Phantom Limb Pain

27th November 2006 at 11:02 GMT by Dr.C.A.Jenner MB BS, FRCA. Permalink.

Article on the clinical features and treatment of Phantom Limb Pain

What is Phantom Limb Syndrome?

Phantom Limb Syndrome is defined as the perception of sensations, usually including pain in a limb that has been amputated. Patients with this condition experience the limb as if it were still attached to the body.

Physicians believe that the brain continues to receive messages from nerves that originally carried impulses from the missing limb, thus causing the phantom limb syndrome.

Studies report that about 50-80% of people who have had an amputation experience the phantom limb syndrome.

Phantom Limb Pain – Basic Facts

Phantom limb pain is the pain felt by an amputee that seems to be located in the missing limb. After amputation of a limb, an amputee continues to have an awareness of it and to experience sensations from it.

Other accompanying and induced sensations include warmth, cold, itching, squeezing and burning. In fact, the missing limb often feels shorter and may feel as if it is in a distorted and painful position.

Phantom pain often occurs in people who are born without limbs and people who are paralyzed. These sensations suggest that perception of our limbs is ‘hard-wired’ into our brain.

This pain also has also been observed in cases where the brain gets disconnected from the body. Some situations can be peripheral nerve injuries and after spinal cord injury, when an area becomes insentient and usually paralyzed.

Causes of Phantom Limb Pain

Here we present a brief list of suggested causes of the phantom limb pain, derived from the patients’ reports and discussions:

1. Experience with pain prior to amputation
2. Incorrect surgical procedure
3. Climatic conditions
4. Stress
5. Inactivity
6. Periodic illness
7. Blood clot
8. Neuroma

Episodes of phantom limb pain are often triggered off by certain circumstances such as:

• Use of the artificial limb (prosthesis)
• Weather changes
• Pressure on the remaining part of the limb
• Emotional stress
• Fatigue

Certain psychosocial and psychological factors also often lead to sudden episodes of phantom limb pain.

Treatment of Phantom Limb Pain

The treatment of phantom limb pain is generally considered difficult, as it does not follow any single method. There are varied approaches that help different patients. Some of these include:

1. A) Drug Therapy

   Drugs used for phantom pain are:

   • Antiseizure drugs (e.g. gabapentin, carbamazepine)
   • Antidepressants (e.g. amitriptyline, nortiptyline)
   • Local anesthetics (such as mexiletine)
   • Alpha-2 adrenergic agonists (such as clonidine or tizanidine)
   • Other medications, including calcitnin, baclofen, dextromethorphan, opioids

2. B) Other therapies

   Other approaches include:

   • Nerve blocks
   • Spinal cord stimulation
   • Hypnosis, biofeedback and other cognitive techniques, such as relaxation training and distraction

However, it is important that before the start of any treatment, the physician clearly differentiates the symptoms of the phantom limb pain from that of stump pain.