Phantom Limb Pain
Phantom pain, sometimes referred to as Phantom Limb Pain or simply ‘PLP,’ is the sensation of pain experienced by individuals who have undergone the removal or amputation of a body part. This pain appears to emanate from the amputated body part itself.
While it is most commonly observed in cases where a foot, leg, finger, or hand has been amputated, phantom pain can also manifest in other body regions. For instance, it can occur following procedures such as breast removal (mastectomy), partial tongue removal, or even tooth extraction.
The existence of phantom pain has been documented for centuries, dating back to 1551 when Ambroise Paré, a French military surgeon, reported instances of amputees still perceiving pain in the amputated body part.
Although phantom pain is most commonly associated with limb loss resulting from amputation or injury, it can also affect individuals born without certain limbs due to congenital birth defects, as well as those who have sustained damage to the spinal cord or specific nerve roots affecting particular limbs or body regions.
In cases of phantom pain, individuals perceive discomfort in the area where their absent body part should exist. Additional challenges associated with the loss of a body part encompass:
- Phantom Sensations: This occurs when the missing limb or extremity continues to feel as though it’s still part of the body, without any accompanying pain. Those experiencing phantom sensations might even momentarily forget the absence of a lower limb and attempt to walk on both legs.
- Residual Limb Pain: This type of pain affects the remaining part of the limb, commonly known as the stump, where the amputation took place. Residual limb pain often arises from medical causes like nerve damage or nerve compression due to pressure. It is a concern for approximately 7 out of every 10 individuals who have undergone limb loss.
Symptoms of Phantom Limb Pain
Phantom pain symptoms can vary in duration, ranging from momentary sensations to persisting for several days. Typically, within the initial six months following limb loss, the intensity and frequency of pain tend to diminish. However, even after two years post-amputation, up to 8 out of 10 individuals still experience phantom pain.
The sensations associated with phantom pain can include:
- A sensation of burning or aching.
- Feelings of clamping or pinching
- Experiencing itching or tingling.
- Sensations akin to shooting or stabbing pains.
- A throbbing sensation.
- The feeling of twisting or contorting.
Causes of Phantom Limb Pain
The precise origins of phantom limb pain remain elusive to researchers. One potential hypothesis suggests that nerves within specific regions of the spinal cord and the brain undergo a process of “rewiring” when they no longer receive signals from the absent arm or leg. Consequently, these rewired nerves transmit pain signals, a customary reaction when the body detects an issue.
An additional illustration of this rewiring phenomenon is when tactile stimulation occurs on a different body part, such as the hip or forearm, the brain may perceive it as originating from the missing limb.
Other potential contributors to phantom limb pain encompass compromised nerve endings and the presence of scar tissue resulting from the amputation surgery.
Diagnostics of Phantom Limb Pain
Your healthcare professional will perform a physical examination and prescribe diagnostic tests aimed at excluding potential sources of residual limb pain, such as infections. These assessments may encompass blood examinations and imaging procedures such as ultrasounds.
Complications of Phantom Limb Pain
Persistent phantom pain can significantly deteriorate your overall quality of life and disrupt your sleep patterns. It may even lead to the development of anxiety or depression. However, there is hope for relief through the use of medications and engaging in therapy sessions with a qualified therapist.
Treatment of Phantom Limb Pain
When pain persists despite the use of medications and non-pharmacological therapies, your healthcare provider may propose alternative medical interventions.
Spinal Cord Stimulation: In this procedure, your doctor will implant minuscule electrodes along your spinal cord and administer a low-level electrical current through them. This approach can be effective in alleviating pain in certain cases.
Brain Stimulation: Similar to spinal cord stimulation, brain stimulation employs electrodes, but in this case, they transmit the current to specific areas of the brain. A skilled surgeon will precisely position the electrodes in your brain. Although ongoing research is underway to determine its efficacy, some individuals have found promising results with this method.
Revision Surgery: In situations where nerve-related pain is the underlying issue, surgical intervention on the residual limb may be recommended to address and rectify the problem.
Research also indicates that mirror therapy may offer relief from phantom pain. In this therapeutic approach, you observe your unaffected limb in a mirror while engaging in movement exercises for approximately 20 minutes daily. The reflection effectively deceives the brain into perceiving the presence of two healthy limbs.
As time progresses, the brain assimilates this information, and it may be necessary to regularly repeat these exercises to alleviate your pain. Because the brain no longer perceives the limb as missing, it ceases to experience pain in the phantom limb. A qualified physical therapist can guide you in mastering this exercise regimen.
