Phantom Limb Pain


 

This refers to pain that comes from a limb that is no longer there. Phantom pain usually has onset within the first few days of amputation; comes and goes or is continuous; affects the part of the limb farthest from the body such as the foot from an amputated leg; can be described as shooting, stabbing, squeezing, throbbing, or burning; and sometimes feels as if the removed limb is in an uncomfortable or twisted position. The pain may be triggered by pressure from the remaining part of the limb or from emotional stress. For many people, the pain will lessen in frequency and duration within six months of amputation, but pain can last from seconds to minutes and days.

It was once believed that this condition was a psychological condition, but it is now understood that these sensations originate from the spinal cord and brain. After an amputation, the spinal cord and brain lose input from the missing limb, which can trigger pain messaging. Studies have also shown that after an amputation, the brain may remap that part of the body’s sensory circuitry to another area. Risk factors for phantom limb pain include pain in the limb prior to amputation; stump pain, which can be caused by an abnormal growth on damaged nerve endings; or a poorly-fitting prosthesis. Poor sleep, stress, change in weather, poor blood flow, infection, and swelling can also increase the pain.

Imaging scans, such as magnetic resonance imaging (MRI) or positron emission tomography (PET), can be used to demonstrate activity in the brain where neurologic connections used to be for the amputated limb when the patient feels phantom pain.

Treatment can consist of medications like antidepressants, anticonvulsants, opioids, beta blockers, muscle relaxants, and N-methyl-d-aspartate receptor antagonists. Your doctor may also recommend transcutaneous electrical nerve stimulation, which is a device that sends an electrical current via adhesive patches on the skin to interrupt pain signals. Other treatment options include steroid injections to provide pain relief; spinal cord stimulation, which delivers electrical currents along the spinal cord to relieve pain; and nerve blocks, which interrupt pain messages from the brain.

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