What causes phantom limb pain?

[Cindy]

Hi

Thank you for taking my question.  What causes phantom limb pain?  Does rehabilitation work to reduce this problem?

[Jeffrey Heckman, DO]

Dr. Cone, Thank you very much for your input.  You bring up a great point regarding deep breathing and relaxation and there are new studies looking at guided imagery and visualization that positively impact phantom limb pain.  This is a great option that your rehabilitation team can offer that does not require use of medications, which is another positive aspect of that treatment program.

[1phantomdr]

The causes of phantom limb pain are multiple.  My experience treating veterans for phantom limb pain has demonstrated that psychosocial challenges (poor body image, grief, anger, relationship conflict, financial problems, stress etc.) play a part in the severity, intensity, and duration of phantom pain episodes.  Recent research suggests that cortical reorganization in the somatosensory cortex is creating phantom pain. Researchers have demonstrated in case reports that use of a visual input (mirror therapy) designed to mimic the movement of a paralyzed limb can reduce phantom pain.  You can find instructions for using the single mirror and the tripartite mirror apparatus by searching the internet.  I have suffered from phantom pain and have found that deep breathing and relaxation helps.  Mirror therapy with the tripartite mirror apparatus eliminated my pain.
Roberta Cone, Psy.D

[Jeffrey Heckman, DO]

Great question Cindy.  Phantom limb pain is very common among patients following limb loss.  Is it not exactly clear what causes phantom limb pain and there are multiple theories behind the phenomenon.  

First, we should define what phantom limb pain is....Phantom limb pain is pain that patients perceive as coming from an amputated limb as if it were still part of their body.  It is usually perceived as occurring in the distal (or farthest from the center of your body) part of the phantom limb.  It can be described as “burning,” “tingling,” “sharp,” “cramping” type pain.  Patients have also described it as an uncomfortable perception of limb distortion or the sensation of retraction of the stump (residual limb).

Rehabilitation can be very helpful for phantom limb pain and there are many treatment options.  Early on following your amputation it is important to learn desensitization exercises to start to re-teach your brain to understand and interpret sensations from your amputated limb or residual limb.  There are many techniques that can be used during a physical therapy program including massaging and tapping.  We can use electrical stimulation or a TENS machine.  There is also a technique called mirror therapy.  And there are also medications that can be prescribed for phantom limb pain.

The most important aspect to understand is to work closely with your rehabilitation team including your doctors, nurses, therapists and prosthetists and to use a system to log your pain so that when you do meet with your doctor that you can appropriately describe your pain and your doctor can you prescribe you the most effective treatment.

Good luck