Phantom Limb Pain Treatment Philadelphia PA
Phantom limb pain occurs after an amputation of a portion of an extremity. This painful condition is quite disabling, and it is often misdiagnosed as psychological. Current evidence shows that phantom limb pain originates from the spinal cord and brain.
How many people have phantom limb pain?
In the U.S. alone, around 1.7 million people have had a limb amputated. Of these individuals around 50-75% experience phantom limb pain.
What body regions are affected by phantom limb pain?
Phantom limb pain can occur after amputation of a hand, arm, foot, leg, or portion of any of these structures. Essentially, the removal of any body part can result in phantom pain, including the breasts, eyes, tongue, nose, or ears.
What does phantom limb pain feel like?
Phantom limb pain is often described as stabbing, throbbing, burning, and electric-shock like pan. This pain is of neuropathic origin, which means it can result in a feeling of pins and needles, as well as tingling pain.
What causes phantom limb pain?
There is much research supporting the cause as peripheral-nerve hyperexcitability. Neurons in the brain continue to be stimulated, which occurs after the limb or body part is removed. While pain originates in the brain and spinal cord, not all amputations result in phantom limb pain.
What are the risks for phantom limb pain?
- A traumatic injury before amputation
- Damaged nerves
- Accumulation of scar tissue
- Memories of pain prior to amputation
What things bring on or trigger phantom limb pain?
Certain conditions, substances, and activities will trigger the pain. These are:
- Sexual intercourse
- Urination or defecation
- Chest pain
- Cigarette smoking
- Exposure to cold
- Changes in barometric pressure
- Herpes zoster
How is phantom limb pain treated?
The cause of phantom limb pain is complex, so multiple therapies are often used in combination. These include:
- Medications – Anticonvulsants (gabapentin and Tegretol) are often used for nerve pain. Tricyclic antidepressants are also prescribed because they reduce pain signals in certain brain regions. For moderate to severe pain, opioids are prescribed.
- Physical therapy – For pain relief, the therapist can use massage, ultrasound therapy, and electrical stimulation. In addition, some patients respond to either hot or cold packs.
- Stump injections – The doctor may inject a corticosteroid agent and a long-acting anesthetic into the stump. A recent research study found that this procedure decreased phantom sensations.
- Botox injections – Botulinum toxin A is a powerful paralyzing agent that alleviates stump pain. The doctor injects the painful region with this substance. A clinical study found this procedure to be successful for stump pain.
- Acupuncture – Also called dry needling, this therapy involves inserting tiny needles into the stump or other body regions. This stimulates the central nervous system to produce endorphins, and is thought to restore body energy flow. A recent case report found that patients who had acupuncture experienced significant pain relief.
- Spinal cord stimulation (SCS) – This procedure is reserved for patients who fail on other treatments. SCS involves implantation of a tiny device. Wires run from the device and attach to electrodes which are implanted near the spinal cord. A research report found that SCS was quite effective for phantom limb pain.
- Mirror therapy – A promising new treatment for phantom limb pain involves use of a mirrored box with two openings. The amputated limb goes in one opening, and the other limb goes in the other. When isometric exercises are performed using the healthy limb, it appears that the other limb is also moving. A randomized controlled study found that patients who had mirror therapy for four weeks reported significant pain reduction.
Chan B., Witt, R., Charrow, A., et al. (2007). Mirror therapy for phantom limb pain. New England Journal of Medicine, 357;21: 2206-2207.
Davies A (2013). Acupuncture treatment of phantom limb pain and phantom limb sensation in a primary care setting. Acupunct Med, 31(1):101-4
Desmond DM & Maclachlan M (2010). Prevalence and characteristics of phantom limb pain and residual limb pain in the long term after upper limb amputation. International Journal of Rehab Res, 33(3), 279-282.
Giuffrida, O, Simpson, L, & Halligan, PW (2010). Contralateral stimulation, using tens, of phantom limb pain: two confirmatory cases. Pain Medicine, 11(1), 133–141.
Kern, U, Martin, C, Scheicher, S, & Muller, H (2004). Long-term treatment of phantom- and stump pain with Botulinum toxin type A over 12 months. A first clinical observation. Nervenarzt, 75(4), 336-340.
Ulger O, Topuz S, Bayramlar K, Sener G, & Erbahçeci F (2009). Effectiveness of phantom exercises for phantom limb pain: a pilot study. J Rehabil Med, 41(7):582-4.
Viswanathan, A, Phan, PC, & Burton, AW (2010). Use of spinal cord stimulation in the treatment of phantom limb pain: case series and review of the literature. Pain Practice, 10(5), 479–484.