Many amputees feel various sensations in addition to “pain.” These could include:
- Tingling
- Numbness
- Sharp, brief stabbing
- Burning
- Hot or cold
- Cramping
Some people have minor symptoms, but others have severe, painful, and incapacitating phantom limb experiences. The most prevalent symptom that patients continue to experience is pain in the missing limb.
What Causes Phantom Limb Pain?
The specific etiology of phantom pain is unknown. However, it appears to originate in the spinal cord and brain. When a person experiences phantom pain, areas of the brain that were neurologically related to the nerves of the amputated limb show activity during imaging studies such as magnetic resonance imaging (MRI) or positron emission tomography (PET).
Many specialists believe phantom pain can be explained as the brain’s response to confusing inputs. Following an amputation, portions of the spinal cord and brain lose input from the missing limb and respond in unforeseen ways to this detachment. As a result, the body’s most basic warning sign that something is wrong is pain.
According to research, following an amputation, the brain may remap that part of the body’s sensory circuitry to another region of the body. In other words, because the amputated limb can no longer receive sensory information, the information is referred elsewhere, for example, from a missing hand to a still-present cheek.
When you touch the cheek, it’s as if the missing hand is being touched. Because this is yet another instance of tangled sensory wiring, the end consequence can be excruciating.
Other reasons for phantom pain include damaged nerve endings, scar tissue at the amputation site, and body memory of pre-amputation pain in the affected area. A poorly fitted prosthesis can also produce pain, but this is rarely a cause of residual limb pain.
How is Phantom Limb Pain Diagnosed?
Although there is no medical test to diagnose phantom pain, doctors diagnose the disorder based on your symptoms and the circumstances that occurred before the pain began, such as trauma or surgery.
Exactly describing your pain can assist your doctor in determining the source of your pain. Even though having phantom pain and residual limb pain at the same time is prevalent, the therapies for these two disorders may differ, so a proper diagnosis is critical.
Treatment Options for Phantom Limb Pain
While no one knows what causes this pain, many doctors believe it is due to injured nerves or scar tissue. Some also blame the brain for receiving confusing signals when an entire limb suddenly stops providing information. When the brain no longer receives input from a limb, it sends the most fundamental indication that something is wrong: pain.
It was treated by conducting additional amputations, reducing the stump, and removing any neuromas that caused pain.
It is crucial to understand that the brain may retrain to build more effective treatment approaches. Among the therapies for phantom limb pain are:
- Medications
- Physical therapy
- Mirror therapy
- Interventional injections
- Neuromodulation
1. Medications:
Tricyclic antidepressants, sodium channel blockers, and anticonvulsant medications have been shown in studies to be effective in neuropathic pain conditions such as phantom limb pain.
2. Physical Therapy:
Patients suffering from complicated regional pain syndrome may benefit from desensitization therapy in conjunction with sympathetic nerve blocks.
Physical therapy also ensures that prosthetics fit correctly and that patients use them properly.
3. Mirror Therapy:
Mirror therapy is one of the most promising therapies for phantom limb pain. Mirror therapy involves using a mirrored box with two openings: one for the amputated limb and one for the other.
Virtual reality (VR) programs have recently supplanted traditional mirror therapy. Patients wear virtual reality goggles while performing duties with their normal limbs, but the goggles display the same tasks completed by the missing limb instead. A patient can also execute tasks in front of a screen using motion tracking equipment.
These therapies are ineffective for patients who have lost both arms or legs since there is nothing for the mirrors to reflect or the VR programs to emulate.
4. Interventional Injections:
Injection therapy can be effective when used in conjunction with other treatments. Interscalene or stellate ganglion blocks may aid with upper extremity pain. Lumbar sympathetic blocks can alleviate phantom limb pain in the lower extremities. Neuroma injections can also help patients suffering from extremity neuromas.
5. Neuromodulation:
Neuromodulation is a technique for blocking nerve signals to the brain, including those that appear to be coming from a missing limb.
Transcutaneous Electrical Nerve Stimulation (TENS):
Many people who did not get results with previous treatment choices find significant alleviation with transcutaneous electrical nerve stimulation (TENS) or spinal cord stimulation. TENS is the less intrusive of the two, using skin patches to send an electrical current to pain receptors in the brain. A gentle buzzing sensation replaces the pain caused by this little electrical current.
Dorsal Root Ganglion or Spinal Cord Stimulation (SCS):
Dorsal Root Ganglion or Spinal Cord Stimulation (SCS) technology works by sending an electrical current into the epidural area near the cause of chronic pain to treat more refractory pain. Your doctor will insert SCS trial leads into the epidural space. These small, soft wires connect to a stimulating device. If it reduces your pain, your doctor can implant a permanent SCS for long-term pain relief.
