Phantom Pain Posts

Phantom Pains After Limb Loss

Phantom Pains After Limb Loss

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The most common question for new amputees relates to phantom pains.  This is pain experienced for a limb that has been amputated.  The mind is not recognizing that the limb no longer exists.  The amputee lost their right leg below the knee but their right big toe is causing them tremendous discomfort.

What is happening?

Recently, we had Dr. Louie attend one of our Amputee Support Group Meetings in Rock Hill, SC at Encompass Health.  She used the following analogy to help us visualize the situation:

Prior to the amputation, the brain is always receiving feedback from the nerves and other sensory tissue.  This happens automatically for healthy individuals and is never given a thought, unless there is discomfort reported back to the central nervous system.  The brain is always receiving feedback from the body similar to “all systems go” or “Houston, we have a problem”.  Prior to the amputation, there is often some type of medical issue that has the brain on high alert regarding the injured or sick limb.  Post amputation, the brain is still expecting feedback from the limb but of course, the limb is no longer present.  The brain does not receive any feedback, so it concludes that something must be wrong and this is the trigger for phantom pain.  It should be noted that little is truly known about the neurological explanation for phantom pains.

During the meeting, amputees offered the following phantom pain coping strategies:

Massage the opposite leg to help ease the pain.  Dr. Louie explained that doctors and scientists believe the reason this technique works is due to the Gate Control Theory.  There are two types of nerves in our Peripheral Nervous System (the majority of nerves outside the spinal cord and brain).  The A-delta nerve fibers transfer messages to the brain at approximately 40 mph.  When we touch a hot stove, the A-delta nerves are carrying the message.  The C-fibers transfer the pain message at approximately 3 mph.  It is believed that phantom pain is delivered by the C-fibers and that by massaging the opposite limb we trigger the A-delta nerve fibers and essentially override the message being sent by the C-fiber nerves.

Electronic Pulse Stimulation – Some patients have found significant relief by utilizing a transcutaneous electrical nerve stimulation device (TENS).  It is believed that this has a similar effect to the Gate Control Theory in which the pain signals are overridden by the electrical stimulation.  The efficacy of this technology has not been proven but some POI patients have indicated that they have achieved some relief from phantom pains with a TENS device.

Medication – There are a myriad of medications prescribed to treat phantom pain.  The medications most often prescribed block the transmission of the pain to the brain.  There are many side effects that accompany these medications but they are a common strategy for managing phantom limb pain.

Mirror box therapy, acupuncture, and other types of brain & spinal cord stimulation techniques have been utilized to treat patients with phantom pain.  These are some alternatives that may or may not be effective.  Treatment effectiveness is always patient dependent.

One thing that was clear in our discussion: each person had a different experience with the different treatment options.  None of the patients had completely eliminated phantom limb pain but most had coping strategies for when the pain is most intense.  They also mentioned that identifying the triggers causing the more intense episodes was helpful for them.  In other words, if they know that walking all day will trigger more intense phantom pains, they are able to mentally prepare.  This understanding can also help them to plan for any supplies that will be necessary if they are traveling or in unusual circumstances.

Many thanks to the patients that attended the Paraclete Amputee Support Group meeting.  We look forward to seeing you at our next meeting (details will be announced soon).  We learn from each other best in community.