What is Phantom Limb Pain?

Phantom limb pain is a neuropathic pain condition that typically occurs post-amputation. While it was once believed that the symptoms of this condition were purely psychological in nature, scientists now recognize that the condition is much more complex. Indeed, evidence has shown that these symptoms of pain originate from the spinal cord and brain.

The onset of symptoms of phantom limb pain generally occurs within the first few days following amputation. Further, symptoms are generally more severe immediately following the procedure and are expected to decrease over time, with most cases resolving completely on their own. In cases of phantom limb pain persisting longer than six months, the prognosis is poor.
The experience of pain with this condition can vary widely from individual to individual. The pain can range from dull and achy to sharp and stabbing. In some cases, the patient has reported feeling as though the phantom body part is being forced into an uncomfortable position. Pain sensations can also change in conjunction with the weather and tend to worsen during periods of increased emotional stress.
Though typically seen in individuals who have had a limb amputated, the name phantom limb pain is a misnomer. Patients can experience these sensations about any part of their body that was removed as a result of surgery. For instance, cases of phantom limb pain have included the breast, eye, and tongue.

Causes of  Phantom Limb Pain

For most individuals, following amputation of a body part, the sensation that the body part is still there is quite common and generally painless.
These sensations are classified as phantom limb sensations. In some cases, however, patients report experiencing pain and symptoms of discomfort in an area of the body that is no longer there as a result of surgery. This is termed phantom limb pain.
Limited evidence exists regarding the exact cause of phantom limb pain. In general, it is recognized that the sensations of pain originate within the spinal cord and brain.
Moreover, imaging studies have revealed neurological links to areas of the brain that are associated with the nerves of the amputated limb. Indeed, many believe that the sensations of phantom limb pain are associated with the loss of nerve input following amputation.
In other words, the brain and spinal cord imply pain following the loss of sensory input from that particular body part.
Not all cases of amputation develop sensations of phantom pain. A number of factors have been shown as related to the development of phantom limb pain following surgery, including damaged nerves, scar tissue, and memories of pre-amputation pain in the affected body part.

Treatment for Phantom Limb Pain

There is no specific cure for phantom limb pain; however, there are a number of available treatments to assist patients in managing the painful symptoms associated with this condition.

In terms of pharmacotherapy, while there are currently no medications approved for the treatment of phantom limb pain, several medications are believed to provide patients with some relief. Some anticonvulsants, such as gabapentin, are often used in alleviating pain that accompanies nerve damage. Further, there are a number of medications that were originally developed to alleviate symptoms of depression that have also been shown to be effective for neuropathic pain. Individuals, whose pain is severe and does not respond well to over-the-counter remedies, may wish to speak to their doctor about prescribing an opioid medication to help manage the pain.

For patients with chronic and severe neuropathic phantom limb pain, TENS units, which are devices that deliver a very mild electrical stimulation to the stump of the amputated body part, have received some support for their usefulness in providing pain relief. Additionally, there is some indication that patients can experience a significant reduction in pain with spinal cord stimulation. This procedure involves implanting a device near the spinal column, which delivers electrical impulses to control the transmission of pain signals from the nerves within the spine. Intrathecal pump implants can also provide patients with pain relief. This device pumps pain-relieving medications directly to the area surrounding the spinal cord.

In terms of alternative techniques, biofeedback training has received support for helping patients manage pain associated with a phantom body part. This treatment involves teaching patients relaxation and coping skills that allows them to gain some control over their own pain symptoms and manage emotional stress, which has been shown to exacerbate pain sensations.

Complementary therapies have also shown promise for patients with phantom limb pain. Techniques, such as acupuncture, when done in combination with other forms of treatment for pain, can be extremely beneficial.

Conclusion

Phantom limb pain is a neuropathic pain condition that occurs following amputation of a body part. While the exact cause of phantom limb pain is unknown, some have suggested that nerve damage as well as mixed neural signals most likely account for these sensations. There is currently no cure for phantom limb pain, though most cases tend to resolve with time. Cases of phantom limb pain that do not resolve in six months following surgery tend to have a much poorer prognosis. A number of treatment options are available for managing the symptoms of pain. Patients are encouraged to speak with their physician about the course of their condition in order to determine the treatment plain that is right for them.

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