Overview of Treatment for Phantom Pain
Phantom pains are a common occurrence post-amputation. People experience phantom pains in parts of the body that are no longer there. Traditionally, doctors considered the condition to be psychological in nature. However, after researching the condition, experts agree that this is a real sensation initiated by the brain and spinal cord.
Most people, after the removal of their limbs, feel the presence of their amputated limb. They consistently feel that their limb is still there. Experts refer to it as phantom limb. While this condition is different from phantom pain, the sensation is similar. On the other hand, phantom limb pain occurs when you feel pain or discomfort in a limb that is no longer there. This condition is common among people who needed limb amputation.
Research estimates show that almost 60 to 85 percent of people who undergo limb amputation experience phantom pain (Source). Usually, they recover from phantom pain over time and may not even need treatment for the condition. However, overcoming the pain can be an arduous task for others. You can visit a professional pain management doctor for the treatment. The doctor will work with you and suggest different therapies and medications for the treatment. In the following sections, we will discuss the symptoms, causes, and treatment for phantom pain.
Symptoms of Phantom Pain
Here are some characteristics of phantom pain:
· You may develop pain during the first week of the amputation. However, you may experience the sensation after months or years.
· Pulsating pain that comes and goes within time. The phantom pain can also be continuous.
· The nature of pain can be cramping, shooting, stabbing, pins, needles, burning, throbbing, and crushing.
· The severity of the pain may also vary.
· You may also experience other symptoms in the regions away from the body, such as the foot.
Causes of Phantom Pain
The causes of phantom pain aren’t clear. However, experts believe that few things contribute to the condition.
1. Remapping
The areas close to your residual limb might develop remapping. During remapping, the brain will send sensory information to the body from the amputated area. For instance, if you have an amputated hand, it might remap to your shoulder. So if you touch your shoulder, you will experience a sensation in that region.
2. Damaged Nerves
After amputation, you may suffer from significant damage to the peripheral nerves. This will overexcite the nerves or affect signaling in the limb.
3. Sensitization
Peripheral nerves connect with spinal nerves, thereby connecting to the spinal cord. Neurons become sensitive and active after the peripheral nerve disconnects. This will generate chemical signals to the region. Pain, before and after amputation of the limb, can lead to phantom pain.
Diagnosis of Phantom Pain
There is no proper test to diagnose if the patient suffers from the condition. Hence, doctors will comprehend the circumstances and symptoms, such as surgery or trauma, that occur before the pain. If you visit a pain management doctor for phantom pain, you should explain the pain accurately to the doctor. They will understand your condition for residual limb and phantom pain and suggest treatments.
Treatment for Phantom Pain
It is difficult to find a treatment to relieve phantom pain. Therefore, it is essential to visit a professional pain management doctor. Doctors start the treatment process with medications. Afterward, you will undergo various therapies such as acupuncture. Apart from these non-invasive treatments, doctors may also improve the conditions with more-invasive techniques such as implanted devices or injections. Surgery will be the last option to relieve you from phantom pain.
· Medications
There is no proper medication to treat phantom pain. However, doctors might prescribe various drugs that can help with nerve pain. If there is no significant benefit of the medication, you can choose from other therapies and treatment options. The following medications can provide effective results. However, you need to consult with your doctor before taking any medication:
OTC pain Relievers
Naproxen sodium (Aleve), Ibuprofen (Motrin B, Advil), or Acetaminophen (Tylenol) are some medications that can provide relief from phantom pain. There are numerous side effects, such as stomach bleeding, of overusing these medications. To avoid these side effects, confirm the dosage before taking these medicines.
Antidepressants
You can take tricyclic antidepressants to relieve nerve damage-related pain. These antidepressants include tramadol (Ultram, Conzip), nortriptyline (Pamelor), and amitriptyline. These medications cause various side effects such as blurred vision, dry mouth, and sleepiness.
Anticonvulsants
These medications include epilepsy drugs. For instance, pregabalin (Lyrica) and gabapentin (Neurontin, Gralise) will treat nerve pain. The side effects of this medication include mood changes, sedation, and dizziness.
Narcotics
Morphine, codeine, and other opioid medications come under the narcotics medication for phantom pain. Following the appropriate dosage as directed by the doctor will help you relieve phantom pain. However, before consumption, you should understand the addictive properties of these medications. Furthermore, these substances also include numerous side effects, such as sedation, vomiting, nausea, and constipation.
NMDA (N-methyl-d-aspartate) Receptor Antagonists
These medications will bind with the NDMA receptors. These receptors help in blocking glutamate activities on the brain’s nerve cells. Glutamate is a protein that helps communicate nerve signals.
· Medical Therapies
You can also seek help from non –invasive therapies for the treatment. Here are some techniques to relieve phantom pain:
Mirror Box
This device includes mirrors to create the illusion of an amputated limb. There are two openings in the box. One opening is for the residual limb and another one for the intact limb. During this therapy, you will watch your intact limb while performing a symmetrical exercise. When you move, you imagine observing the movement of the other limb also. Only a few studies support that you can get relief from phantom pain.
Acupuncture
According to the National Institute of Health, acupuncture can provide relief from different types of chronic pain. A professional practitioner will insert sterilized and fine stainless steel needles in the body's specific part into the skin. Acupuncture is a safe technique that can relieve your pain. However, it is essential to visit an expert first.
rTMS or Repetitive Transcranial Magnetic Stimulation
An expert will use an electromagnetic coil on your forehead during this therapy. The coil will release short pulses, sending electric currents to your nerves. These small electric currents will target the brain and help with phantom pain. According to researchers, this therapy is effective, but it does not treat the condition specifically. After the treatment, you might experience side effects such as light-headedness or mild headaches. This therapy has similar magnetic fields as MRI scans.
Spinal Cord Stimulation
The doctor will insert electrodes along the spinal cord. These electrodes will generate a small current towards the spinal cord and relieve the pain.
· Surgery
If none of the above treatments help relieve phantom pain, you can treat your condition with surgery.
Brain Stimulation
Deep brain stimulation is similar to motor cortex stimulation. They both help with spinal cord stimulation. However, in deep brain stimulation, a current flows through the brain. A surgeon will place electrodes properly to use the magnetic resonance imaging or MRI scan. This treatment might not work for every patient suffering from phantom pain. Moreover, using MRI for treatment purposes has yet to gain approval. Few people may also find brain stimulation to get relief from phantom pain.
Conclusion
You may develop phantom pain in a limb no longer attached to your body or is not functioning. People who underwent amputation will most commonly develop this condition. The duration, intensity, and type of the pain may be different for some patients. Even though the actual cause for the development of this disorder is unclear, a professional doctor will suggest various techniques. You may develop this condition because of your nervous system's complex adaptations. Your brain will adjust the sensation of missing limbs, causing the pain.
A professional pain management doctor will treat your phantom pain condition through numerous treatments such as medication, acupuncture, mirror therapy, and other options. Doctors might also suggest more than one treatment at a time for better results. When you visit your doctor for the first time, they will ask various questions to confirm your condition's severity. After that, they will plan your treatment depending on the diagnosis.