The medical necessity to have a limb or part of the body amputated is a big decision and subsequent lifestyle change. Whether due to trauma or a medical condition, a person who loses a part of their body will have to manage a new, different way of living. On top of this lifestyle change, there is also the opportunity that the person will experience phantom limb pains, which are feelings of pain in the area of the body that is no longer there. On top of feeling pain, this can also cause feelings of sadness and depression. Thankfully, there are treatment options that have proven helpful. The Texas Pain Care team in the Sugar Land, Missouri City and Houston areas is able to recommend the best treatment option with a goal to help each patient improve their quality of life.
After an amputation, there is the opportunity for a person to experience pain sensations in the limb that is no longer there. In fact, almost 80% of patients who had to undergo an amputation report feeling some form of phantom limb pain, even up to two years after their amputation surgery.
The “phantom” part of the condition refers to the part of the body that is no longer there, such as an arm or a leg. Even though the arm, for instance, has been amputated, the person will experience sensations as if the arm was still part of the body.
While the condition is referred to as “pain,” and the most often reported sensation is pain, there are other feelings that a person can experience, including:
While some sensations can be brief and mild in nature, there are instances where the sensation can be so great and long-lasting that it greatly disrupts the person’s quality of life.
Phantom limb pain varies from person to person. However, it’s most common to experience phantom pain in the lower part of the body, and in the part of the limb that is farthest from the body, i.e. toes in the leg, or fingers in the arm. Pain or discomforting sensations can also mirror what was felt prior to amputation.
While many of the painful or uncomfortable phantom limb sensations can diminish over time, there is the possibility that phantom limb pain can last for a long time and be difficult to treat. This is why it’s important to partner with a pain management specialist who can help reduce the frequency and duration of pain sensations.
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Anyone who has undergone an amputation can develop phantom limb pain. The most common risk factors that lead or contribute to the development of phantom limb pain include:
The most common phantom limb pain is related to the fingers and toes because those are the body parts most associated with the cortex of the brain.
While there is no clear cause of phantom limb pain, the most common beliefs point to scar tissue or nerve damage. The brain has been sending signals to, for instance, the arm and hand for the person’s entire life up until this point, so when the arm is removed, the brain isn’t sure what to do. In this case, the brain might send whatever signal it can to alert the body that something is wrong (the arm is missing), which can be conveyed as pain.
While phantom limb pain is considered a complex condition, there have been great strides made to help amputee patients combat these painful and disturbing sensations. The goal is to attempt to retrain the brain so it stops sending unwanted sensations. Treatment methods include:
Medications: NSAIDs, prescription medications, anti-seizure medications and beta blockers have proven effective for pain relief. Opioids can also be a useful tool, but some patients might opt to utilize other methods to avoid taking opioids for the long term.
Physical therapy: partnering with a physical therapist will help to not only strengthen the muscles around the removed limb, but will also help to ensure the prosthetic limb fits properly, which is a common cause of limb pain. Physical therapy is also most often used in conjunction with medical therapies, such as nerve blocks.
Complementary therapies: acupuncture, biofeedback, massages and meditation can all provide helpful relief as they reduce a person’s perception of pain and also reduce the feelings of pain and possible subsequent depression
Mirror therapy: a simple, non-invasive and effective way to treat phantom limb pain, mirror therapy involves repeated exercises to trick the brain into thinking that the amputated limb is not missing. This practice involves using a mirrored box with two openings, one for the amputate limb and one for the other limb. Movement exercises are performed with both the amputated limb and the other limb, which makes the brain think that the amputated limb is functioning. Over time, the brain encodes this information and since it believes that the limb is not missing, it does not send signals that something is wrong. Recent technological advancements include virtual reality (VR) options, instead of a mirrored box. This technique, however, does not work for people who are double amputees because there is nothing to mirror.
Phantom motor execution: this technique aims to achieve the same goal as mirror therapy but focuses instead on the muscles in the stump of the amputated limb, versus the missing limb itself. Electrodes are placed on a patient’s stump and the patient performs certain movements, such as opening their hand, which “trains” the computer program and allows the real-time movement of a superimposed arm on a screen. Not only does this allow the patient to visualize they are moving the arm, but it also engages the area of the brain that is responsible for that limb’s movement. This treatment has proven effective for reducing pain, and is suitable for double amputee patients.
Interventional injections: injection therapy, targeted at stopping nerves from sending pain signals, help to provide pain relief, especially when used with other methods such as physical therapy. Stellate ganglion blocks and interscalene blocks help for upper body pain relief, lumbar sympathetic blocks help for lower body pain relief, and neuroma injections help for those who suffer from extreme neuromas.
Neuromodulation: this is a great option for blocking nerve signals from being sent to and recognized by the brain. TENS (transcutaneous electrical nerve stimulation) uses electrical stimulation via skin patches to replace pain sensations with a mild buzzing sensation, and SCS (spinal cord stimulation) uses wires placed in the epidural space to deliver the same result.
If you are suffering with phantom limb pain and would like more information about available treatment options, please schedule an appointment with the Texas Pain Care team in the Sugar Land, Missouri City and Houston areas today. We are committed to both helping you achieve pain relief and increase your quality of life.
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