Phantom Limb Pain

Treated By Top Pain Management Doctors In Fort Smith, Arkansas

Phantom limb pain is a sensation felt when a body part or limb has been amputated, but still feels as if it is attached. Many amputees will have phantom sensations that are not painful. It is estimated that 85% of people experience phantom limb sensations in the first several weeks following amputation.  However, a smaller population will continue to feel these sensations for prolonged periods of time. It is reported that 60% of people will continue to experience sensations one year after surgery (Manchikanti and Singh, 2004). phantomlimb_300

Some patients have severe painful and debilitating phantom limb sensations. Some of the sensations include tingling, numbness, hot or cold sensations, cramping, stabbing, and burning. The most common sensation that patients continue to feel is pain in the missing limb area. These painful sensations often diminish over time, but some suffer from long-term pain, which can be difficult to treat.

Treatment

Some treatments for phantom limb pain include:

  • Medications
  • Physical Therapy
  • Mirror Therapy
  • Interventional Injections
  • Spinal Cord Stimulation

Medications: Studies have shown that tricyclic antidepressants, sodium channel blockers, and anticonvulsant medications can be useful in neuropathic pain conditions like phantom limb pain. Currently, gabapentin is the most commonly used medication for phantom limb pain. Many studies have shown that oral opioid medications are not effective at treating neuropathic pain. However, other studies have shown that intrathecal administration of buprenorphine was effective in many patients, and provided them with prolonged resolution of their phantom limb symptoms.

Physical Therapy: Desensitization therapies along with sympathetic nerve blocks may provide relief for patients who have “sympathetically mediated pain.” Proper fit of any prosthetic is also important in decreasing pain for many who suffer from phantom limb pain.

Mirror Therapy: One of the more promising treatments for phantom limb pain is mirror therapy. Mirror therapy involves the use of a mirrored box with two openings: One for the amputated limb, and one for the other limb. The patient then performs isometric exercises with the non-amputated limb, so it appears as though the amputated limb is moving. In a randomized controlled study by Chan, et al. (2007), it was found that the patients who had mirror therapy for four weeks experienced a significant reduction in pain.

Interventional Injections: Injection therapy such as interscalene blocks or stellate ganglion blocks can be used for upper extremity phantom limb pain.  Lumbar sympathetic blocks are used for lower extremity phantom limb pain. Neuroma injections can also be beneficial for those who suffer with extremity neuromas. The blocks are often combined with physical therapy.

Spinal Cord Stimulation: Transcutaneous Electrical Nerve Stimulation (TENS) or spinal cord stimulation offers significant relief too many patients who have not had success with other treatments. Spinal Cord Stimulation (SCS) is often described as a “pacemaker for pain” and uses groundbreaking technology that works by introducing an electrical current into the epidural space near the source of chronic pain. After a local anesthetic and minimal sedation your doctor will first place the trial SCS leads into the epidural space. The SCS lead is a soft, thin wire with electrical leads on its tip and is placed through a needle in the back into the epidural space. The trial stimulator is typically worn for 5-7 days.  The lead is taped to your back and connected to a stimulating device. If the trial successfully relieves your pain you can decide to undergo a permanent SCS.

References

  • Phantom Limb Pain – PainDoctor.com
  • Chan B., Witt, R., Charrow, A., et al. (2007). Mirror Therapy for Phantom Limb Pain. New England Journal of Medicine, 2007. 357;21: 2206-2207 2. Manchikanti L. and Singh V. (2004)
  • Managing Phantom Pain. Pain Physician, 2004; 7:365-375. 3. Mayo Clinic (2009). Phantom Pain. Retrieved November 19, 2009 from: http://www.mayoclinic.com/print/phantom-pain/DS00444/DSECTION=all&METHOD=print 4. National Institute of Neurologic Disorders and Stroke (2009).
  • Pain: Hope Through Research. Retrieved on November 19, 2009 from: http://www.ninds.nih.gov/disorders/chronic_pain/detail_chronic_pain.htm#140643084 5. Omote, K., Ohmori, H., Kawamata, M., et al. (1995).
  • Intrathecal Buprenorphine in the Treatment of Phantom Limb Pain. Anesth Analg 1995; 80: 1030-1032