Phantom Limb Pain

You’ve made – or were given – the difficult decision to have a limb amputated. As hard as that is, now you have the possibility of feeling phantom limb pain. A tough feeling to wrap your head around unless you’ve actually experienced it, phantom limb pain is the feeling of pain in the limb that is no longer part of your body. It’s a complicated condition that can lead to intense physical and emotional stress and duress, but fortunately there are available treatment options that can help. The California Pain Consultants team in the Escondido, El Centro, La Mesa, San Diego, Chula Vista areas can help provide solutions that can ease phantom pain to help patients more comfortably cope with their new lifestyle. 

What is Phantom Limb Pain?

Phantom limb pain is a very real sensation of pain that is felt in the part of the limb that has been amputated. It’s called “phantom” because it refers to the location of pain, which is the missing limb or part of the limb. The pain can range from moderate to severe, and can be felt anywhere from seconds to days, or even longer. It is estimated that almost 80% of patients who have had an amputation experience phantom limb pain. 

Most often described as pain, phantom limb pain can also be experienced as: 

• Stabbing
• Throbbing
• Burning
• Cramping
• Tingling
• Hot or cold
• Itching 
• Pinching 

While some patients might be able to continue their daily activities with minimal disruption, there are patients who suffer debilitating effects from phantom limb pain that creates extreme disruption to their lives. 

It is also important to reach out to your pain management specialist if you experience severe pain the interferes with sleep or daily activities, or you have a fever or there are signs of redness in the residual limb, which could be the sign of an infection. 

Phantom limb pain is more likely to occur in a lower limb amputation versus an upper limb amputation (i.e. leg versus arm). It also usually occurs in the part of the missing limb that is furthest from the body, so if the leg was amputated, the pain would be felt where the toes were. The pain itself could also mimic the pain that was felt in the limb prior to the amputation. 

What Causes Phantom Limb Pain?

There unfortunately is no clear cause of phantom limb pain. Some experts believe that it could be caused from scar tissue or damaged nerves from the amputation surgery itself. Others believe that it’s essentially a “mix up” of nervous system signals, specifically between the brain and the spinal cord. When a body part is amputated, the nerve connections from the outer area of the amputated limb remain intact. The brain could misinterpret the information it’s receiving, essentially recognizing it as a sensation of pain even though that limb portion is no longer part of the body. Or, because there is no stimulation coming from the amputated limb in the first place, also known as sensory deprivation, the brain emits a sensation (pain) that something is wrong and needs attention. 

Risk factors that can lead to phantom limb pain include: 

• Phantom sensations (non-pain)
• Residual limb pain (affects the stump where amputation occurred)
• Pain felt in the limb prior to amputation and that is still recognized after amputation
• Use of a prosthetic limb
• Time since amputation

Phantom pain symptoms can be felt after surgery, but pain and intensity generally decrease within the first six months afterward. However, most patients report feeling pain up to two years after surgery. 

How Can You Treat Phantom Limb Pain?

Treating phantom limb pain is complex, and successful treatment takes an understanding of the brain and how it can be best retrained to adapt to losing a limb. The most common treatment options that help to manage symptoms and treat pain include: 

• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), prescription pain relievers, antidepressants, anti-seizure medications, beta blockers, muscle relaxers, and in some cases, opioids have proven helpful for managing pain
• Physical therapy: used as effective methods for ensuring that prosthetics are fitting properly and the patient is most effectively using them, as well as providing desensitizing relief, therapy is a great tool for lessening pain syndromes
• Mirror therapy: practicing exercises while looking at a mirror that shows an intact limb tricks the brain into thinking that there are two healthy limbs. Over time, the brain encodes this information and because it believes the limb isn’t missing, there is no need for phantom limb pain signals to be sent or felt. 
• Phantom motor execution (PME): an attempt to achieve limb and brain realignment by having the patient manipulate their phantom limb in specific ways, while seeing the effects in virtual reality, which engages the areas of the brain that control the limb’s movement
• Injections: injections and blocks, including interscalene blocks, stellate ganglion blocks, lumbar sympathetic blocks, and neuroma injections have proven helpful for stopping the pain signals from reaching the brain
• Neuromodulation: Transcutaneous electrical nerve stimulation (TENS) and spinal cord stimulation (SCS) are two effective treatment options that both work by introducing electrical currents that replace the pain sensations

Additional complementary therapies for reducing phantom limb pain include acupuncture, biofeedback, massage and meditation. 

It’s important to discuss phantom limb pain with a trained healthcare provider because if left untreated, it can harm your quality of life. Not only can it affect a person’s sleep, it can also lead to anxiety and depression. The good news is that phantom limb pain does improve over time and can possibly go away completely, with the help of medications and/or treatment. 

If you are living with phantom limb pain and would like to learn more about available treatment options, please schedule an appointment today with the California Pain Consultants team in the Escondido, El Centro, La Mesa, San Diego, Chula Vista areas. We are expertly trained to help you most comfortably adjust to your new lifestyle and provide treatment options to help you experience as little pain as possible, as quickly as possible.