Facts About Phantom Limb Pain
_Fact #1: Amputating a painful limb may not stop the pain. _
Living with chronic pain in an arm or a leg leads someone to wonder if cutting the limb off will stop the pain. Those who do go so far may only discover the reality that pain is not so simple and that the limb pain might continue despite the absence of the limb. Except then, the pain is not felt in an actual limb; the pain is felt in a limb that is not really there, the phantom limb. This phenomenon is called phantom limb pain.
_Fact #2: A good portion of the phantom limb pain originates from the brain and spinal cord. _
In days of old, many people believed that the pain afflicting an amputee originated from the residual limb stump. Surgeons would go digging for neuromas to remove or would try to revise the stumps. But despite the best efforts, the pain would remain in the phantom hand, arm or leg. The limb was no longer there, but the pain felt as if the real limb was on fire or being stuck with needles. In a recent survey, only 50% of people who had such procedures actually gained relief.1
So what about the others afflicted with phantom limb pain? With today’s newer imaging studies and latest theories about pain, what was once felt to be a pain coming from the remaining portion of a limb, is now understood to be coming from a reorganized central nervous system.2
_Fact #3: Non-opioid medication can relieve phantom limb pain. _
Over half of the people living with phantom limb pain find that the anti-convulsant medications are able to decrease the intensity and frequency of the pain.1 Medications like gabapentin (Neurontin) and pregabalin (Lyrica) are well worth trying because of their abilities to reduce the sensitivity of the nervous system and the intensity of the pain signals that originate from the central nervous system. Other medications worth considering because of their special ability to treat pain that comes from the nervous system include ketamine and dextromethorphan.3
_Fact #4: Some opioid medications work better than others for the treatment of phantom limb pain. _
One might be lead to believe that there is no difference between morphine, hydrocodone, oxycodone and alike. But the fact is that all opioids work a little differently because of a slightly different chemical footprint. In terms of treating phantom limb pain, the doctors at treat v eterans returning home with missing limbs can speak from vast experience. Many of them are using buprenorphine as a first line treatment for phantom limb pain because it seems to work the best. Methadone is also another option because of its special effects on the nervous system.
_Fact #5: Physical therapy can help relieve phantom limb pain. _
Some physical therapists have specialized in the treatment of phantom limb pain using specific techniques that help to reorganize and retrain the brain. Recognizing that pain is a signal output from the brain,4 these physical therapists use laterality reconstruction to help amputees regain their ability to tell the difference between left and right, a skill that is often impaired in someone who has phantom limb pain.5 Mirror boxes are also used to trick the brain into thinking the limb is still there and give it some needed visual feedback of being whole.6 Other therapist use visualization techniques to teach an amputee phantom exercises that can help the body feel whole again. All of these specialized therapy exercises help to reframe the amputee experience into something that is less threatening and less painful.
_Fact #6: Using a prosthetic limb helps to minimize phantom limb pain. _
Because of the tactile stimulation felt by the stump and the sensory feedback to the brain, prosthetic limb use does help to ease phantom limb pain. Prosthetic limb technology has exploded with the recent increased numbers of amputees returning from the middle-east conflict. Look for advancements in not only the area of functionality but also in the area of sensory capabilities.7 Besides, the use of a prosthetic limb helps laterality reconstruction and cognitive reorganizing. A prosthetic limb helps the body feel whole again.
- Pain Med. 2012 Sep 26. doi: 10.1111
- Nat Rev Neurosci. 2006 Nov;7(11):873-81
- Cochrane Database Syst Rev. 2011 Dec 7;(12):CD006380
- Neurorehabil Neural Repair. 2012 Jul-Aug;26(6):646-52
- Neurosci Lett. 2010 Dec 17;486(3):240-5
- Neurology. 2006 Dec 26;67(12):2129-34
- Neurosci Lett. 2012 Jan 24;507(2):97-100
Christina Lasich, M.D., wrote about chronic pain and osteoarthritis for HealthCentral. She is physiatrist in Grass Valley, California. She specializes in pain management and spine rehabilitation.