Phantom limb pain is a condition that occurs when an amputee feels pain in their missing limb. It most commonly occurs in the legs or arms, though it has been known to appear in cases where other body parts were removed, such as following a mastectomy. For some, the pain disappears by itself. Other patients might experience chronic pain that requires treatment. Pain can be limited if patients talk to a doctor and find a treatment option. The majority of individuals who have an amputation will experience sensation or feelings related to their limb within six months following their surgery. Though researchers aren't exactly sure what causes phantom pain, they have found treatment methods that show success.
Specific medications can help manage and treat phantom limb pain. While there aren't any medications developed exclusively for phantom limb pain, drugs used to treat certain other conditions might be helpful. Tricyclic antidepressants ease pain in the nerves by changing the chemicals responsible for pain signals. Common tricyclic antidepressants used, including for phantom limb pain, are tramadol, nortriptyline, and amitriptyline. Anticonvulsant medications can also be used to help nerve and phantom limb pain, even though they were originally developed to treat seizures. Medications like pregabalin, gabapentin, and carbamazepine have been used to treat chronic pain, nerve issues, and muscle problems. Some patients have reported a reduction in symptoms with the use of opioid medications, but these don't work for everyone. It's also important to be aware of the risk of dependency that comes with opioids. If none of these medications work, doctors may use other painkillers. Some potentially effective ones include NMDA receptor antagonists or over-the-counter medications like acetaminophen. Some patients might benefit from a shot of pain-blocking medication in the area the amputation was done.
Acupuncture is a common non-drug therapy that can help relieve multiple types of pain, including phantom limb pain. With acupuncture, thin needles are inserted into specific points in the skin. This causes the body to release chemicals that relieve pain. In addition to phantom limb pain, acupuncture is often used to relieve pain from osteoarthritis, migraines, fibromyalgia, rheumatoid arthritis, nerve pain, and other persistent undiagnosed pain. The treatment has been used by Chinese health professionals for thousands of years, and modern studies have indicated it does have benefits regarding nausea and pain. With traditional Chinese medicine, acupuncture is related to the theory that disease is caused by a disruption to an individual's energy flow. Western scientists have come up with alternate hypotheses for why the treatment works. The main one is acupuncture stimulates a patient's nerves. The nerves then send signals to the brain, which releases hormones like beta-endorphins, relieving pain.
Spinal Cord Stimulation
Spinal cord stimulation might provide relief for symptoms of phantom limb pain. One study was done on four patients who had intractable phantom limb pain. After treatment, all four patients indicated they had reduced pain symptoms. Experts recommend using spinal cord stimulation techniques in situations where normal pain medications aren't effective enough. This treatment works by stimulating the patient's nerves. Many individuals have heard of transcutaneous electrical nerve stimulation (TENS) units, which can be bought at most drugstores and are marketed for muscle pain relief. These units send small electrical currents into the body through sticky patches on the skin. The goal is to interrupt pain signals before they reach the brain. When phantom limb pain is caused by the nervous system sending pain signals, spinal cord stimulation can interrupt the signals when they're still in the spinal cord, before the brain has a chance to interpret them.
The mirror technique is a common way of treating phantom limb pain that isn't relieved by medications or spinal cord stimulation. Some patients experience a feeling of tenseness or muscle pain in their missing limb. The tenseness is difficult to relieve, because they don't have actual muscles to relax.
Mirror box therapy involves a box without a lid. There are two holes in the side, one for the remaining limb and one for the stump. The center has a mirror. A patient sees the reflection of their intact limb where their stump is, which tricks the brain into believing their amputated limb is still intact. The patient will then go through therapy exercises to relax their muscles and ease pain using their intact limb. The brain interprets the exercises as applying to the missing limb as well. Research has shown this can lead to significant pain relief.
Psychotherapy has been used to treat phantom limb pain in the past, although its efficacy varies widely. When the phantom pain is caused by the rewiring of the nervous system, psychotherapy alone doesn't tend to be effective. However, therapy can be used to treat psychosomatic pain. Psychotherapy is quite effective in treating patients with phantom limb pain when it is combined with other methods. It is particularly useful in cases in which the amputation or loss of limb was traumatic, as the psychotherapy helps the patient deal with the underlying issues causing the phantom pain to occur in the first place.