phantom pain
Individuals who experience an amputation will most likely also experience a phenomenon called phantom pain. This is a particular type of pain that is felt below the level of the amputation and is theoretically caused by the nerves which are severed during the procedure, although the exact cause is not known. For decades doctors believe that this was a psychological problem but today researchers and doctors recognize that it is a physical situation.
Most individuals who have had a limb removed will report that they sometimes feel as though it is still there. This is a pain feeling known as phantom limb sensation and can also happen to individuals who were born without a limb. The sensations can include feelings of being cold, warm, itchy or tingling but should not be confused with pain. For many individuals the phantom pain will get better over time with out treatment but for others managing the pain is challenging.
Individuals who experience phantom limb pain will most often find that it starts within a few days of the amputation. The tendency is for the pain to come and go rather than be constant over time and it seems to come from particle area that is farthest from the body such as the foot in an amputated leg or the hands in an amputated arm. Most patients describe the pain as shooting, stabbing, squeezing or burning. Interestingly, the pain can be triggered by weather changes or pressure on the remaining part of the limb.
Some individuals report that the phantom pain will flareup as a result of stimulation or pressure on the stump. Unfortunately, this is the result of the prosthetic that will put pressure on the nerves which can cause phantom limb sensations. Pressure can also cause seemingly unrelated symptoms like nausea. Some people also report that pressure on other parts of the body, over the head or back pain can trigger a phantom sensations or pain.
As with most conditions pain will flare with a fever and illness. Stress, inactivity and anemia may also trigger feelings of phantom pain. It is still unknown why some develop this pain and condition and others don't but there are some factors which seem to increase the risk of phantom pain. Researchers have found that people who have had pain in the limb before amputation are likely to have it afterwards and people who have persistent pain in the stump will also have pain as well. Individuals who have a poor fitting prosthetic or who are not putting it on correctly may cause pain in the stump and also phantom limb pain. (1)
Treatment from this condition is varied and will range from massage to surgery. At this time there are no specific medications for phantom limb pain, although researchers and doctors have found good relief using tricyclic antidepressants, anticonvulsant medications such as gabapentin or OB is narcotics such as codeine and morphine. Individuals who use the narcotic medications must be monitored closely by their physician and the dosages closely controls. Those who have had a previous history of substance abuse are not able to use opiate narcotics to control phantom limb pain.
Tricyclic antidepressants appear to work by modifying the chemical messengers that relay the pain signals. In other words, the medication changes the neurotransmitters or blocks them from linking and being interpreted as pain. Antidepressants can also help individuals sleep which will improve their overall ability to tolerate and control pain. (2)
Transcutaneous electrical nerve stimulation is another option used in individuals who may be candidates for noninvasive therapies. This device sends a weak electrical current into the body that may interrupt or change the pain signals before they reach the brain. It is safe and painless but does not work for everyone who has phantom pain.
Research from the National Institutes of Health has found that acupuncture is an effective treatment for some types of chronic pain. It is thought that the acupuncture needles stimulate the central nervous system to release endorphins which are bodies natural pain relieving substances.
Individuals who have difficulty managing severe phantom limb pain may be candidates for deep brain stimulation or motor cortex stimulation during which a surgeon will use an MRI scan to positional electrodes over the motor cortex. Although current data is limited, it is still fairly promising. Another surgical option is a resection or revision of the stump but cutting nerves which also carries the risk of making the pain worse.
Researchers also have three other treatment options currently in clinical trials to relieve the pain of phantom limb pain. Salon is an artificial limb which has motors controlled by electrical signals that sometimes results in reduced phantom pain. The other two options use imagery and virtual reality in order to trick the brain into believing that it is exercising the lost limb and therefore decreases the pain.
While phantom limb pain may be challenging and painful current research and treatment protocols are available to assist patients in dealing with this condition on a daily basis. Don't attempt to treat phantom limb pain on your own but instead seek the advice of a rehabilitation therapists or physician who is well-versed in the treatment plans and protocols associated with phantom limb pain.
(1) MayoClinic: Phantom Pain
http://www.mayoclinic.com/health/phantom-pain/DS00444/DSECTION=risk-factors
(2) British Journal of Anesthesia: Phantom Limb Pain
http://bja.oxfordjournals.org/content/87/1/107.long
RESOURCES
RXList: Tricyclic Antidepressants
http://www.rxlist.com/script/main/art.asp?articlekey=95236
Journal of Neuropsychiatry: Management of Phantom Limb Pain
http://neuro.psychiatryonline.org/article.aspx?articleID=103461
Neurosurgery: Pain management after lower extremity amputation
http://neuro.psychiatryonline.org/article.aspx?articleID=103461
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