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Phantom Pain: What Phantom Limb Syndrome Is and How to Deal With It

The phantom limb pain that may be felt in a recently amputated limb is the residual reaction of the nervous system. Here we explain phantom limb sensation and give you some options for managing it.

Phantom limb syndrome or phantom limb sensation refers to the sensations that are often felt in an amputated limb. Most people who have had a limb removed say that they sometimes feel as if the amputated limb is still there. This is because the brain continues to receive messages from the nerves of the missing limb.

Phantom limb syndrome or phantom limb pain is a medical condition in which people may experience a painful sensation in a limb that is no longer present. Occurring in about 80 to 100 percent of amputees (a person who has had a limb amputated), pain often lasts for a long time and is frequently resistant to treatment. Doctors previously thought that phantom limb syndrome was a psychological condition; however, experts now know that it originates in the brain and spinal cord.

Phantom pain may present the following characteristics:

  • Phantom pain usually begins in the week following the amputation of the limb, but it’s not unusual for it to occur after a few months or even longer. The pain may either be continuous or come and go.
  • The pain may be shooting, stabbing, crushing, burning, throbbing, cramping, or feel like pins and needles, tickling, or numbness.
  • The symptoms occur in the part of the amputated limb farthest from the body, such as the foot of the amputated leg. 
  • The limb may feel as if it is still attached and working normally.
  • The phantom limb may experience pressure-like sensations from material such as clothing.

The exact causes of phantom limb pain remain unclear; however, it is thought to originate in the brain and the spinal cord. Medical imaging — such as positron emission tomography (PET) or magnetic resonance imaging (MRI) — of areas in the brain previously connected to the amputated limb show neurological activity when an individual experiences phantom pain.

Experts believe that phantom limb pain may be in response to the mixed signals sent by the brain. After the amputation of a limb, regions of the brain and spinal cord no longer receive any input or signals from this limb and thus adjust to this in erratic ways. This may trigger pain, which is the body’s basic message conveying that there is a problem somewhere. The brain has to rewire or reorganize itself to adapt to bodily changes.

A variety of other factors may also contribute to the occurrence of phantom limb pain, including scarring at the amputation site, a physical memory of pre-amputation pain in the affected area, and damaged nerve endings.

Factors that may raise the risk of developing phantom pain include:

  • Pain in the limb before amputation. According to some researchers, individuals who already had pain in their limb before amputation are more likely to suffer from phantom pain. This may be due to the brain retaining a memory of the pain and continuing to send signals of pain even after the removal of the limb.
  • Residual pain in the limb. People who experience continuing pain in the residual portion of the limb are more likely to develop phantom pain. This pain may occur due to the development of a neuroma, which is the abnormal growth of damaged nerve endings.
  • Presence of a clot of blood in the amputated limb
  • History of damage to the peripheral nerves, which supplied the amputated limb or spinal cord
  • Unexpected, sudden/traumatic amputation, such as in an accident
  • The type of anesthetic procedure used while amputating the limb
  • Emotional trigger factors, including anxiety, depression, and stress, may contribute to the exacerbation or persistence of phantom limb pain.

Treatment for phantom pain is not always easy to find. Doctors generally start with medicines and may then add noninvasive treatments, including acupuncture. Surgery is only an option if other treatments have not relieved the pain.

No specific medicine exists for phantom pain treatment; however, certain medicines used to treat other conditions may help in relieving phantom pain. Some medicines that your doctor may use in phantom pain treatment are:

  • Over-the-counter pain relievers may help in relieving phantom pain.
  • Tricyclic antidepressants may help in relieving the pain that occurs due to nerve damage.
  • Anticonvulsants may also help in reducing nerve pain.
  • N-methyl-D-aspartate (NMDA) receptor antagonists may help in relieving phantom pain. Studies have shown that they bind to the NMDA receptors present on the nerve cells in the brain and block the action of glutamate, a protein that plays a large role in transmitting nerve signals.

The following non-drug therapies may help in relieving phantom pain in some people:

  • Mirror box. In this device, mirrors are used to make it appear that the amputated limb still exists. In some studies, it has been found that performing exercises with the mirror box may help in relieving phantom limb pain.
  • Acupuncture. According to the National Institutes of Health, acupuncture may help in easing some kinds of long-standing pain. The therapist inserts fine, sterilized,  stainless steel needles into the skin at particular points on your body.
  • Stimulation of the spinal cord. The doctor stimulates the spinal cord by inserting small electrodes along the spinal cord and passing a small current of electricity to help relieve the pain.
  • Transcutaneous electrical nerve stimulation (TENS). TENS may also help relieve phantom limb pain.

Stimulation of the motor cortex and deeper areas of the brain is quite similar to the stimulation of the spinal cord but the electric current is passed directly into the brain. Limited data exists on this method, and this type of treatment isn't approved to treat phantom pain, but some people have found it to be a favorable treatment option.

Your doctor may suggest the option of surgical intervention only if other phantom pain treatments have been unsuccessful. Options may include revision surgery of the stump, nerve block, the surgical removal of a part of a nerve, or severing (destroying) the nerve roots in the spinal cord.

In some people, phantom limb pain may improve with time without any  treatment. For others, it may be more challenging to manage phantom limb pain. Work together with your doctor to find the best treatment plan to relieve your phantom limb pain effectively.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3198614/
https://thejns.org/view/journals/j-neurosurg/2/3/article-p251.xml
https://www.winchesterhospital.org/health-library/article?id=96857
https://www.mayoclinic.org/diseases-conditions/phantom-pain/symptoms-causes/syc-20376272
https://www.mayoclinic.org/diseases-conditions/phantom-pain/diagnosis-treatment/drc-20376278
https://www.ncbi.nlm.nih.gov/pubmed/17684875

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