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Phantom Limb Pain

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Disease Awareness Page for R3 Stem Cell – Phantom Limb Pain

 

 

Phantom Limb Pain

What is it?

A phantom limb is the feeling that an amputated limb is still present or attached to the body. Phantom limb pain is pain felt on a phantom limb long after the limb has been amputated or removed. This kind of pain is very unique because of the way it presents itself. 

With other kinds of pain, the individual can reach out for, and feel the source of the pain. However, with a phantom limb, the individual feels the pain, even though the limb is missing. Furthermore, knowing that the limb is missing does not stop the pain. 

Phantom pain doesn’t only occur on an amputated limb and can be experienced in other parts of the body as well. For example, individuals that have had breast and teeth removed still feel sensations in these absent body parts. 

The explanations for phantom limb pain

Research is still being conducted on the exact cause and mechanism of phantom limb pain and sensations, and several theories have been proposed. In the past, the dominant hypothesis explaining the pain was that the nerve endings in the amputated area were irritated. What happens when a limb is amputated is that the nerves and blood vessels terminate prematurely at the point of the amputation, instead of running to the end of the limb. Over time, the endings can get inflamed. This led to the belief that the inflamed endings sent signals to the brain, which were them interpreted as pain.

However, this hypothesis was debunked. A more recent one is based on how the body reorganises the somatosensory cortex. The somatosensory cortex is the part of the brain responsible for organising and processing all the sensory information in the body. Since this condition is pain related, the sensory nerves are involved in its propagation. This explanation of phantom limb pain proposes that since the sensory nerves are no longer delivering information to the somatosensory cortex, the body reorganises the information it receives. 

This hypothesis is one of the more plausible explanations, and it accounts for why stroking some parts of the body might be sensed on the missing limb. If a person with amputation were stroked on the face, they could feel sensations on the missing limb. This provides support to the reorganisation of the somatosensory cortex explanation.

While a lot of research is still being done on how phantom limb sensations comes about, there has not been any widely accepted cause. The most prevalent explanations are related to the peripheral mechanism and central neural mechanisms. 

 

How phantom limb sensations feel

People who have had amputations often experience phantom limb sensations, and what happens is that they feel that the limb is there, even though it isn’t. Phantom limb pain is just one of the sensations experienced in the phantom limb. Besides the physical feelings, there are also emotional and psychological elements.

Psychological effects of amputation and phantom limb sensations

Depression and anxiety have been identified in individuals who suffer phantom limb pain. These accompanying conditions are not just as a result of the pain, but also the conditions that led to the amputation. A study found that 25% of all individuals who had amputations and accompanying phantom limb sensations suffered depression and anxiety in the early stages after the amputation. As time passes, the symptoms of depression reduced, as individuals became more accustomed to the amputated limb.

Phantom limb sensations and gender reassignment surgery

As mentioned earlier, phantom limb sensation is not isolated to the limbs, but other parts of the body as well. Any part of the body that’s been amputated can give the individuals phantom sensations. People who have undergone gender reassignment surgery often report feeling phantom sensations in the genitals. These sensations are more common in transsexual men than in transsexual women.

Individuals who had undergone mastectomies also reported experiencing phantom breasts. 

What does phantom limb pain feel like?

They kind of phantom limb pain differs from individual to individual. Consider that even though everyone feels the same kinds of sensation, the intensity and kind of sensation, we feel are different. Additionally, amputations and missing limbs aren’t all done the same way, and the nerves are bound to be severed at different levels of their course in the body. These contribute to the difference in the kind of phantom limb pain that people experience. 

However, pain is common among people who have had amputations and the majority of them experience pain like

  • Burning 
  • Shooting
  • Twisting
  • Crushing
  • Pins and needles

All of these sensations are usually felt at or near the site of the amputation. In addition to pain, other sensations are felt at the site of the phantom limb. They include

  • Feelings of movement. Often people forget that they’ve had amputations and try to reach out for items with the missing limb. Other times, they feel the limb moving, and it takes looking at the amputated stump to remember that it’s no longer there.
  • Temperature.
  • Pressure
  • Itchiness
  • Vibration

How common is phantom limb pain, and who is at risk?

Phantom limb pain and other phantom limb sensations are experienced by everyone who has ever had an amputation. However, the intensity and severity of the feelings differ from individual to individual. Also, as stated earlier, different feelings might be felt, ranging from pressure to heat and cold, and itchiness. 

60%-80% of amputees complain of phantom limb pain, among other sensations. Phantom limb sensations are just as common in men as they are in women.

The risk factors for getting phantom limb sensations is a missing limb. The most common cause of this is amputation, but other causes include trauma and fatal accidents. The amputation may be done due to several reasons, including

  • To prevent the spread of a gangrene 
  • To prevent the spread of cancer, as in the case of mastectomies
  • When the limb is no longer functioning, as in the case of complete denervation
  • Diabetes
  • Blood clots

How is phantom limb pain diagnosed?

There is no medical test to diagnose phantom limb pain; the diagnosis can be made based on the description of symptoms and medical history alone. Feeling pain at the point where an amputated limb once confirmed a diagnosis of phantom limb pain, and appropriate treatment can follow. 

How is phantom limb pain treated? 

Medications

Pain relievers: These can help relieve the pain associated with the phantom limb sensations, especially if they are severe.

Antidepressants: As mentioned earlier, some of the people who experience phantom limb pain also undergo depression, especially during the first few periods after the amputation. Antidepressants may be useful for combating this condition.

Therapy

Mirror box: The mirror box is a device that’s used to treat phantom limb sensations. It is a hollow box with mirrors on its sides.  The way it works is that the individual places the amputated limb the mirror’s compartment and moves the intact limb while watching its reflection in the mirror. This will promote the feeling that the limb is still there. As the individual performs actions, it feels like the amputated limb Is performing the actions. There is inconclusive evidence on the effectiveness of mirror therapy on phantom limb sensations. 

Acupuncture: Acupuncture has been found to ease the chronic pain associated with phantom limbs. In acupuncture, stainless steel needles are inserted into specific nerve points on the body of the individual. This procedure is safe when performed by qualified individuals.  

Other forms of treatment

Phantom limb sensations are usually worse when the individual experiences stress, anxiety, and drastic weather changes. Therefore, it is advised that individuals who have undergone amputations stay stress-free and avoid situations that can cause anxiety. 

 

Learn More about ongoing clinical studies sponsored by R3 Stem Cell HERE.

 

References 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2967165/ 

https://www.ingentaconnect.com/content/imp/jcs/2008/00000015/00000001/art00001 

https://journals.sagepub.com/doi/abs/10.1177/0269215508094710 

https://wellcome.ac.uk/en/pain/microsite/medicine2.html 

https://www.hindawi.com/journals/prm/2018/5080123/#B29 

https://www.ncbi.nlm.nih.gov/pubmed/21326041 

https://www.mayoclinic.org/diseases-conditions/phantom-pain/diagnosis-treatment/drc-20376278 

https://www.amputee-coalition.org/limb-loss-resource-center/resources-for-pain-management/managing-phantom-pain/ 

https://www.webmd.com/pain-management/guide/phantom-limb-pain#1 

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