Causes, types, treatment options
Many people are affected by phantom pain, which means pain in the limb that was amputated. Experts believe that up to 70 percent of all amputees suffer from this, temporarily in most cases. The psychological strain for affected individuals is sometimes very high. There are various theories regarding the causes of phantom pain. Nevertheless, various and also promising treatment options are now available. Unfortunately there is no treatment that helps everyone equally. Here we want to inform you about possible causes and the various treatment options. In any case, talk to your O&P professional, therapist or doctor. They will work with you to find a solution that offers you relief.
Causes of phantom pain
There are various theories among experts regarding the origin of phantom pain. One of the most common ones is that different areas in the brain are responsible for different body regions. When a body part is missing and no feedback is received from there anymore, the brain interprets this lack of a signal as pain. Against this background, it is interesting to note that people with a congenital malformation of a limb, known as dysmelia, do not suffer from phantom pain as often. So apparently there is a sort of "learning effect" in the brain. Pain memory appears to play an important role as well. If the patient was already experiencing pain before the amputation, this can affect the development of phantom pain and should also be taken into account in selecting the therapy.
Types of phantom pain
Phantom pain is highly individual and depends on many factors. It affects individuals with leg or arm amputations equally. The pain may be triggered or intensified by certain types of weather, exposure to cold temperatures or emotional stress. It may occur only at certain times, gradually decrease or increase, or always be present. The type, intensity and characteristics of the pain can differ as well. Affected individuals speak of pulling and piercing or burning and cramp-like pain.
Phantom pain is different from phantom sensations, feelings in the lost limb that are not painful.
Treatment options for phantom pain
Various kinds of pain may occur in the residual limb after an amputation. It is important to differentiate between residual limb pain and phantom pain, since these types of pain are treated differently.
There are numerous treatment approaches for both types of pain. Combining several treatments is recommended for phantom pain. There is no standard treatment that helps all affected individuals. Furthermore, many therapies are of a long-term nature and require active participation of the person affected. You may need a lot of patience and endurance. Nevertheless we encourage you to do this, even if it is challenging. Be sure to talk to your doctor, O&P professional and therapist. They will work closely with you and support you to the best of their ability. The following methods are suitable and complement each other for the treatment of phantom pain after an amputation
- Mirror therapy: Sitting in front of a mirror, the patient's sound limb is reflected with the help of mirrors. This makes it appear as though the amputated limb is there again. Known as the phantom limb, it can now be moved purposely via the sound side and therefore influenced. Thus the phantom limb can be released from cramped and painful positions with the help of movements of the sound side, bringing it into a more comfortable, pain-free position. Comparable results can be obtained by looking at photographs (known as lateralisation training). This is intended to practice right/left memory.
- Sensorimotor therapy: Massaging the residual limb with various materials stimulates nerves via the skin. This can be accomplished with ultrasound, thermal or electrical therapy.
- Wearing a prosthesis or liner: With many affected individuals, the pain is alleviated when they wear a liner or prosthesis. This may be explained on the one hand by sensory stimulation of the residual limb and, on the other hand, by the idea that, with a prosthesis, the body part is still there so the brain is receiving corresponding feedback.
- Pain therapy: Pain therapists are doctors who have specialised in the treatment of pain. Your doctor will put you in contact with such a specialist. It is important not to take pain medications on your own accord in any case.
Residual limb pain
Residual limb pain and phantom pain are different types of pain and therefore treated differently. It is therefore important that you are thoroughly examined in order to determine whether you are suffering from phantom pain or another form of residual limb pain. Residual limb pain can also be caused by a poorly fitting prosthesis. Medical examinations help clarify whether you may have bothersome scar tissue, painful residual limb neuromas, inadequate soft tissue coverage or excess soft tissue. These causes of pain can be eliminated by adapting the components, or for the long term through another surgical intervention.
Certain operating techniques can also help reduce residual limb pain and especially the pain originating from some nerves in the residual limb after the amputation. If possible, preventive pain therapy should commence during the operation with a local anaesthetic or begin directly after the operation to prevent the onset of pain or the development of chronic pain.