POVs, especially when there is romance involved because there always tends to be Manic Pixie Dream Girl elements. Phantom Limbs didn’t have this, for which I was extremely grateful. I was a initially worried because Otis seemed to be doing a lot of pining for Meg, his childhood best friend and first love, but Paula Garner definitely managed to steer her story away from being yet another MPDG book. Otis was probably the main reason why I enjoyed this book so much. His voice was funny and relatable and I thought it was an extremely insightful portrayal of the daily life and thoughts of a teenage boy. Otis was a great main character. He was incredibly caring and thoughtful and treated his friends and himself with a lot of respect.
I also thought that the friendships in this book were incredible. My favourite friendship in the book was the one between Otis and Dara, his swimming coach. Dara was a swimming prodigy until she lost her arm in shark attack. She now suffers from phantom pains, feelings of failure and feelings of confusion about her sexual orientation. Otis was there to support Dara through her physical and mental pain even though he often saw her as a drill sergeant who had unrealistic expectations of him. It was really beautiful to see all the things he did for her and all the times he put her needs before the things that he wanted. And of course, I also enjoyed the friendship between Otis and Meg, though I didn’t feel as strongly about it as I did Otis and Dara. It took me a little while to like Meg, mostly because I was anticipating that she’d be another MPDG but I began to connect with her halfway through the book. I loved the past history and the connection that Otis and Meg had, and I really enjoyed watching them gradually reconnect and let each other in.
I thought Phantom Limbs was a fantastic debut novel. It was thoughtful and sensitive and had a perfect balance of grief, friendship and first love.
Rating: 4 out of 5
Thanks to Walker Books Australia for sending a review copy!
The sport she loves is out of reach. The boy she loves has someone else. What now? She expected to start Harkness College as a varsity ice hockey player. But a serious accident means that Corey Callahan will start school in a wheelchair instead. Across the hall, in the other handicapped-accessible dorm room, lives the too-delicious-to-be real Adam Hartley, another would-be hockey star with his leg broken in two places. He’s way out of Corey’s league. Also, he’s taken. Nevertheless, an unlikely alliance blooms between Corey and Hartley in the “gimp ghetto” of McHerrin Hall. Over tequila, perilously balanced dining hall trays, and video games, the two cope with disappointments that nobody else understands. They’re just friends, of course, until one night when things fall apart. Or fall together. All Corey knows is that she’s falling. Hard. But will Hartley set aside his trophy girl to love someone as broken as Corey? If he won’t, she will need to find the courage to make a life for herself at Harkness — one which does not revolve around the sport she can no longer play, or the brown-eyed boy who’s afraid to love her back.
I read very little new adult fiction because I feel like most of the ones that I have read have all had similar themes and concepts. However, The Year We Fell Down came highly recommended to me and I thought I would check it out because I was intrigued by the fact that both the main character and the love interest had physical disabilities. I thought this element of the book was executed extremely well. The novel made me consider things about disabilities and accessibility that I’ve never given a second thought. It was incorporated into the book in a way that felt very genuine and thoughtful and I thought it worked really well.
Sports books are not my thing and I know close to nothing about ice hockey (sorry, we don’t do winter sports things here in Australia), but I have to admit that I quite enjoyed it. All of the hockey references flew over my head but I didn’t mind that there were a lot of references because I found that it injected a lot of fun into the book. It was the main thing that Corey, our main character, and Hartley, her hot neighbour, had in common and I loved watching them interact because of hockey, despite neither of them being able to play.
Corey and Hartley had some really good banter together and I liked their relationship. However, there is some cheating in this book and it put a bit of a sour taste in my mouth. I really dislike the trope where the love interest has a bitchy and rude girlfriend who’s not right for him and isn’t really even in the story… but they’re still together. It’s always been my opinion that if a character isn’t even in the book, they shouldn’t be there at all. I just didn’t like the “he’s taken” aspect of the book very much because it was obvious that Corey was much better to and for Hartley than his actual girlfriend and she didn’t need to be in the book in the first place. End rant.
The Year We Fell Down was a very quick read and I enjoyed it for the most part. I had some issues with the romance and the cheating in the story but I thought it ended in a really heartwarming way. I also enjoyed some of the side characters and I’m excited to pick up some of the other books in the series so that I can read about them.
Rating: 3.5 out of 5
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Tags: 2016 reads , contemporary , fiction , new adult , romance , young adult
18 responses to “ Contemporary Reviews: Phantom Limbs & The Year We Fell Down ”
I can’t pass a male POV well done. I haven’t heard about Phantom Limbs before, thanks for putting it on my radar. I enjoyed The Ivy Years series. If you need NA or adult recommendations, just let me know, I read a lot of books in these genres. Wonderful reviews, Jenna! My recent post Review: Saving Francesca by Melina Marchetta. Why my heart is cold?
I'm not very good at connecting with male POVs either, so I was surprised by how much I enjoyed Phantom Limbs. Definitely let me know your NA recommendations! I'm keen to read more good ones as I've always kind of avoided that category.
I really like the sound of the first book but idk contemps aren't really my thing so i dont see myself getting it any time soon but i wanna but i dont? I just bought like 6 contemps so i should try those first i guess My recent post Review: The Dark World by S.C. Parris
Haha I love contemporaries and the fact that they're really easy to get through. I hope you manage to get through the six that you bought!
Both seem like incredibly interesting books but I definitely prefer Phantom Limbs because The Year We Fell down has cheating in it and that mean girlfriend stereotype which I also hate.
Yeah the mean girlfriend trope is one that I'm particularly tired of. I really don't understand why a mean girlfriend character needs to be added to the story when she barely appears in it anyway.
I am so glad that you enjoyed Phantom Limbs so much too! It was such a win for me, I think it was a really strong debut too. And I totally agree, I was more invested in Dara and Otis too- especially at first, just because they were such close friends, and I was sure I was going to hate Meg (even though I didn't end up hating her at all hhaha). I haven't heard of The Year We Fell Down, but I DO like the idea of a disability being handled well, especially in NA which can be so… well, you know hahha. I don't outright hate cheating in books, but I also dont' like the whole trope of the girlfriend like, being the "reason" for cheating. That never sits well with me either. Fabulous reviews! My recent post #PiqueWeek- Iron Cast Review & Maresi Feature!
Eeeep, I'm extremely late with this reply but I'm so happy that you also enjoyed Phantom Limbs. It's a bit of an underrated book but I loved almost everything about it. It's definitely one of the better contemporary releases of this year in my opinion! I really liked The Year We Fell Down because of the disability aspect. I binge read the rest of the series and I liked the diversity the author put into each of her stories.
I was curious about Phantom Limbs! I'm glad you're able to appreciate the author's method of dealing with grief and friendship.
I've also had The Year I Fell Down for a long time now, but I just couldn't get past two chapters. I really should try again. My recent post : The Hating Game by Sally Thorne
Ahhh new adult is a bit hit and miss but I really liked The Year We Fell Down. It wasn't my favourite of the companion series but I liked the disability that was in the book. And the ice hockey was kind of interesting (though I realised after recently visiting Canada, that it's just hockey and not ice hockey HAHA).
I didn't know who Paula Garnet was until I attended this amazing panel earlier this month at the Texas Teen Book Festival. She was one of the panelist and I loved her answers and the sound of her book!! I immediately added it to my TBR so I'm glad to hear you liked it. 😀 My recent post The Value In Saying “Latinx”
I love when an author is able to convince you to read their book because they're a wonderful person in real life! I really loved Phantom Limbs and I hope you get to read it soon!
OOOHHH I'm actually really interested in both. It's hard to find NA books with diversity, so I definitely want to check it out. Plus Phantom Limbs sonds great and upbeat. Thank you for the reviews!
Yeah I surprised myself with how much I enjoyed The Year We Fell Down. I ended up finishing the rest of the books in the series and enjoyed them all. I kinda became a bit obsessed with them HAHA.
I loved both of these reviews! I have a copy of Phantom Limbs, but I haven't gotten the chance to read it yet…really loving the synopsis of it. I always thought k was weird, liking books that deal with grief…good to know I'm not alone!
I've never heard of The Year we Fell Down, but that sounds like a really great read, too. Going to have to look into this one. Thanks for sharing! My recent post Blog Tour: Kiss Cam by Kiara London – Spotlight
Thank you so much! Phantom Limbs is a pretty quick read and it has a lot of really great elements. There was a perfect balance in the themes that it explored and I just loved the main character's voice! Oh man, you are definitely not alone in liking books about grief. I love seeing how different authors tackle the theme and I especially appreciate it when authors can explore it effectively without all the emotional blackmail that makes you enjoy the book just because it made you ugly cry.
I hadn't heard of The Year We Fell Down until last week either! I don't really read a lot of new adult so I guess most titles are new to me. A lot of people seemed to love this author and this companion series though so I thought I'd check it out. Plus this first book was $0.99 on iBooks!
never heard of Phantom Limbs, will add it to GR in hopes I can read it, the blurb sounds fantastic, I like that its a bit on a lighter side My recent post Terminal by J.L. Bryan
It is definitely a lighter book about grief. It's not one that's going to make you ugly cry, but it still manages to explore the theme just as effectively, which I think is even more masterful!
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Review: Phantom Limb by Lucinda Berry
Genre: Psychological Thriller
Emily and Elizabeth spend their childhood locked in a bedroom and terrorized by a mother who drinks too much and disappears for days. The identical twins are rescued by a family determined to be their saviors.
But there’s some horrors love can’t erase…
Elizabeth wakes in a hospital, strapped to her bed and unable to move or speak. The last thing she remembers is finding Emily’s body in their bathroom. Days before, she was falling in love and starting college. Now, she’s surrounded by men who talk to themselves and women who pull out their eyebrows.
As she delves deeper into the mystery surrounding Emily’s death, she discovers shocking secrets and holes in her memory that force her to remember what she’s worked so hard to forget-the beatings, the blood, the special friends. Her life spins out of control at a terrifying speed as she desperately tries to unravel the psychological puzzle of her past before it’s too late.
Phantom Limb is a character-driven mystery that begs to be read in a single setting. The shocking and shattering conclusion will make you go back and read it again.
Perfect for fans of The Girl on the Train, Behind Closed Doors, and The Girl With No Past.
I read another book by Berry a few months back, Missing Parts and while I enjoyed that one, I liked this one even more. From the blurb alone I was hooked, I always like reading about the relationship between twins and combine that with holes in one of the characters memories and a dark past and I’m jumping in feet first.
I will be saying very little about the plot with this one, but there were some killer twists that jarred me. Elizabeth wakes up in a hospital and the last thing she remembers is finding Emily dead and soon enough she’s a patient in a psychiatric hospital. But she knows she’s not crazy, she has worked really hard to overcome her past demons and make something of herself. But she’s confused and unsure about several things her family and team of doctors have been telling her and she has no idea who to believe.
I loved the pacing here, it was fast and furious and kept me glued to my Kindle. It’s relatively short and with so many crazy things happening, it’s one of those books that just begs you to read it as fast as possible. This was one of those reads where you’re constantly trying to figure out exactly what’s going on and a few times I wondered if I was going a little bit crazy.
As much as I was into the storyline, I really liked the deep look into the human psyche. Berry is a clinical psychologist and it’s very apparent that’s she knowledgeable while reading this, her insight and attention to detail was impeccable. Psychology has always fascinated me and seeing how a high security mental hospital runs was so interesting.
I do want to mention that this is very dark and disturbing and there is a lot of difficult subject matter from child abuse, eating disorders, sexual abuse and more.
Overall rating: 4.5/5
Thanks to the author for my review copy.
32 thoughts on “ review: phantom limb by lucinda berry ”.
Great review! I also really enjoyed this one!
Like Liked by 1 person
Thank you! It was definitely dark and twisty, my fave.
so why was 0.5 points deducted ?? Meanwhile another super review and another book on to my TBR .. I wonder if my TBR would explode one day 😖
Only because I figured out one small twist, nothing major but I had to deduct a bit. Haha I feel you! There is literally no way it’s possible for me to finish all of the books on my TBR in this lifetime. Especially when I add to it daily.
I always try to shorten my TBR but then you awesome bloggers and your awesome reviews make me pile more books on my poor TBR shelf 😦
Lol poor TBR
Fab review Just added this one to my “wish list” as it’s not out in the UK until the 17th x
Wow, I can’t wait to read this now. I have it sitting here and can’t wait to dive in and discover all these twists myself. Thanks for your fab review :-).
Hope you enjoy it!!
This books sound right up my street! And I love your review of it too! It’s not coming up in my Goodreads search so I’ve taken a screen shot so I don’t forget about it lol.
Lol, thank you! I think the author is looking for reviews so if you want me to pass her info to you let me know.
Oh yes, please do. I’m currently training to be a Mental Health Nurse so as bad as this sounds, it’s perfect reading material for me. Enjoyment and education lol
Makes perfect sense!! I’ll email her now. 😊
Thank you! ❤️
She’ll be in touch ❤️
I was hooked just from reading the blurb before I read your review. Now I am going to go add it to be TBR list on Goodreads.
Thanks hope you like it!!
I was waiting to see this review! 😉 I am super excited that it did not disappoint. On the TBR again..
This does sound like a gritty read but sometimes they are important to read too – that cover is certainly eye-catching!
Dark and disturbing, with twins? I’m in! I love it when the author’s knowledge shines through a book, it makes everything so much more authentic and realistic.
Same! It was so interesting
Reblogged this on Mike Thomas .
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Ahhhhh this one sounds so crazy! When I do read thrillers, this is what I want. Fast paced and unsettling! How much child abuse are we talking about? Is it referenced or does it go into graphic detail?
It’s pretty detailed, not often but when it is mentioned it’s fairly graphic and upsetting.
I really must get thicker skin lol
😂 I’m just disturbed I sometimes think mine should be thinner
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- v.2011; 2011
Phantom Limb Pain: Mechanisms and Treatment Approaches
The vast amount of research over the past decades has significantly added to our knowledge of phantom limb pain. Multiple factors including site of amputation or presence of preamputation pain have been found to have a positive correlation with the development of phantom limb pain. The paradigms of proposed mechanisms have shifted over the past years from the psychogenic theory to peripheral and central neural changes involving cortical reorganization. More recently, the role of mirror neurons in the brain has been proposed in the generation of phantom pain. A wide variety of treatment approaches have been employed, but mechanism-based specific treatment guidelines are yet to evolve. Phantom limb pain is considered a neuropathic pain, and most treatment recommendations are based on recommendations for neuropathic pain syndromes. Mirror therapy, a relatively recently proposed therapy for phantom limb pain, has mixed results in randomized controlled trials. Most successful treatment outcomes include multidisciplinary measures. This paper attempts to review and summarize recent research relative to the proposed mechanisms of and treatments for phantom limb pain.
The concept of phantom limb pain (PLP) as being the pain perceived by the region of the body no longer present was first described by Ambrose Pare, a sixteenth century French military surgeon [ 1 ]. Silas Weir Mitchell, a famous Civil War surgeon in the nineteenth century, coined the term “phantom limb pain” and provided a comprehensive description of this condition [ 2 ]. It continues to remain a poorly understood and difficult to treat medical condition. A recent study estimated that there were about 1.6 million people with limb loss in the USA in 2005 and this number was projected to increase by more than double to 3.6 million by the year 2050 [ 3 ]. Vascular problems, trauma, cancer, and congenital limb deficiency are among the common causes of limb loss. The number of traumatic amputations has also increased since the beginning of conflict in Iraq and Afghanistan [ 4 ]. The incidence of PLP has been reported to range from 42.2 to 78.8% in patients requiring amputation [ 5 – 8 ].
Stump pain is described as the pain in the residual portion of the amputated limb whereas phantom sensations are the nonpainful sensations experienced in the body part that no longer exists [ 6 , 7 ]. Superadded phantom sensations are touch and pressure-like sensations felt on the phantom limb from objects such as clothing [ 9 ]. Risk factor for PLP are shown in Table 1 . Recent studies report the prevalence of PLP to be more common among upper limb amputees than lower limb amputees. It was also reported to be more common among females than males [ 10 , 11 ]. A survey reported greater overall average pain intensity and interference in females than males and females endorsed significantly greater catastrophizing, use of certain pain-coping strategies, and beliefs related to several aspects of pain resulting in poor adjustment [ 12 ]. Larger population studies are needed for more definite establishment of the risks associated due to the site of involved limb or gender of the patient in development of PLP. Phantom sensations and pain have been reported following amputation of different body parts including the eyes, teeth, tongue, nose, breast, penis, bowel, and bladder but the most common occurrence is following limb amputation [ 4 ]. The phantom pain and sensation may have its onset immediately or years after the amputation. There are reports of two peak periods of onset, the first within a month and the second a year after amputation [ 7 ]. The prevalence is reported to decrease over time after amputation [ 10 , 11 ]. PLP has been reported in people with congenital absence of limbs [ 13 ]. Tingling, throbbing, piercing, and pins and needles sensations were among the most commonly described types of pain [ 13 ]. The rate of phantom pain or sensation was not reported to be higher in people with bilateral limb amputation than those with single limb amputation [ 14 ]. A significant association has been reported between the PLP and residual limb pain [ 15 ]. The presence of preamputation pain is also reported to increase the risks of developing PLP [ 16 ]. It is likely that stress, anxiety, depression, and other emotional triggers contribute to the persistence or exacerbation of PLP. A study has found that amputees with depressive symptoms were more likely to characterize their pain as more severe than those without depressive symptoms [ 17 ].
Risk factors for phantom limb pain.
PLP was once thought to be primarily a psychiatric illness. With the accumulation of evidence from research over the past decades, the paradigm has shifted more towards changes at several levels of the neural axis, especially the cortex [ 18 ]. Peripheral mechanisms and central neural mechanisms are among the hypotheses that have gained consensus as proposed mechanisms over the recent years. Proposed mechanisms to explain phantom limb pain are shown in Table 2 . However none of these theoretical constructs appears to be able to explain the phenomenon of PLP independently and many experts believe that multiple mechanism are likely responsible.
Proposed theoretical mechanisms to explain phantom limb pain.
2.1. Peripheral Mechanism
During amputation, peripheral nerves are severed. This results in massive tissue and neuronal injury causing disruption of the normal pattern of afferent nerve input to the spinal cord. This is followed by a process called deafferentation and the proximal portion of the severed nerve sprouts to form neuromas [ 18 ]. There is an increased accumulation of molecules enhancing the expression of sodium channels in these neuromas that results in hype-excitability and spontaneous discharges [ 19 ]. This abnormal peripheral activity is thought to be a potential source of the stump pain, including phantom pain [ 18 ]. Studies reporting the reduction of phantom pain with drugs blocking the sodium channels lend further support to this theory [ 20 , 21 ]. However, this cannot explain the mechanism of PLP in patients with congenital absence of limbs [ 4 , 18 ].
2.2. Central Neural Mechanisms
2.2.1. changes at the level of spinal cord.
The axonal sprouts at the proximal section of the amputated peripheral nerve form connections with the neurons in the receptive field of the spinal cord. Some neurons in the areas of spinal cord that are not responsible for pain transmission also sprout into the Lamina II of the dorsal horn of the spinal cord which is the area involved in the transmission of nociceptive afferent inputs [ 18 , 19 ]. This is followed by increased neuronal activity, expansion of the neuronal receptive field, and hyperexcitability of other regions. This process is called central sensitization. During this process, there is also an increase in the activity at NMDA receptors mediated by neurotransmitters such as substance P, tachykinins, and neurokinins at the dorsal horn of the spinal cord [ 22 ]. This is followed by a phenomenon called the “windup phenomenon” in which there is an upregulation of those receptors in the area [ 22 ]. This process brings about a change in the firing pattern of the central nociceptive neurons. The target neurons at the spinal level for the descending inhibitory transmission from the supraspinal centers may be lost. There also may be a reduction in the local intersegmental inhibitory mechanisms at the level of the spinal cord, resulting in spinal disinhibition and nociceptive inputs reaching the supra spinal centers. This lack of afferent input and changes at the level of the spinal cord have been proposed to result in the generation of PLP [ 22 – 24 ].
2.2.2. Changes at the Level of the Brain
Cortical reorganization is perhaps the most cited reason for the cause of PLP in recent years. During reorganization, the cortical areas representing the amputated extremity are taken over by the neighboring representational zones in both the primary somatosensory and the motor cortex [ 18 , 25 , 26 ]. The process and extent of cortical reorganization have been studied in both animal and human models following amputation and deafferentation. Cortical reorganization partly explains why the afferent nociceptive stimulation of neurons within the stump or surrounding area produces the sensation in the missing limb [ 4 , 27 ]. The extent of cortical reorganization has been found to be directly related to the degree of pain and the size of the deafferentiated region. Multiple imaging studies have correlated greater extent of somatosensory cortex involvement with more intense phantom limb experience [ 4 , 28 – 30 ].
Another proposed mechanism of PLP is based on the “body schema” concept that was originally proposed by Head and Holmes in 1912. The body schema can be thought of as a template of the entire body in the brain and any change to the body, such as an amputation, results in the perception of a phantom limb [ 31 ]. A further expansion of the body schema concept is the “neuromatrix and neurosignature” hypothesis proposed by Ronald Melzack in 1989. The neuromatrix can be conceptualized as a network of neurons within the brain that integrates numerous inputs from various areas including somatosensory, limbic, visual, and thalamocortical components. It then results in an output pattern that evokes pain or other meaningful experiences. The term “neurosignature” was proposed by Melzack to refer to the patterns of activity generated within the brain that are continuously being updated based upon one's conscious awareness and perception of the body and self. The deprivation of various inputs from the limbs to the neuromatrix causes an abnormal neurosignature to be produced that results in the generation of PLP [ 32 – 34 ].The other hypothesis relative to the mechanism of PLP has been derived from the research into illusory perceptions. It has been shown that the parietal and frontal lobes are also involved besides the primary somatosensory cortex in the perception of the abnormal somatosensory phenomenon [ 35 ]. Painful sensations, such as PLP, may be related to the incongruence of motor intention and sensory feedback and a corresponding activation of the parietal and frontal brain areas [ 36 , 37 ].
2.3. Psychogenic Mechanism
The assumption that PLP is of psychogenic origin has not been supported in the recent literature even though stress, anxiety, exhaustion, and depression are believed to exacerbate PLP [ 38 ]. A cross-sectional study found that amputation in people with personality traits characterized by passive coping styles and catastrophizing behavior was found to be associated with the development of PLP independent of anxiety and depression [ 39 ]. Most research on the relationship between psychological symptoms and PLP has been retrospective and cross sectional rather than longitudinal and thus limited inferences can be derived from these studies.
A number of different therapies relying on different principles have been proposed for the management of PLP as shown in Table 3 . However, specific treatment guidelines are yet to evolve and most successful measures employ multidisciplinary approaches in the management of pain and in rehabilitation [ 40 ].
Treatments for phantom limb pain.
Adapted from [ 4 , 41 ].
3.1. Pharmacological Approaches
3.1.1. preemptive analgesia and anesthesia.
Preemptive use of analgesics and anesthetics during the preoperative period is believed to prevent the noxious stimulus from the amputated site from triggering hyperplastic changes and central neural sensitization which may prevent the amplification of future impulses from the amputation site [ 42 ]. However, the results of the studies in this area have not been definitive. A recent study reported the decrease in PLP at six months following amputation when optimized epidural analgesia or intravenous patient controlled analgesia was started between 48 hours preoperatively and 48 hours postoperatively [ 20 ]. Prolonged postoperative perineural infusion of ropivacaine 0.5% was reported to prevent or reduce PLP and sensations after lower extremity amputation [ 21 ]. Ketamine, however, was not found to significantly reduce acute central sensitization or the incidence and severity of postamputation pain [ 43 ]. A randomized controlled double-blind trial comparing epidural infusions between a group receiving ketamine and bupivacaine and another receiving ketamine and saline following intrathecal or epidural anesthetic for surgery showed no significant difference between the two groups but much less pain at one year was reported in both groups compared to other comparable studies [ 44 ].
3.1.2. Acetaminophen and Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
A cross sectional study found that acetaminophen and NSAIDs were the most common medications used in the treatment of PLP [ 45 ]. The analgesic mechanism of acetaminophen is not clear but serotonergic and multiple other central nervous system pathways are likely to be involved [ 46 ]. NSAIDs inhibit the enzymes needed for the synthesis of prostaglandin and decrease the nociception peripherally and centrally [ 47 ].
Opioids bind to the peripheral and central opioid receptors and provide analgesia without the loss of touch, proprioception, or consciousness. They may also diminish cortical reorganization and disrupt one of the proposed mechanisms of PLP [ 4 ]. Randomized controlled trials have demonstrated the effectiveness of opioids (oxycodone, methadone, morphine, and levorphanol) for the treatment of neuropathic pain including PLP. Comparative trials have also shown benefit with opioids when compared with tricyclic antidepressants and gabapentin though the opioids were associated with more frequent side effects [ 48 ]. The total amount of opioid required to achieve analgesia may be less when used together with other agents, such as tricyclic antidepressants or anticonvulsants, which also have use in neuropathic pain modulation. Tramadol, a weak opioid and a mixed serotonin-noradrenalin reuptake inhibitor, has also been used in the treatment of PLP [ 4 , 49 ].
Tricyclic antidepressants are among the most commonly used medications for various neuropathic pains including PLP. The analgesic action of tricyclic antidepressant is attributed mainly to the inhibition of serotonin-norepinephrine uptake blockade, NMDA receptor antagonism, and sodium channel blockade [ 50 ]. The role of tricyclic antidepressants is well established in other neuropathic pain conditions, but the results are mixed relative to their role on PLP [ 51 ]. A recent study reported excellent and stable PLP control with an average dose of 55 mg of amitryptline, but there are others in which tricyclic antidepressants failed to effectively control the pain. [ 49 , 52 ]. Nortriptyline and desipramine have been found to be equally effective and with less side effects compared to amitriptyline [ 53 ]. A small case series demonstrated the effectiveness of mirtazapine, an alpha 2 receptor antagonist with fewer side effects than tricyclic antidepressants in the treatment of PLP [ 54 ]. There are case reports relative to the efficacy of duloxetine, a NE and serotonin receptor inhibitor, in the treatment of PLP [ 55 ]. Even though there may be a role for the use of SSRI and SNRI in the treatment of neuropathic pain, the evidence is very limited and further research is needed [ 56 ].
Gabapentin has shown mixed results in the control of PLP with some studies showing positive results while others not showing efficacy [ 57 – 59 ]. Carbamazepine has been reported to reduce the brief stabbing and lancinating pain associated with PLP. Oxcarbazepine and pregabalin may also play a role in the treatment of PLP, but further studies are required [ 4 , 60 ].
The mechanism of action of calcitonin in treatment of PLP is not clear. Studies relative to its therapeutic role have been mixed [ 61 , 62 ].
3.1.7. NMDA Receptor Antagonist
The mechanism of action of NMDA receptor antagonism in PLP is not clear. Memantine has shown some benefits in some case studies but controlled trials have shown mixed results [ 63 , 64 ]. A review concluded that memantine may be useful soon after amputation rather than for use in chronic neuropathic pain conditions [ 65 ].
3.1.8. Other Medications
The beta blocker propranolol and the calcium channel blocker nifedipine have been used for the treatment of PLP [ 60 ]. However, their effectiveness is unclear and further studies are needed. Flupirtine, an NMDA antagonist and potassium channel agonist, has been reported to be effective when used together with opioids in cancer-related neuropathic pain but needs further studies for other etiologies [ 66 ].
3.2. Nonpharmacological Treatment
3.2.1. transcutaneous electrical nerve stimulation (tens).
Transcutaneous electrical nerve stimulation has been found to be helpful in PLP [ 40 ]. Historically, there have been multiple studies showing the effectiveness of TENS of the contralateral limb versus ipsilateral to decrease PLP [ 67 ]. Though there is no strong evidence, low-frequency and high-intensity TENS is thought to be more effective than other doses [ 68 ]. TENS devices are portable, are easy to use, and have few side effects or contraindications.
3.2.2. Mirror Therapy
Mirror therapy was first reported by Ramachandran and Rogers-Ramachandran in 1996 and is suggested to help PLP by resolving the visual-proprioceptive dissociation in the brain [ 69 , 70 ]. The patient watches the reflection of their intact limb moving in a mirror placed parasagittally between their arms or legs while simultaneously moving the phantom hand or foot in a manner similar to what they are observing so that the virtual limb replaces the phantom limb. Simian studies have shown the existence of mirror neurons in the brain which fire both at times when an animal performs an action or observes an action [ 71 ]. Similar homologous neurons have also been discovered in humans [ 72 ]. The presence of mirror neurons in the brain is also supported by the phenomenon of tactile sensation in the phantom limb elicited by touching the virtual image of the limb in the mirror [ 73 ]. When a person with an intact limb observes a person with amputation, he can only “empathize about the amputation” rather than “feel it himself” because of the null input to the mirror neurons from his intact limb. However, a person with an amputation does not receive such null input as the limb is amputated and this results in the activation of mirror neurons which create a perception of tactile sensation. Consequently, since the activation of these mirror neurons modulates somatosensory inputs, their activation may block protopathic pain perception in the phantom limb [ 72 , 73 ]. A randomized controlled trial of mirror therapy in patients with lower leg amputation has shown significant benefit of PLP versus the control group [ 74 ]. Another controlled trial, however, reported that the mirror condition only elicited a significantly greater number of phantom limb movements than the control condition but did not attenuate phantom limb pain and sensations any more than the control condition [ 75 ].
3.2.3. Biofeedback, Integrative, and Behavioral Methods
Although there are earlier reports suggesting temperature biofeedback to be helpful for burning sensation of PLP, there is no specific evidence to match specific types of PLP with specific biofeedback techniques [ 76 ]. There is also a case report of visual feedback helpful in reduction of phantom pain [ 74 ]. Guided imagery, relaxation techniques, and hypnosis have been employed in the treatment of different neuropathic pains and may also be useful for PLP [ 28 , 77 , 78 ]. There are case reports of the beneficial effect of acupuncture for PLP [ 79 , 80 ]. The effectiveness of cognitive behavioral therapy in neuropathic pain syndromes has been reported in a number of case studies [ 81 , 82 ].
3.2.4. Surgical Intervention
Surgical interventions are usually employed when other treatment methods have failed. A case report relates the effectiveness of lesioning the dorsal root entry zone (DREZ) on upper limb phantom pain resulting from brachial plexus avulsions [ 83 ]. Another case report showed that, for selected patients, who have not obtained adequate relief with medical management, spinal cord stimulation was found to be effective [ 84 ]. Case reports of improvement of PLP with deep brain stimulation of the periventricular gray matter and thalamic nuclei have been published [ 85 ]. Motor cortex stimulation was also found to be helpful in a case of PLP [ 86 ].
3.2.5. Electroconvulsive Therapy
A case report of positive outcome has been published even though the mechanism and role of ECT relative to PLP is not well understood [ 87 ].
PLP is a relatively common and disabling entity. We have learned much about the pathophysiology and management of PLP since it was first described about five centuries ago. However, there is still no one unifying theory relative to the mechanism of PLP. Specific mechanism-based treatments are still evolving, and most treatments are based on recommendations for neuropathic pain. The evolution of the mechanistic hypothesis from body schema and neuropathic theories to the recently proposed role of mirror neurons in the mechanism of pain have added to our understanding of PLP. Further research is needed to elucidate the relationship between the different proposed mechanisms underlying PLP. A synthesized hypothesis explaining the phenomenon of PLP is necessary in the future for the evolution of more specific mechanism-based treatment recommendations.
The Booknerd Dragon
Trying to read all the books I can get my hands on!
Book Review: Phantom Limb by Lucinda Berry
Title: Phantom Limb: A Gripping Psychological Thriller Author: Lucinda Berry Publisher: Createspace Independent Publishing Platform Goodreads Rating: 4.18 Synopsis (Goodreads): Emily and Elizabeth spend their childhood locked in a bedroom and terrorized by a mother who drinks too much and disappears for days. The identical twins are rescued by a family determined to be their saviors. But there’s some horrors love can’t erase… Elizabeth wakes in a hospital, strapped to her bed and unable to move or speak. The last thing she remembers is finding Emily’s body in their bathroom. Days before, she was falling in love and starting college. Now, she’s surrounded by men who talk to themselves and women who pull out their eyebrows. As she delves deeper into the mystery surrounding Emily’s death, she discovers shocking secrets and holes in her memory that force her to remember what she’s worked so hard to forget-the beatings, the blood, the special friends. Her life spins out of control at a terrifying speed as she desperately tries to unravel the psychological puzzle of her past before it’s too late. Phantom Limb is a character-driven mystery that begs to be read in a single setting. The shocking and shattering conclusion will make you go back and read it again. Perfect for fans of The Girl on the Train, Behind Closed Doors , and The Girl With No Past . “Dark suspense at its finest” … Thriller Beats
Ola peeps! How are you all?
I am here to have yet another review!
First and foremost, I thank Ms. Lucinda Berry for giving me a copy of her book in exchange of a review. Now let’s get started…
When I read the title of the book, Phantom Limb, I was like “What does that even mean?” When I read its synopsis it got my interest when I found out that it’s about a set of twins. My, I love twins. I don’t have twins and having friends that are twins and knowing some twins, I find them interesting and weird but bonded. So I read it.
The title of the book in Goodreads has an extension of ‘A Gripping Psychological Thriller’ and when it said gripping, it didn’t disappoint. It was indeed gripping!
It’s about a set of twins, Emily and Elizabeth, who suffered from a lot of abuse, physical, emotional, sexual, mental, since their childhood. When they were freed from those abuse a married couple adopted them and started treating them like they were their own children. But because they experienced those abuse for around seven years since their birth, they were struggling on adjusting to their new family. Each of them have their own way of adjusting to their situation; Emily is cutting herself and Elizabeth has a way to shut herself out from the world. Then one night, Elizabeth found Emily inside the bathroom bleeding and practically dead. When Elizabeth opened her eyes again she’s in a hospital because her doctor said she tried killing herself even though she can’t remember she did it. So she was sent to a psych ward where she was treated. And while she’s being treated, she discovered a lot of things that helped her remember some of the missing memories she have. She found answers.
Dude this book made me cringe a lot of times. I can’t imagine how it must have been to the twins when they were suffering those abuse from their mother and the special friends. Like seriously. It’s disturbing that I can’t think back about that part of the book without cringing or having goose bumps or a shiver. Like I can’t even begin to explain how it made me feel. I know parents should love their parents but the twins’ mother is a devil. She’s a mother! The twins came from her! She have them for nine months but why does she treat them like nothing? And if she can’t take care of the twins why didn’t she just gave them up for adoption while they were still babies? Ugh! She is so sick and I hate her so much!
Emily and Elizabeth are both amazing girls despite their struggle in adjusting to new environments. They are really really close to each other. They didn’t have anyone when they were suffering from the abuse aside from themselves. It was hard for them to be separated from each other. The abuses they suffered, though they suffered them all at the same time, has different effect on them. Emily became broken and depressed that is why she’s cutting herself. And because Elizabeth has her way to shut the world out if she likes to, she became the strong one to them. But still both of them are still suffering even though they are already free from their mother and those special friends.
While Elizabeth was having her treatment in the psych ward, I thought some of the parts of that story isn’t important but those were actually the clues about the twist. Though seriously I must admit that the twist of this story is way too vivid to figure out. Heck, I didn’t even saw it coming. When it was revealed I was like
Like seriously what?!
I did back up a few pages and recall a few things and then just stared at those three words of revelation. This book— I don’t know how many psychological thrillers I’ve read since I started reading but I can say that this book is the only one that left a mark in my head. I honestly don’t even remember if I ever have read psych thrillers this hardcore before. But seriously, this one is just so gripping.
I want to say that I enjoyed this book but I feel like if I say those I would be saying that I enjoyed reading their tragedy. Let’s just say that I enjoyed the adventure I have with Elizabeth all throughout the book.
Please don’t think about my review as a bad one. I honestly liked the story of the book but I still can’t move on from the gruesome abuse they experienced when they were a child and up till they adjusted to their own coping mechanism. Don’t get me wrong, this book is good. It really is. It’s the abuse that I find disturbing and couldn’t get past it. Now I’m just blabbing. Again, the story is good! I just can’t get myself to be enthusiastic about it.
Though I won’t say that this is going to be the last psych thriller I will read ever. I will still read psych thrillers. I just need time to get the images the book created out of my head. 😀
If you are the kind of person who enjoys hardcore psychological thrillers, this book is surely perfect for you. Go check it out first and let you be the judge. Like I always say, we all have different opinions towards the same thing.
About the Author..
Dr. Lucinda Berry’s background is as unique as her stories. She has a Ph.D. in clinical psychology, specializing in trauma and children. She is the Assistant Director of Evidence-based Practice at UCLA’s National Center for Child Traumatic Stress. She uses her clinical experience to create compelling tales that blur the lines between fiction and nonfiction. Website | Goodreads
Published by Jannin Chou (The Booknerd Dragon)
Weird | Bibliophile | Demigod | Blogger View all posts by Jannin Chou (The Booknerd Dragon)
3 thoughts on “ Book Review: Phantom Limb by Lucinda Berry ”
Wow! Awesome review!! What a creepy cover!
Like Liked by 1 person
Thanks! The story will blow you. 😀
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Phantom Limb: A Gripping Psychological Thriller Audio CD – Unabridged, August 4, 2020
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- Language English
- Publisher Dreamscape Media
- Publication date August 4, 2020
- Reading age 18 years and up
- Dimensions 6.04 x 1.13 x 5.04 inches
- ISBN-10 1662022360
- ISBN-13 978-1662022364
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- Publisher : Dreamscape Media; Unabridged edition (August 4, 2020)
- Language : English
- ISBN-10 : 1662022360
- ISBN-13 : 978-1662022364
- Reading age : 18 years and up
- Item Weight : 1.76 ounces
- Dimensions : 6.04 x 1.13 x 5.04 inches
- #6,457 in Medical Thrillers (Books)
- #46,752 in Psychological Thrillers (Books)
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About the author
Dr. Lucinda Berry is a former clinical psychologist and leading researcher in childhood trauma. Now, she spends her days writing full-time where she uses her clinical experience to blur the line between fiction and nonfiction. She enjoys taking her readers on a journey through the dark recesses of the human psyche. Her work has been optioned for film and translated into multiple languages.
If Berry isn’t chasing after her son, you can find her running through Los Angeles, prepping for her next marathon. To hear about her upcoming releases and other author news, visit her on social media or sign up for her newsletter at https://lucindaberry.com/.
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