Phantom Limb Pain

By Meg Marinis, Director of Medical Research Jan 24, 2013
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Can you imagine the feeling? 

It stings as if a thousand wasps had attacked or if someone had tried to twist off the toes from the foot. The pain keeps its sufferers up all night, leaving them in a constant state of misery and hellish agony. It's electrifying, searing, debilitating, stabbing. These are the words that various amputees have used to describe the terrible affliction of phantom limb pain – pain that feels as if it comes from a body part that is no longer there.

But as seen by Arizona's experience, the name of the condition seems to be a misnomer – her symptoms are very much real, not "phantom-like" at all.

As well as having the sensation that the limb is still there, one may feel:

• Tingly, prickly, numb.
• Itchiness.
• Hot or cold.
• Like the missing toes or fingers are moving.
• Like the missing limb is getting shorter (called telescoping).
• Sharp or shooting pain.
• Achy pain.
• Burning pain.
• Cramping pain.

Experts do not completely agree on the underlying cause of phantom limb pain, but several theories center on the origin as coming from the spinal cord or the brain. After amputation, these areas lose signals from the missing limb and may adapt to this detachment in unpredictable ways, translating as pain. Other factors that may contribute to phantom limb pain include damaged nerve endings, scar tissue, and the physical memory of pain in the limb before amputation.

There is no one cure for phantom limb pain, but various treatments work for different people. For example, Arizona first attempts "mirror therapy."

Frequently used with Iraq war veterans who suffered limb loss, the technique is fairly simple. The amputee sits with a mirror facing the remaining leg, moves the remaining leg, and watches the reflection in the mirror; it appears that both the uninjured leg and the amputated leg are moving. Essentially, mirror therapy allows the amputee to "trick" their brain… out of pain. When both limbs appear to be moving, the brain interprets that both limbs are functional and therefore does not send out pain signals.

Arizona then tries the technique of biofeedback as well as having Alex stab her prosthetic foot with a scalpel.

Biofeedback is a form of complementary medicine in which one learns to control bodily functions, such as the heart rate, using the mind. The patient is connected to electrical sensors that help them measure and receive information (feedback) about their body (bio). The sensors show them how to make subtle changes in the body, such as relaxing certain muscles, to achieve the results they want, such as reducing pain. Recently, studies have been done to determine whether virtual reality can help people use biofeedback more effectively to get these functions under conscious control.

Besides pain, this type of therapy may also be used for many other physical and mental health issues such as: anxiety or stress, asthma, side effects from chemotherapy, constipation, heart ailments, high blood pressure, incontinence, irritable bowel syndrome, physical performance, and Reynaud's Disease.

And how did the stabbing help Arizona's pain? Even though the technique may not be widely used, the stabbing of the foot at the exact site of the pain somehow helps the amputee's brain better understand that the source of the pain is not real.

Other amputees find relief from their pain from other methods.

Additional treatments include:

• Massage therapy.
• Meditation.
• Prescription medications (antidepressants, anticonvulsants, pain relievers).
• Acupuncture.
• Nerve stimulation.
• Electric artificial limb.
• Surgery (Stump revision, brain stimulation).

Phantom limb pain should decrease over time, but a small percentage of people do not improve completely. Many patients have found that certain triggers (weather changes, emotional stress, pressure on the remaining limb) exist for the pain and try to avoid them as prevention.

For more information on phantom limb pain, please visit the following:

http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000050.htm