- Antidepressants, to relieve pain associated with nerve damage in the affected area.
- Anticonvulsants, to reduce or slow pain signals sent by nerves in the affected area.
- Narcotics, including codeine and morphine prescribed in small doses to control associated phantom limb pain.
- N-methyl-d-aspartate (NMDA) receptor antagonists, a type of anaesthetic that blocks the activities of proteins that relay signals from the nerve to the brain.
Phantom limb pain is the sensation of pain or discomfort that feels like it is coming from a body part that has been amputated and is no longer there. Once thought to be a psychological disorder occurring post-amputation, doctors have now discovered that these feelings are real and originated in the spinal column before traveling to the brain.
Causes of Phantom Limb Pain
While the specific cause of phantom limb pain is not known, experts believe the condition actually originates in the spinal cord and/or the brain. Experts also have found that phantom limb pain appears to partially be caused by a response to various signals received in the spinal nerves and the brain.
After a limb is amputated, medical experts believe the areas of the spinal cord and brain that typically receive messages from nerves in the missing limb adjust in ways that are unknown and unpredictable; this often results in the brain sensing that something is not functioning correctly, to which the brain responds by sending signals of pain and discomfort.
Other factors thought to contribute to phantom limb pain include signals received from nerve endings that have been damaged, scar tissue in the vicinity of the amputations, and the physical sensation and stored memory of pain and feelings experienced, pre-amputation, in the area experiencing phantom pain.
Risk Factors Associated with Phantom Limb Pain
Although researchers have not yet figured out why phantom pain after amputation occurs in some and not in others, they have identified risk factors that increase the risk of phantom pain, including:
- Pain in the amputated area prior to amputation; research demonstrates that patients who experienced pain in an area pre-amputation are more likely to experience phantom limb pain in the area post-amputation.
- Stump pain; those who experience chronic pain in the stump of an amputated limb are more likely to also report experiencing phantom limb pain.
- Poor-fitting artificial limb (prosthesis); an artificial limb that is not fitted correctly has been linked to an increase in reported phantom limb pain.
Symptoms
The most commonly reported symptom reported by people who’ve had a limb amputated is the feeling that the limb is still there; this sensation is painless and is referred to as phantom limb sensation.
Those experiencing phantom limb sensations commonly report feelings such as coldness, heat, itching, and tingling; however, these sensations are not considered phantom pain. According to the Mayo Clinic, and by definition, phantom pain is described as pain and/or discomfort originating in the body part that has been amputated and is no longer attached to the body .
Typical characteristics associated with phantom pain include:
01
Experiencing phantom pain within the week following amputation
02
Pain that is continuous or tends to come and go
03
Often is experienced in the portion of the limb furthest from the body; for example, the hand of an arm that has been amputated
04
Pain that varies in intensity and is often described as shooting, stabbing, boring, squeezing, throbbing or burning
Diagnosis
While there is not a specific medical test designed to identify phantom limb pain, physicians typically diagnose the condition by conducting a physical examination, assessing reported symptoms, and evaluating your medical history.
Possible Treatments
Determining effective treatment methods for phantom limb pain has proven challenging. Treatment approaches typically start with the least invasive means, medication, and then progress overtime to include noninvasive therapy, minimally invasive therapy, and as a last resort, surgery.
Medications used to treat phantom limb pain include:
Medications
Using noninvasive treatment therapies to treat phantom limb pain tends to rely on trial and error; noninvasive treatment methods that might assist in relieving phantom limb pain include:
- Nerve stimulation with the intent of interrupting signals associated with pain from being sent to the brain.
- Using a mirror box which creates the appearance that the amputated limb still exists. Using the mirror box, the patient performs symmetrical therapeutic movements while using imagery to picture that he or she is watching the missing limb complete the movements. Research has demonstrated these types of exercises to be effective in relieving phantom limb pain.
- Acupuncture: the National Institutes of Health (NIH) reports acupuncture to be an effective way to treat chronic pain, including phantom limb pain.
Minimally invasive therapies used to treat phantom limb pain include:
- Injection of local anaesthetics or steroids, injected directly into the stump to provide pain relief.
- Spinal cord stimulation
- Nerve blocks, used to interrupt or block signals of pain from being
When all other methods of treatment have failed, your physician may recommend surgery as a way to treat phantom limb pain; specifically
- Deep Brain stimulation to interrupt signals of pain from being sent and/or received by the area associated with phantom limb pain.
- Stump revision or neurectomy; to severe the nerves associated with signals being sent to brain and resulting in phantom limb pain.
For some, phantom limb pain tends to dissipate over time and without treatment. However, for others, phantom limb pain is challenging and can become progressively worse over time. When treating phantom limb pain, it is best for you and your physician to collaborate on a proactive plan designed to treat phantom limb pain.
Dr. Raju Mantena is an anesthesiologist and pain specialist based in the Houston area and has over 15 years of medical experience which he relies upon each day to successfully treat his patients’ acute and chronic pain.
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