Unraveling the Mystery of Phantom Limb Pain: Triggers and Therapeutic Options

An important issue in medicine has always been how to treat pain as a psychophysical experience. This is especially true now. Up to 80% of those who have their limbs amputated have the common post-operative symptom of phantom limb pain. The sense of pain or discomfort in a limb that is no longer present is known as phantom limb pain. The arms and legs are where it occurs most frequently, although some people also experience it when they have other body parts removed, including a breast. Some people’s pain eventually goes away by themselves. Some may experience it severely and for a long time. Due to the acute and chronic character of the disease, it is a clinical phenomenon that is still poorly understood and a focus of ongoing investigations.

Amputee

Onset and natural progression

Table of Contents

1 Onset and natural progression
2 Causes
3 The mystery behind phantom limb pain
4 Treatment options that could help
5 Mirror therapy
6 Conclusion
- - 6.0.1 References

Phantom pains are frequently characterized as crushing, toe twisting, “pins & needles,” hot iron, scorching, tingling, cramping, and shocking. Most onset cases occur right away following amputation, however, some do so a few weeks or even months later. According to US research, 3 to 4% of those with amputations experienced the beginning of phantom limb pain more than a year after the procedure. One-third of patients experience their worst symptoms right away after surgery, which usually go away within 100 days. The other half suffers pain that progressively increases and gets better within 100 days, while a quarter of patients experience a gradual rise to their worst pain. Phantom limb pain often gets better over time, with a resolution that might take anywhere from a few weeks to two years.

Causes

Experts are unsure of the precise origin of pain from phantom limbs. One potential explanation is that the spinal cord and brain’s nerves “rewire” as a result of the loss of messages from the missing arm or limb. As a result, they cause the body to generate pain signals, which are a usual reaction when anything is wrong. Another illustration of this rewiring is the possibility that the brain will register the touch of one body part on the missing limb, such as the hip or forearm. Also, scar tissue from the amputation procedure and damaged nerve endings are two more potential reasons for phantom limb pain.

The mystery behind phantom limb pain

A group of Israeli and Albanian scientists have identified the nerves around the spine as the major site of phantom limb syndrome and have successfully treated the resulting discomfort. Research demonstrates that phantom limbs are “felt” in the body rather than “imagined” in the brain. They set out to investigate a different neurobiological hypothesis, which states that the nerve fibers that used to connect to the severed limb are what causes phantom limb pain. The researchers administered local anesthetic injections to 31 leg amputees with phantom limb syndrome – 16 in Albania and 15 in Israel – around the location where the nerves from their amputated legs enter the spinal cord in the lower back, under the guidance of medical imaging. All of the amputees had a temporary reduction or elimination of phantom limb sensation and pain within minutes. In the few cases investigated, nerve numbing of the stump and control injections had no impact. The study’s findings demonstrate that the neural system at or below the spine is the primary source of phantom limb pain. The injections wouldn’t have worked if the sensations were originating from the brain. The dorsal root ganglion, a group of neurons that transmits information from the body to the spinal cord and then to the brain, is the most likely offender.

Treatment options that could help

Treatment outcomes will be enhanced by combining physical and occupational therapy with a cognitive grasp of the problem. By educating the patient about their disease and the steps they may take to take control, as well as by working to change harmful or mistaken beliefs and behaviors, the patient should be equipped and empowered.

There is no medicine that cures the agony of phantom limbs. Yet medications for other diseases, such as epilepsy or depression, might provide some help. Amitriptyline and Nortriptyline are examples of tricyclic antidepressants that help reduce nerve pain by altering the neurotransmitters in the body that trigger pain sensations. Anticonvulsants like carbamazepine and gabapentin can ease the pain. Some people may experience less pain after taking opioids like morphine and codeine, but not everyone does. Other painkillers like Tramadol, aspirin, and ketamine could help.

Popular self-treatment techniques include using an elastic stump sock to reduce volume fluctuations in the residual limb, massaging the stump, visualizing the phantom limb in the mind, and engaging in physical activity. For upper limb amputees in particular, visualization of limb movement and prosthesis use has been shown to minimize phantom limb pain. However, this benefit will be countered by joint dysfunction near the residual limb and poor prosthetic fit. Proper prosthesis use is essential. In cases where wearing a prosthetic limb is not an option, the therapist should use their imagination to come up with alternative methods of recreating visual and even motor stimuli to replicate the usage of the limb.

Mirror therapy

With the relative predominance of the visual input it delivers, mirror therapy, a therapeutic intervention, has been proven to impact motor and sensory processes. The impression is produced by looking through a mirror that has been placed where the severed limb would have been to see a reflection of the intact limb. As therapy continues, this tricks the brain into believing both limbs are intact. With only a few well-controlled research, case studies, and anecdotal evidence making up the majority of the evidence for this intervention, this could help relieve the pain in the missing limb.

Conclusion

The majority of patients who undergo amputation surgery have phantom limb discomfort or pain. In most cases, symptoms get better with time. It can be managed so that it does not overwhelm life activities. In order to develop and maintain a pain management strategy that is effective for them, patients should collaborate closely with their healthcare team.