Why Specialists Treat Phantom Limb Pain With More Than Medication
Reading Time: 4 minutes
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Summary:
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Phantom limb pain is pain that seems to come from a limb that has been lost or is absent, and it can feel like throbbing, stabbing, burning, or cramping.
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It is estimated that about 64% of people with limb loss experience phantom limb pain.
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It typically appears within six months of limb loss and is seen more often with lower limb loss.
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Dr. Amarnath Reddy B says conventional medications provide little to no relief; an integrated plan that combines multiple treatment approaches is best.
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Dr. Reddy says mirror therapy gives the brain a visual illusion of the missing limb moving without pain, which can reduce pain signals through neuroplasticity.
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Feeling pain in a hand, foot, or leg that is no longer there is real, but so is the gap in treating it. Two specialists in Hyderabad, India, say medication often falls short for phantom limb pain. They recommend building a comprehensive care plan that brings several therapies together.
Dr. Amarnath Reddy B, a pain management consultant at Yashoda Hospitals in India, and Dr. Joy Mounica, a consultant neurologist at Renova Hospitals in Langar Houz, shared their views with The New Indian Express.
A common experience among people living with limb loss
According to Dr. Reddy, it’s estimated that 64% or roughly two in three people living with limb loss develop phantom limb pain. But the effects go well beyond the pain. He says phantom limb pain can disrupt sleep, make it harder to get around, interfere with wearing a prosthesis, strain work and social life, and contribute to anxiety, depression, and an overall lower quality of life.
For clinicians and patients, what matters is that no two cases of phantom limb pain are the same. Dr. Mounica says people describe it in very different ways—as throbbing, stabbing, burning, or cramping—and its intensity and duration vary as well.
According to Dr. Mounica, the pain typically develops within the first six months after limb loss and is more common following lower-limb loss.
What causes phantom limb pain
Dr. Mounica says phantom limb pain may result from maladaptive changes in the neuromatrix—the network the brain uses to generate its own pain patterns. The brain then locates those patterns in the missing limb. In other words, the nervous system keeps adjusting to the loss, but that adjustment can go wrong for some people.
Why medication alone often doesn’t fix it
Dr. Reddy shares that there is a broad range of options available to treat phantom limb pain, including antidepressants, gabapentinoids, N-methyl-D-aspartate (NMDA) receptor antagonists (a class of drugs that block or inhibit the action of the NMDA receptor), and opioids. He also names mirror therapy, nerve blocks, neuromodulation techniques such as repetitive transcranial magnetic stimulation (rTMS), transcranial direct-current stimulation (tDCS), and peripheral nerve or spinal cord stimulation, as well as occupational and physical therapy. In select cases, surgery may also be considered.
But he is aware of their limitations: conventional medications often offer little or no relief. That’s why both physicians rely on integrated treatment plans.
Dr. Mounica shares that a comprehensive approach that combines medication, physical therapy, and psychological support works best. Additional treatment options include acupuncture, biofeedback, massage, and transcutaneous electrical nerve stimulation (TENS). She also lists electroconvulsive therapy (ECT) as another possible additional therapy. But she notes that each plan’s components depend on the individual’s unique needs.
Spotlight on mirror therapy
Dr. Reddy highlights mirror therapy for its use of vision and neuroplasticity. A mirror shows the intact limb’s reflection in place of the missing limb, allowing the brain to see both limbs move without pain. He explains that this visual feedback can, through neuroplasticity, quiet pain signals and recalibrate the brain’s maps of the body.
He cites a randomized controlled trial showing that 89% of upper-limb amputees improved after mirror therapy. He also says that mirror therapy is most effective for phantom limb pain and is also used to treat complex regional pain syndrome (CRPS).
The bottom line
Both physicians reject the idea that phantom limb pain is something you simply have to endure. They say that timely care, rehabilitation, psychological support, and the right combination of treatments can bring relief and improve quality of life.
If medication alone hasn’t helped, these are good options to discuss with your care team.
Related Reading:
Possible Causes, Treatments of Phantom Limb Pain
The Link Between Phantom Limb Syndrome and Mental Disorders
Relieving Phantom Limb Pain with Mirror Therapy and Progressive Muscle Relaxation
