Phantom Limb Pain

What is Phantom Limb Pain

Phantom limb pain is pain in a body part that no longer exists. It usually happens in an arm or leg (extremity) after it has been surgically removed (amputated).

Most cases of phantom limb pain are brief. However, it can last for years, and it may be severe and disabling.

The exact mechanism of how phantom limb pain occurs is not known. The problem may start in a part of the brain that processes feelings and awareness (sensations) from the rest of the body (sensory cortex).

When a body part is lost, the sensory cortex may not be able to handle the loss and may reorganize (rewire) itself to make up for the lost signals.

Phantom limb pain is chronic, severe pain perceived to be located in amputated body regions. People with PLP may also report feeling movement of the amputated body part or other phantom limb sensations such as paresthesias or temperature changes.

What are the causes?

This condition only happens in patients with amputations, but the cause is not known. It may be caused by:

  • Damaged nerve endings (peripheral nerves).
  • Scar tissue.
  • Rewiring of nerves in the brain or spine (central nerves).

What are the symptoms?

Symptoms vary and are related to the lost limb or the remaining stump. Stump pain may be mistaken for phantom limb pain, or you may have both at the same time. Symptoms include:

  • Phantom pain. Pain often feels like the pain you had before the amputation. It usually comes and goes, and it gets better over time. The pain may feel like:
    • Burning.
    • Stabbing.
    • Throbbing.
    • Cramping.
    • Prickling.
    • Crushing.
    • It is moving over time from the farthest part of the amputated limb (fingers or toes) up to the site of amputation, as if the limb is shrinking (telescoping).
  • Phantom sensation. This is a feeling other than pain, as if the limb is still part of the body. This may include sensations of:
    • Movement.
    • Shape or length.
    • Position.

Physical or emotional factors can trigger or worsen pain sensations. Those factors may include:

  • Weather changes.
  • Stress.
  • Strong emotions.
  • Certain positions or movements of the body.
  • Pressure on the affected area.

How is this diagnosed?

Diagnosis is based on your history of amputation and symptoms that you have after surgery. Your health care provider may:

  • Do a physical exam.
  • Talk with you about your symptoms and past history of pain.

You may have imaging tests to examine your stump, such as X-rays or CT scan.

Is phantom limb pain a neuropathic pain state?

Evidence exists that cortical reorganization as well as peripheral and central sensitization may contribute to PLP. Should these prove to be correct, PLP would fit the criteria established by the definition of neuropathic pain; furthermore, as PLP is pain referable to tissues that do not exist, it can only be either referred pain or neuropathic pain.

How is this treated?

There are different therapies and medicines that may give you relief. Work with your health care provider until you have adequate relief. Treatment options may include:

  • Pain medicine. Medicine can be given for pain right after surgery (acute pain) and for pain that goes on for some time (chronic pain). Commonly used medicines include:
    • Antidepressant medicine.
    • Anticonvulsant medicine.
    • Narcotics, analgesics, or anti-inflammatory medicine.
    • Nerve blocks.
  • Techniques that help to retrain the brain and nervous system (movement representation techniques), such as:
    • Looking at your unaffected limb in a mirror and thinking about painless movement of your extremity (mirror therapy).
    • Thinking about moving your limbs without actual movement (motor therapy).
    • Watching and sensing the movement of other people (action observation).
  • Relaxation techniques that use the mind and body to control pain. These often involve guided imagery, deep breathing, and muscle relaxation exercises.
  • Hypnosis and mental imagery. These techniques can help you focus or concentrate to regain control.
  • Biofeedback. This involves using monitors that alert you to changes in your breathing, heart rate, skin temperature, or muscle activity, and using relaxation techniques to reverse those changes. Biofeedback tells you if the techniques you are using are effective.
  • Acupuncture. This involves inserting small needles into certain places on your skin to help relieve pain.
  • Sensory discrimination training. For this treatment, painless stimulation is applied to different parts of your stump and you describe what you feel. This may help with nerve rewiring.
  • Physical therapy involving the stump, which may include:
    • Exercise. This may be physical movement, or it may involve applying sound waves (ultrasound) or tapping (percussion therapy) to the stump. These exercises may help to heal and retrain tissue and nerves.
    • Massage. Stump massage creates new sensations, breaks up scar tissue, and prepares the stump (desensitization) for an artificial limb (prosthesis).
    • Heat or cold treatment. This can improve blood flow and reduce inflammation.
    • Applying painless electrical pulses to the skin to prevent sensations of pain from reaching the brain (transcutaneous electrical nerve stimulation, TENS).

Follow these instructions at home:

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Do not drive or use heavy machinery while taking prescription pain medicine.
  • Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
  • Join a support group. Express your feelings and talk with someone you trust.
  • Seek counseling or talk therapy with a mental health professional. This may be helpful if you are having trouble managing your emotions about losing an extremity.
  • Keep all follow-up visits as told by your health care providers and therapists. This is important.

Contact a health care provider if:

  • You have a sore on your stump that does not get better with treatment.
  • Your pain does not improve with medicine or treatment.

Get help right away if:

  • You have suicidal thoughts.

If you ever feel like you may hurt yourself or others, or have thoughts about taking your own life, get help right away. You can go to your nearest emergency department or call:

  • Your local emergency services (911 in the U.S.).
  • A suicide crisis helpline, such as the National Suicide Prevention Lifeline at 1-800-273-8255. This is open 24 hours a day.

Summary

  • Phantom limb pain is pain in a body part that no longer exists. It happens in an arm or leg (extremity) after it has been surgically removed (amputated).
  • Medicines or techniques that help to retrain the brain and nervous system (movement representation techniques) may help to relieve symptoms.
  • Physical therapy for phantom limb pain may involve exercise, massage, heat or cold therapy, or painless stimulation of the skin (transcutaneous electrical nerve stimulationTENS).
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