Phantom Limb Pain
Phantom limb is when sensation is felt in a limb that has been amputated. It is estimated that almost 9 out of 10 amputees will feel phantom limb sensations for the first several weeks following an amputation, and a small group of those will feel phantom limb sensations for several months or years after an amputation. Sufferers of phantom limb may experience tingling, hot, cold, numbness, cramping, stabbing or burning, but pain is the most common. The sensations usually decrease over time, but in a select few, it can become long-term pain, which is often hard to treat. Phantom limb most often affects patients with amputation of the bilateral limbs or the lower extremities, but body parts associated with the cortex of the brain (fingers and toes) also have a high risk of being affected. Phantom limb sensations usually occur in the distal parts of the limb and may mimic pain or other sensations felt in the limb before amputation. Treatments for phantom limb pain include mirror therapy, physical therapy, medication, interventional injections and spinal cord stimulation.
Physical therapies often involve desensitization therapy in combination with a sympathetic nerve block if considered sympathetically mediated pain . A refitting of a prosthetic can also be very beneficial in reducing phantom limb pain.
Mirror Therapy is a new but promising therapy that uses a mirrored box with openings for both the amputated limb and the existing limb. The patient then does isometric exercises with the non-amputated limb next to the mirror so it looks like both limbs are there and moving. This has shown to pain in patients who underwent the therapy for four weeks or more.
Some of the more common medications used in the treatment of phantom limb pain include: sodium channel blockers, tricyclic antidepressants, and anticonvulsants. Opioid medication has shown not to be effective in the treatment of neuropathic pain, including phantom limb.
Interventional injections, such as the lumbar sympathetic block, for phantom limb of the lower extremities and interscalene blocks or stellate ganglion blocks for phantom limb in the upper extremities, can be very beneficial in controlling phantom pain sensations. Blocks are often combined with physical therapy for maximizing results.
Another possible solution for phantom limb pain involves a Spinal Cord Stimulator (SCS). A SCS trial will first be administered for roughly 1-5 days in order to check the effectiveness of the stimulator. The trial consists of electrodes being fed to the to the epidural space near the source of the pain that will send a mild electrical current, disrupting the signals and causing a mild tingle instead of pain.