Phantom limb pain, also known as phantom limb, is a pain most commonly associated with missing or amputated limbs. Although the body parts are no longer there, those affected feel pain. Phantom pain is one of the amputation pain categories along with residual limb pain.
What is phantom pain?
Already in the ancient high cultures of mankind, for example in ancient Egypt or among the South American Mayas, doctors amputated sick or injured limbs. In earlier times, gangrene was a common cause of amputation of an arm or leg and often the only hope of saving a life. See electronicsencyclopedia for Slang Microangiopathy.
Even today, limbs sometimes have to be amputated, for example due to irreparable damage caused by an accident or an infectious disease.
An estimated 50 to 80 percent of patients who have had a limb or even an organ removed subsequently complain of phantom pain or phantom sensations in the now missing body parts.
Phantom pain usually occurs within a month after the operation and can vary in intensity. In rare cases, however, those affected first complain about phantom pain for months or years.
Causes
Science has not yet been able to find any concrete causes for the occurrence of the phenomenon of phantom pain. A few years ago it was believed that the reason for the virtual pain was inflamed nerve stumps. Today, doctors assume that the phantom pains are caused by some kind of confusion in the brain.
Even after the amputation, the brain has not yet classified the limb or organ as missing and simply continues to assume the old, complete body schema. This approach also explains why phantom sensations occur: some patients, for example, think they can gesture with a missing hand.
Another observation supports the thesis of the brain that cannot change its mind: the intensity of phantom pain is based on the pain actually felt before the operation. The patients’ brains seem to remember the real pain they experienced before the operation.
Some people claim to feel phantom pains when the weather changes from a former wound or fracture, e.g. from high pressure to low pressure. However, this cause has not yet been scientifically verified and therefore represents a subjective sensation.
Symptoms, Ailments & Signs
Patients can usually indicate exactly where they feel the phantom pain. For example, a person who has had their right forearm amputated may feel the phantom limb pain in the palm of their hand (now absent), or their pinky and ring finger. Although the pain does not emanate from an adequate stimulus in the amputated tissue, the nervous system responds as if an appropriate neural stimulus were present. The pain is not simulated and does not occur directly at the residual limb.
In principle, phantom pain can develop in any part of the body that has been amputated. However, the symptoms occur particularly frequently when the surgical site is close to the torso. Phantom pain often occurs in phases. Continuous pain is also possible, but is less common. Both the pain attacks and the permanent phantom pain represent a burden that often leads to psychological complaints.
Both the intensity and the quality of the pain can vary. The phantom limb pain can feel stabbing, cutting, or burning. Those affected may also have the impression that they have a painful cramp in the amputated body part.
Some patients suffer from phantom pain immediately after the amputation. In other cases, the symptoms only appear after a long time. Most sufferers develop phantom limb pain within the first month after surgery. However, the symptoms can also appear for the first time after several years.
Diagnosis & History
Phantom pain is mainly diagnosed on the basis of patient descriptions. However, before the doctor commits himself to this diagnosis, he must first rule out organic causes of the pain. So-called residual limb pain is also common after an amputation and is sometimes difficult for the patient to distinguish from phantom pain.
Stump pain is often caused by pressure points caused by poorly fitting prostheses, inflammation or circulatory disorders. Phantom pain usually occurs in the form of flare-ups or attacks. Rarely are they described as constantly present.
The type of pain can be very different: Patients reported sharp, burning, cramping, stabbing or cutting phantom pain. Phantom pain also differs in intensity and duration. Some people suffer so badly that they want to take their own lives.
Complications
Phantom pain after an amputation is common, about 70 percent of all those affected suffer from it. It is normal to a certain extent and is often associated with residual limb discomfort. Even if phantom pain is harmless in most cases, a doctor should still be consulted so that the symptoms do not worsen or become chronic.
It is important that phantom limb pain is treated early, otherwise the body will develop what is known as a pain memory. When this happens, signals are sent from the brain to the amputated area of the body and there is no response. If this happens repeatedly, the brain classifies the lack of feedback as an injury and responds with pain. It is therefore important to counteract this pain memory as early as possible.
Phantom pain can be very severe and require pain medication. Long-term use of painkillers, however, carries the risk of becoming dependent on painkillers. In addition, phantom limb pain can cause increased irritability and sleep disturbances, and can limit both health and social life. Without treatment, depression or even mental illnesses that require treatment can also occur.
When should you go to the doctor?
Phantom pain is experienced by people who have lost body parts. Other people do not belong to the risk group of this unpleasant experience of pain. If the person concerned experiences discomfort in areas of the limb that have been severed as a result of an accident or amputation, they should consult a doctor. In these cases, therapeutic work with various exercises and training sessions is required so that the necessary reprogramming can take place in the brain. Otherwise, the symptoms will continue or increase in intensity. In order for a treatment plan to be drawn up, a doctor’s visit should be made.
A doctor should be consulted in the event of insomnia, persistent stress, inner restlessness or impairment of joie de vivre. If there are vegetative dysfunctions, personality changes, general dissatisfaction or a restriction in lifestyle, a doctor is needed. Depressive moods, listlessness or behavioral problems should also be discussed with a doctor. Concentration disorders, attention deficits and a decreasing resilience are signs of a health impairment.
A doctor should be consulted so that the symptoms can be alleviated. The intensity of the symptoms often varies. There may also be a period of freedom from symptoms. Normally, no doctor is needed during these times. However, if the pain returns after a certain period of time, it is advisable to consult a doctor.
Treatment & Therapy
There is no one-size-fits-all treatment for phantom limb pain. Possible therapies must be individually tailored to each patient and should help the brain to reorganize itself. As a rule, phantom pain is treated with medication, physical or psychosomatic therapy or a combination of one or more of the options mentioned.
Severe cases of phantom limb pain are first treated with anesthetic opiates, such as morphine, to alleviate the patient’s suffering. Treatment with antidepressants and/or electrostimulation is common. An electrode placed under the skin stimulates the spinal cord with electrical impulses intended to distract the brain from the phantom pain.
Newer methods such as mirror therapy and therapy using virtual reality seem to be very successful. Both therapies simulate the amputated limb and ask the patient to move it to get it out of its painful position. A targeted distraction and other activities for the patient can sometimes make the phantom pain disappear.
On the other hand, therapies such as acupuncture, hypnosis, physiotherapy or biofeedback have proven to be of little help . Treatment methods such as shortening the residual limb, cutting through the sensory nerves in the spinal cord and removing the thalamus are no longer common. They usually showed little or no success.
Outlook & Forecast
The prognosis for phantom limb pain depends on certain factors. It is particularly important to start medical treatment of the pain as early as possible. If the pain treatment is positive, about 70 to 90 percent of all affected people experience a favorable course of the symptoms. However, if pain therapy is started at a later point in time, the prospects are less favourable. Only a third of the patients show a positive course of healing.
It is basically impossible to say how long the phantom pain lasts. So there is a possibility that the pain will disappear spontaneously. A sudden return of the painful symptoms is also possible. The prognosis is particularly unfavorable if the patient suffers from amputation pain for more than six months.
The type of amputation pain plays an important role in the further course of the symptoms. Immediately after the surgical procedure, abrupt residual limb pain sets in, which in some cases can become chronic. However, they are often acute and fail violently. In the case of phantom pain, the symptoms can generally be expected to persist for a longer period of time. In addition, the pain can reappear at any time.
Sometimes phantom pain occurs as a result of inflammation or infection. The prognosis can usually be improved by the administration of antibiotics.
Prevention
Phantom pain is difficult to prevent. In many cases, however, the administration of neuroleptics or analgesics before a planned operation has proven to be helpful. Phantom pains did not occur as severely afterwards, or in some cases not at all.
Aftercare
With appropriate therapy, phantom pain subsides in the first few weeks after an amputation. Many patients do not require follow-up care because they are symptom-free. Subsequent acute discomfort is not uncommon, but can usually be stopped without consulting a doctor. However, if there are recurring pain attacks or a constant feeling of pain, follow-up care is essential.
The scope of the follow-up depends on the intensity of the symptoms. Long-term treatment with medication is not uncommon. Alternative healing methods are sometimes promising. Depending on the severity of the symptoms, psychotherapy may be indicated. The mediation of relaxation exercises often helps as well.
Some sufferers are so devastated by their condition that they attempt suicide. The controls and treatments serve to identify and address life-disregarding tendencies in the early stages. As part of the aftercare, the patient’s feelings are reflected in particular.
Physical examinations serve to rule out other diseases. The treating physician documents the effect of the therapies carried out. What promises success is continued, what does not contribute to improvement is discarded. Doctors cannot prevent phantom pain because it develops unpredictably. As is usual with tumor diseases, follow-up care cannot have a preventive character.
You can do that yourself
People who suffer from phantom pain can improve their symptoms through cognitive approaches. Since the pain is stored in the brain based on experiences and experiences and is not based on a real impact, training can alleviate the pain. It is helpful to use and support a therapist. Together with him, exercises can be developed that the person concerned can carry out independently in everyday life as needed.
The approaches of mirror therapy are helpful and very promising. They represent an enormous relief for the patient and improve the well-being considerably. In consultation with the therapist, the training units carried out can be carried out independently between or after the treatments. Skill exercises in front of a mirror evoke sensory impressions that help to cope with pain.
In addition, awareness-raising processes are helpful in dealing with the changed situation. Since it is an imaginary pain, some patients manage to deliberately change their stored memories by dealing with them. Cognitive techniques offer possibilities and methods that can also be used independently by the patient in everyday life. The phantom pain should not be ignored, as it can lead to an increase in symptoms and significant impairments in everyday life.
