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Phantom Pain: What it means to hurt in an invisible space.

Phantom Pain Defined

When patients feel pain coming from a body part that no longer exists, they are experiencing phantom pain. Most of the time phantom pain is felt in a lost limb such as an arm or a leg, but this disorder can occur in the removal an appendage. For example, patients have reported the experience of phantom pain after the surgical removal of the breast, the eyes, the the tongue. [4]

What Causes Phantom Pain?

While many patients will experience the sensation of a phantom limb, not all patients will experience phantom limb pain. Phantom pain is classified neuropathic disorder, or a disease that targets the the brain, the spinal cord, and/or the nerves that connect the body and organs to those structures. It is possible that phantom limb pain is caused by damage of the central or peripheral neurons. Neuron's are specialized cells within the nervous system that are responsible for relaying information.

The sensory motor incongruence theory [3] suggests that the pain caused by a phantom limb is the result of a miscommunication between the mind's intention for the limb, and the actual movement of the limb. In other words, the neurons are not relaying pain signals correctly from the brain to the lost appendage.[1]

Patient Uses Mirror Box to Relieve Phantom Pain

Characteristics of Phantom Pain

Phantom pain usually occurs within the first few days after an amputation has been performed, and can either be acute (quick onset short duration) or become chronic (slow oncoming, progressive). Phantom pain typically affects the part of the limb that is furthest from the body, such as the hand or fingers of an amputated arm. Patients often describe their phantom pain as tingling, shooting, stabbing, burning, throbbing, boring, and squeezing. Patients also describe their phantom limb as being twisted or distorted in an uncomfortable position [4]. Thirty percent of patients have reported a symptom known as telescoping, or the retraction of the phantom limb toward the actual limb, and it is associated with a higher severity of phantom limb pain [2].

Treatment Options

[4]
I did not include the possible side effects and risks of these treatment options. Please, always consult your health care provider before starting or stopping any new medication or treatment plan.

MedicationsMinimally Invasive TherapiesNon-Invasive TherapiesSurgery

Antidepressants are used to relieve pain caused by damaged nerves.

Injections: pain killers, local anesthetics, or steroids into the stump.

Transcutaneous Electrical Nerve Stimulation (TRENS), is a nerve stimulation technique to disrupt pain signals on the surface of the skin near the stump site.

Brain Stimulation: The surgeon places electrodes around the motor cortex.

Anticonvulsants, or epileptic drugs, are used to treat nerve pain by silencing damaged nerves so that inappropriate pain signals are either prevented or slowed.

Spinal Cord Stimulation: tiny electrodes are inserted along the patients spinal cord and a small electrical current is passed through to the spinal chord to relieve pain.

Acupuncture is used to stimulate the central nervous system and release endorphins to naturally relieve the pain.

Neurectomy (stump revision): Phantom pain may be caused by nerve irritation. A surgical option is to cut the nerves in attempts to eliminate the nerve irritation.

Narcotics may be used to help control phantom pain.

Nerve Block: medications used to disrupt the signal between the brain and pain receptors at the stump site.

Mirror Box: This is a device that uses mirrors to make an amputated limb appear whole to the patient. The patient performs symmetrical exercises with the phantom limb which my trick the brain and relieve pain.

 

N-methyl-d-aspartate (NMDA) receptor antagonists, are effective because they block the protein glutamate which is responsible for relaying nerve signals.

 

 

 

Phantom-Limb Pain: Characteristics, Causes, and Treatment

Test Your Noodle

For each question, choose the best answer. The answer key is below.

  1. Where is phantom pain most commonly felt?
    • The part of the limb that is furthest from the body.
    • The part of the limb that is closest to the body.
  2. What natural chemical does acupuncture release to relieve pain?
    • adrenalin
    • sedatives
    • endorphins
  3. What percent of amputee patients are affected by phantom pain?
    • 15% - 30%
    • 40% - 60%
    • 405 - 80%

Answer Key

  1. The part of the limb that is furthest from the body.
  2. adrenalin
  3. 15% - 30%

Citations


1) domain-b. (2013, March 7). Amputee phantom pain linked to brain retaining picture of missing limb. Retrieved from Health Reference Center Academic

2) Flor, H. (2002). Phantom-limb pain: Characteristics, Causes, and treatments. The Lancet NEUROLOGY, 182-188.

3) Journals, O. (2005). Sensory–motor incongruence and reports of ‘pain’. Rheumatology, 1083-1085.

4) Staff, T. M. (2014, Dec. 3). Mayo Clinic. Retrieved from www.mayoclinic.org: http://www.mayoclinic.org/diseases-conditions/phantom-pain/basics/definition/con-20023268

Comments

Ashley Vailu'u (author) from Central Texas on February 18, 2015:

From what I've read, I agree. Do you believe it is due to the incongruity between the motor cortex of the brain and the actions of the phantom limb?

advicequeen1 from EASTCOAST on February 18, 2015:

you do still hurt despite removing the cause of the pain

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