Phantom Pain

What is Phantom Pain?

Phantom Pain that seems to be coming from a body part, which is not there. For instance, you may have undergone a limb amputation, but you have a sensational pain experience in already a limb that has been removed.

The phantom pain sensations can be described as perceptions an individual experiences, which relate to an organ or limb that may not physically be there or it is not part of the body.

The sensations can be felt most frequently after an amputation of a leg or an arm, but they can also occur after removal of an internal organ or a breast. The sensation pain varies from an individual to another.

It is believed that close to 80 percent of patients who undergo a limb amputation experience this kind of pain sensation at least one point in their lives. Other individuals may experience a feeling of pain sensation in a missing limb during the rest of their lives after the removal of the limb. ¹

Symptoms

You will find that most people whose limbs have been removed may still be having the feeling that the amputated limbs are still there. They will have a painless phenomenon, which is common referred to as phantom pain sensation. However, this kind of sensation rarely occurs in individuals born without limbs.

A person with phantom limb sensation may have feelings of warmth, coldness, itchiness, or even tingling, but this should not be assumed to be phantom pain and it shouldn’t be confused with phantom pain.

At the same time, pain arising from the remaining part or stump of a removed limb is actually not phantom pain. Phantom pain occurs as just a sensation or perception of pain from a limb part that is not physically present meaning a limb part that has been removed.

Phantom pain manifests in the following ways:

• It may start within the first few days following an amputation
• It may come and go or it occurs continuously. Sometimes, it may come, go away, and occur again in that sequence.
• The pain particularly affects parts of the limb that are farthest from the body for example, the foot of a removed leg
• The pain sensation may be described as stabbing, squeezing, boring, shooting, throbbing, or burning
• At times, a patient may feel as if the removed part or the phantom part has been forced into an uncomfortable position
• Phantom pain could be triggered by pressure exerted on the remaining part of a limb. At other times, it may be triggered by an emotional stress.

Causes

It is unclear what exactly causes phantom pain, however, it appears to come from the brain and spinal cord. Initially, doctors believed that the post-amputation pain known as phantom pain was a psychological problem, however, it has now been recognized that such real sensations actually originate in the brain and spinal cord.

• In imaging scans like magnetic resonance imaging and positron emission tomography, parts of the brain that previously had a neurological connection to the nerves of a removed limb showed activity at times when an individual was experiencing phantom pain.
• A vast majority of experts now believe that phantom pain could at least have a partial explanation as a response occurring due to mixed signals from a person’s brain.
• When an individual gets his or her limb amputated, parts of the brain and spinal cord lose inputs from the removed or missing limb and the body tends to adjust to that kind of detachment in quite unpredictable ways.
• As a result, there may be a trigger by the body on the basic message that there may be something that is not right, and this basic message comes in form of the pain sensations.
• Also, studies have shown that following an amputation, the person’s brain could start remapping the part of the sensory circuitry of the body directing it to another part of body. Since the amputated part is not able to get the sensory information, that information could be referred to another part, for example, a missing hand sensory information may be referred to a cheek.
• That way, when the cheek is touched, it may feel as though the touch is done on the missing hand. The result may be some form of pain sensation.

There may be other factors, which could contribute to phantom pain and they include damages done to nerve endings, physical memory related to the pre-amputation pain in that affected area, or a scar tissue that is found on the area of amputation.

Risk Factors

Some people may develop this pain sensation after having an amputation, but others don’t. It is know yet know why this happens to some people. However, there are some risk factors, which have been associated with having phantom pain. These include:

Stump pain

In people who have unrelenting stump pain, they are likely to have phantom pain. If there is abnormal growth occurring on the damaged nerve endings, it can lead to painful nerve activity.

Pain before limb removal

Some patients who have pain before having an amputation are more likely to have phantom pain thereafter following an amputation. The contributing factor to this is that, brain holds on pain memory and may keep sending the signals even after an individual has had the limb amputated.

Poor-fitting artificial limb

If you have a poorly fitted prosthesis, it could result in increased risk of having phantom pain. You may want to talk to your doctor just to ensure that you put the artificial limb properly and that it fits correctly.

Diagnosis

There is no medical test that can help diagnose phantom pain, however, doctors can collect information pertaining the symptoms an individual has been having and the circumstances in which they occur. For example, a doctor may want to know if the pain started after a trauma or surgery.

You may want to describe the pain precisely so that you help the doctor determine its cause. It is common for paints to have stump pain and phantom pain occurring simultaneously, however, the treatment approaches for these pains are different.

Treatment

It may be difficult to find treatment for phantom pain. A multifaceted approach may be adopted in offering treatment for this pain sensation phenomenon. A doctor may prescribe medication and other noninvasive therapies like acupuncture and transcutaneous electrical nerve stimulation (TENS).

There may be more-invasive procedures such as implanted devices or injections. A doctor may use surgery to treat phantom pain, but this should be a last resort. Among the medications used in treating phantom pain include:

• Antidepressants to treat pain arising from damage of nerve. These drugs modify the chemical messengers responsible for relaying pain signals. They also help you to sleep so that you feel better.
• Anticonvulsants like gabapentin can be used to treat nerve pain. These medicines sooth the damaged nerves and prevent uncontrolled pain signals.
• Narcotics may also be taken in prescribed doses to help in controlling phantom pain. People with a history of being addicted or substance abuse may not be prescribed narcotics.
• NMDA receptor antagonists work on nerve signals by blocking activity of glutamate, which is a protein associated with the relay of nerve signals.

There may be no specific medications that have been designed to treat phantom pain, however, medications that treat other forms of pain may be used, especially the nerve related pain.

Apart from medication, a patient having phantom pain may also get noninvasive therapies such as:

• Nerve stimulation (TENS) where a devise sends some weak electrical current through patches placed on the skin around the pain area. This nerve stimulation procedure helps to mask the pain signals or interrupt them. This way, the signals don’t reach the brain.
• Mirror box is a device containing mirrors making it look as if an amputated limb exists. In the mirror box, there are two openings, which represent the intact limb and another one for the remaining stump. An individual will perform exercises by watching the intact limb and imagining it is the missing limb moving. This way, the exercises may help in relieving phantom pain.
• Acupuncture can help in easing phantom pain. This procedure uses sterilized stainless needles that are inserted into the skin. Acupuncture can also help in stimulating the release of endorphins, which are regarded as natural pain relievers of the body.

Other treatment options include minimally invasive therapies such as injection, spinal cord stimulation, and nerve blocks.

Surgery is an option in the event that other forms of treatment do not offer relieve. The surgery procedure may include brain stimulation using magnetic resonance imaging scan to ensure electrodes are correctly positioned.

Stump revision or neurectomy may be opted as a surgery procedure if the phantom pain is being triggered by nerve irritation occurring on the stump. However, patients need to understand that cutting nerves could result in worsening the pain, so they should consider this procedure carefully to avoid complications.

Reference List

1. http://www.mayoclinic.org/diseases-conditions/phantom-pain/basics/definition/con-20023268
2. Phantom pain. Available at https://en.wikipedia.org/wiki/Phantom_pain
3. Managing Phantom Pain. Available at http://www.amputee-coalition.org/limb-loss-resource-center/resources-for-pain-management/managing-phantom-pain/#.WVJQ-rjHYsY