What to Do About Phantom Limb Pain After Amputation

Rahul Sood, D.O.

About 80 percent to 85 percent of people who have amputations develop phantom limb pain, painful sensations that seem to be coming from the limb that was removed. In addition to sharp or dull pain, many people experience symptoms like throbbing, burning, and squeezing sensations. Most phantom pain starts within the first few days following an amputation, and it can persist for months afterward. In a few cases, phantom pain can begin months or years after losing the limb.

Not too long ago, the common theory was that phantom limb pain was a psychological condition, with no real basis in physiology. But today researchers know there are real, physiological mechanisms involved in these sensations. And thanks to those recent developments, new treatment approaches have been developed that can provide a significant amount of meaningful relief.

What causes phantom limb pain?

Researchers aren’t entirely sure what causes phantom limb pain, but it’s probable that multiple mechanisms are involved. 

Peripheral nerve injury

Phantom nerve pain may begin at the site of the amputation when nerves and surrounding tissues are traumatized. Severing nerve endings disrupts the normal flow or signaling pathways that more or less “define” the nerve’s activity and relative identity. Small lumps called neuromas begin to develop at the nerve endings, and sometimes, those nerves can become over-excited and overactive as a result of local chemical imbalances.

Changes in the spinal cord

Researchers think phantom pain may also be associated with alterations in the spinal cord. Like nerve endings, the spinal cord can also become over-sensitized, and that probably has to do with reordering that occurs when a limb is removed. The central nervous system is used to specific signaling pathways and processes, and when those processes are disrupted or altered, it can cause a restructuring of the nerves inside the spinal cord, along with some key chemical imbalances. In turn, the spinal cord can become “confused,” sensing pain signals in the amputated limb space.

Brain-related factors

Just as nerves in the spinal cord undergo a restructuring process, areas of the brain also begin to reorganize. Every area of your body is controlled by a corresponding area of the brain. After amputation, the area of the brain that was responsible for sensing in that limb is rendered inactive, and neighboring areas of the brain may “move in” and take over. Researchers think this reorganization may be a primary cause of pain sensed in the missing limb. In fact, imaging studies show that when a patient senses pain in the amputated limb, the areas of the brain that once controlled that part of the limb become active.

Psychological factors

Although researchers know phantom limb pain isn’t “just” psychological in nature, they still feel issues like depression, anxiety, and stress following an amputation play a role. People with acute and chronic stress don’t manage pain as effectively, and they may be more likely to develop chronic pain syndromes that can persist for months or even years.

Treating phantom nerve pain

Because multiple factors can be involved in phantom nerve pain, treating phantom nerve pain often requires several interventions. Medications like antidepressants, muscle relaxants, and anticonvulsants can help some patients manage their symptoms and even eliminate those symptoms over time. Steroid injections may also be helpful. 

Many patients benefit from interventional therapies, like transcutaneous electrical nerve stimulation, or TENS therapy. In TENS therapy, a special device sends a mild electrical current through your skin via small adhesive patches. These electrical currents interrupt abnormal pain signals to prevent pain sensations from occurring. Another option is spinal cord stimulation, which uses a similar technique to deliver mild electrical currents to the nerves inside the spinal column. Nerve blocks can help by preventing pain signals from reaching the brain.

Get relief for your symptoms

At Metro Pain Centers, we understand the very real symptoms associated with phantom limb pain. As a leading pain treatment clinic in NY and NJ, we offer a custom approach to treatment that focuses on helping each patient find and maintain symptom relief. If you have phantom limb pain, we can help. To schedule your evaluation and consultation, book an appointment online today.

Rahul Sood, D.O.

Rahul Sood, D.O.

About Rahul Sood, D.O.

As a board-certified anesthesiologist and doctor of osteopathy, Rahul Sood, DO, is an integral part of the team at Metro Pain Centers. He is also a specialist in venous medicine with an extensive history and experience in treating lower extremity spider and varicose veins. He practices from the offices in Clifton, Middletown, Riverdale, Edison, and Jersey City, New Jersey; and Staten Island and Ardsley, New York.

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