Phantom limb syndrome was first coined by American physician Silas Weir Mitchell in 1871. The sensation of “feeling” a limb that’s not there is a relatively common medical condition. Sometimes the pain is present, which ranges from mild to severe and can last for seconds, hours, days, or longer. PrimeCare team sure that because the pain is real, you should always tell your doctor, so they can help alleviate the symptoms.
What Is Phantom Limb Syndrome?
Phantom limb syndrome is a condition that occurs in 80-100% of amputees where they experience sensations in a limb that does not exist, i.e., the amputated limb. A phantom limb pain definition expands upon this phenomenon, whereby amputees experience pain that feels like it is coming from a body part that’s no longer there.
How long does phantom limb pain last? For most, it diminishes in both frequency and duration during the first six months post-amputation; however, some continue to experience a degree of the sensation for years. Medical professionals had originally thought it was a psychological problem but have since come to understand it’s a real sensation that originates in the spinal cord and brain.
What’s the Difference between Phantom Limb Pain, Phantom Sensation, and Residual Limb Pain?
- What is phantom limb sensation? This is when the missing limb still feels like part of the body. A person experiencing this sensation may forget their limb is gone and try to walk on both legs or use both hands, for example.
- What is phantom limb pain? As the name suggests, phantom limb pain is the experience of pain in a limb that is no longer there.
- What is residual limb pain? Also called stump pain, this is pain felt in the part of a limb that remains after an amputation. It’s common in half of all amputees, who may feel it soon after surgery, within the first week, or beyond healing.
What Are the Symptoms of Phantom Limb Pain?
Phantom limb pain after amputation may be constant or irregular, either precipitated by motion or have no relation to movement whatsoever. Common symptoms include feelings like:
- Clamping, pinching, or a vice-like sensation
These symptoms may affect part of the limb furthest from the body, such as the foot of the amputated leg. Onset within the first week after amputation is common, although it can be delayed by months or longer.
What Is the Cause of Phantom Limb Pain?
One of the most commonly asked questions by new amputees is, “what is phantom limb pain caused by?”. Current theories of phantom limb pain posit it’s the result of damaged nerve endings in scar tissue at the site of amputation and the physical memory of pre-amputation pain in the area.
In layman's terms, it means a mix-up in nervous system signals between the spinal cord and the brain (sensorimotor cortex). When a limb is amputated, the nerve connections from the periphery to the brain are still in place, except they lose input from the missing limb.
So, the body understands something is not right and adjusts with its most basic survival response: sending pain signals to the brain. In other words, there is a mismatch between a movement and the perception of that movement.
Phantom Limb Pain Risk Factors
Some factors that increase chances of phantom pain include:
- Pain before amputation: Some amputees who have pain before their limb is removed experience it after amputation. This is thought to be because the brain holds on to the memory of pain and keeps sending the body these signals, even after the limb is no longer there.
- Residual limb pain: Those who have persistent pain in residual limbs tend to experience phantom pain. Residual pain is often caused by medical conditions such as nerve damage or entrapment (pressure on the nerve).
How Is Phantom Limb Pain Diagnosed?
To date, there are no medical tests to diagnose phantom limb pain. Most doctors identify the condition based on a patient's symptoms and circumstances, like trauma or surgery which occurred before the pain began. Sometimes, MRIs or CAT scans are done to determine if part of the brain that handles pain sensitivity for the amputated limb shows activity.
Phantom limb sensation is usually a diagnosis of exclusion, meaning all other possible causes must be ruled out. These include poor blood flow, infection, nerve tumors, and pressure wounds.
Phantom Limb Pain Treatment
How is phantom limb pain treated? Medication used for phantom limb pain depends on the type of pain sensations a patient experiences.
Typical pharmaceutical medications include:
- Muscle relaxants
Some of these medications work better when taken at a certain time of day or with other medications. For instance, antidepressants work more effectively before sleeping and are taken with anticonvulsants. Finding the appropriate phantom limb syndrome treatment with the least side effects requires collaboration between patients and healthcare workers.
Non-Medication Treatments may include mirror therapy for phantom pain, as well as:
- Massage of the residual limb
- TENS (transcutaneous electrical nerve stimulation)
- Spinal cord stimulation
The best treatment for phantom limb pain will likely involve both types, as most patients need solutions to eliminate immediate discomfort. Another question is how to get rid of phantom limb pain. The good news is that the pain usually goes away on its own, and patients can be weaned off treatment.
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