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Phantom Limb Pain

Phantom limb pain is the name given to pain experienced in the region where a limb or a portion of a limb once existed. This painful experience can occur after surgical or traumatic amputation of any body part such as breast or tongue, but most commonly is reserved for pain associated to amputation of part of a leg or arm.

Not all sensation felt by these patients is painful. Some patients experience what is called phantom sensation which is not painful and very common after surgical removal. This may include a feeling that the non-existent limb is moving or a feeling of touch, tingling and pressure in that limb.

Phantom limb pain is when the perception of these sensations is pain or unpleasantness. Some patients will experience pain in the residual limb or stump as well. This is usually secondary to local trauma from a prosthesis or a neuroma (swelling of the damaged nerve).       

Symptoms

Phantom limb pain may be described as sharp, dull, burning, squeezing, cramping, electrical-like pain in the area of the lost limb. This may be associated with residual limb/stump pain or may occur on its own. This may also occur at the time of painful tremors or cramping of the residual limb/stump.

After amputation, the way one describes the pain may change with time. Initially, the pain may feel like it is encompassing the entire lost limb and feel knife-like and stabbing. As time progresses, the pain may feel more like burning or squeezing, and mostly notable only in the further parts of the limbs (hands, toes).

Sometimes the symptoms resolve spontaneously, and other times the pain persists. The longer the pain persists, the harder it may be to treat the pain. Phantom limb pain is not to be confused with phantom limb sensation (described above).       

Causes

Amputees will experience pain in the remaining limb (residual limb or stump) post operatively or post trauma. However, a significant portion of patients will experience pain in the non-existent limb as well. This is most common in the arms and legs as there are a significant number of nerves going to these regions, and a significant portion of the brain responsible for sensory input is assigned to these limbs.

The actual mechanism or phantom limb pain is not well understood. Development of this pain syndrome has been correlated with the intensity of the pain prior to the amputation. Aggressive treatment of the pain prior to amputation may help to reduce the incidence of phantom limb pain.    

Treatments

Treatment of phantom limb pain most often includes referral to a pain management specialist. You and your JLR Center for Pain Medicine physician will design a treatment plan designed just for you. Aggressive treatment is recommended, and ideally, the treatment plan should be initiated prior to amputation when possible.

The plan of care will depend on your symptoms and a complete physical examination. Early treatment focuses on confirmation of the diagnosis and alleviating the pain. Your doctor will help distinguish whether you are experiencing phantom limb sensation, phantom limb pain, or residual limb/stump pain. 

Your treatment plan may involve physical therapy, cognitive behavioral therapy, mirror therapy, medications, and injection therapy. Medications prescribed may include a combination of anti-convulsants (nerve-stabilizing medications) and anti-depressants which also work to stabilize nerves. Injection therapy may include stellate ganglion blocks for the upper extremities and lumbar sympathetic blocks for the lower extremities. Injection of the stump neuroma may also be performed. If the pain persists, despite the initial treatment options, your provider may suggest a spinal cord stimulator trial.