Possible Causes, Treatments of Phantom Limb Pain
Phantom limb pain is one of the most common experiences among people who experience limb loss. But half of those who report phantom pain do not receive treatment or find relief from the pain and discomfort, making phantom limb pain a chronic pain condition that needs to be addressed.
Those who experience phantom pain describe the sensation of feeling the presence of their ankle or foot for example. But unlike residual limb pain, which is isolated to the site of the amputation, phantom limb pain is felt in the part of the limb that no longer exists.
Phantom limb pain is often described as a burning, throbbing, or stabbing sensation along the toes for example. These pain descriptors are typical of neuropathic pain. These sensations may occur in a continuous cycle, or they may be triggered by external factors, like stress, skin irritation, temperature changes and even infections like Covid-19.
These phantom sensations can occur at any time after an amputation, although it’s typical to observe the onset of phantom pain in the first few months after surgery.
Causes of phantom limb pain
There are different theories about what causes phantom pain. But, as of this publication, researchers are still trying to get to the bottom of this mystery.
Stochastic entanglement or nerve bundle stimulation
The theory of stochastic entanglement explains how the severed nerves can bundle up—also known as neuromas. When these nerves fire signals, the brain then interprets it as though the nerve was still intact, which is why you feel pain or an itch along your limb loss side "ankle."
Nervous system rewiring
Studies have shown that changes happen in the brain and spinal cord when a limb is amputated. These changes lead to the brain interpreting pain differently than before. Researchers are still trying to identify if this rewiring causes the pain or if the pain occurs because of it.
The memory of limb pain
Another theory looks at how the brain is “used to” feeling pain after a limb is injured beyond its ability to heal properly. This phenomenon is like having a memory of the pain because it is "wired" into the brain.
Treatment options
As phantom limb pain is categorized as chronic pain, it requires various combinations of different treatment approaches. Here are some of the most common options:
Residual limb stimulation
Often, providing an alternate sensation can interrupt pain signals. This is why for some people, residual limb stimulation, like rubbing the residual limb or using TENS (transcutaneous electrical nerve stimulation), can help relieve phantom pain.
Medication
Since the pain descriptors of phantom limb pain are similar to neuropathic disorders, medication like anticonvulsants, antidepressants, opioids, and NSAIDs are often prescribed. As with other chronic pain conditions, successful pain relief can require a combination of these medications.
Mirror therapy
Physical therapists most commonly use mirror therapy to treat patients who suffer from stroke and phantom limb pain. This method tricks the brain to reduce phantom pain in some patients. Additional studies are required to see if mirror therapy offers relief, but the good thing about this option is the minimal potential for side effects.
Cognitive therapies
Cognitive therapy options, like hypnosis, are also viable options. These approaches can change the way the brain interprets phantom sensations, including phantom limb pain.
Other medical options
Some people who suffer from phantom limb pain may require more invasive forms of treatment, such as surgery to untangle neuromas or nerve blocks. These options also change the way the brain interprets pain.
Yet another option that you can ask your physician is to implant pain pumps to deliver medications directly to the spinal cord.
How to cope with phantom pain
Chronic phantom limb pain affects a person's quality of life. One way to help manage pain and cope with limb loss is by undergoing psychotherapy. People who go through psychotherapy can learn different coping and relaxation techniques that can reduce phantom pain.
Another way to cope with the pain during the treatment process is by keeping a pain journal, which can give you clarity on what works and what doesn’t. It’s also important to strive to lead a healthy lifestyle. Lifestyle plays a huge role in managing pain. So, it’s best to watch out for lifestyle habits that can make chronic pain worse, like smoking.
Do you suffer from phantom pain? What techniques are working for you?
