Because it affects many of our patients, I’ve chosen Phantom Limb Pain as our first topic of discussion. It is defined as pain in the missing or amputated part of the limb(s) or some part of it. It’s important to note the differences between phantom pain and pain in the residual limb. They are very different problems with totally different causes and very different treatments. Phantom pain is never experienced in the residual limb even though it can be triggered by something happening to the residual limb. Residual limb pain is always experienced in the portion of the limb that is present. More detailed info on residual limb pain will be given at the end of this discussion.
 
Unfortunately, phantom limb pain is experienced by 60-70% of new amputees and after a year as many as 40% of them may still be bothered by it in a significant way. Many amputees report that it becomes much less frequent and lessens in severity over time; however, when it recurs it may be just as bothersome as when it was first experienced.
 
There is tremendous variability of phantom limb pain. It can be extremely unpleasant and even disabling for some amputees. It is complex, resistant to treatment and very frustrating to the amputee and caregivers alike. The debate over what causes phantom pain rages on. Following are some of the suggested causes of phantom pain accumulated from discussions by people on internet amputee forums.
 
1. Prior experience with pain before amputation - If you have had continued pain in your limb prior to amputation, this is thought to have a “phantom” effect post amputation.
 
2. Incorrect surgical procedure - Chances are your surgeon (especially if it is a traumatic amputation) may not be wholly experienced in amputations.
 
3. Climatic conditions - Changes in weather, particularly related to changes in air pressure and temperature can dramatically affect levels of phantom pain. Other than moving to a different climate, this is a hard one to avoid.
 
4. Stress - Stressful lifestyles lead to different kinds of ailments and if you are an amputee, phantom limb pain is just another to add to the list.
 
5. Inactivity - Remaining in the same position for long periods of time.
 
6. Periodic illness - Viruses can increase the level of phantom sensation, sometimes to unbearable levels. This is particularly noticeable for people who only experience phantom pain when ill. If you experience this type of pain, it’s best to get prescription medicine from your doctor to control it.
 
So what can be done to relieve the pain? Listed below are some ways amputees have found helpful in relieving phantom limb pain without medication:
 
1. Wrap your residual limb in a warm, soft fabric such as a towel. Or use a heating pad. The warmth will sometimes increase circulation. Poor circulation is thought to be one cause of phantom limb pain.
 
2. Mentally exercise the limb that is not there in the area that is painful.
 
3. Mentally relax the missing limb.
 
4. Do some mild exercise to increase circulation.
 
5. Tighten the muscles in the residual limb, then release them slowly.
 
6. Put an ace wrap or shrinker sock on.
 
7. Change positions. If you are sitting, move around in your chair, or stand up to let the blood get down into your residual limb.
 
8. Soak in a warm bath. A hot tub is reported to do wonders.
 
9. Massage your residual limb with your hands or have someone else massage it while you try to relax your entire body.
 
10. Keep a diary of when pain is most severe. This can help you and your doctor identify recurring causes.
 
In many cases, increased blood flow to the amputated area will reduce the amount of pain. So exercise, whether it’s stretching, running, walking, bike riding or lifting weights can provide relief from phantom pain.
 
A promising new therapy is being used at Walter Reed Medical Center to help amputees fight their way out of pain and back to normal living. But it isn’t a new drug, it’s a mirror, about four feet long and a foot wide. This is the way it works: First, the amputee is seated on an exam table (or bed if at home) with their legs straight out in front of them. The mirror (which can be purchased at most department stores for less than $20) is placed between the amputee’s legs with the reflective side facing the sound leg. This will give the illusion of two sound legs in the mirrored image. Through the use of the mirror the amputee is able to visualize flexing or massaging the missing limb, which helps alleviate the pain.
 
A Navy doctor at Walter Reed set up clinical trials with 18 volunteer amputees, and he was astounded by the results. Participants in the trial used the mirror therapy technique 15 minutes a day, five days a week for four weeks. Every single person who used the mirror experienced relief, and some reported that their phantom limb pain disappeared.
 
Remember - When discussing pain management, it is important to note the difference between phantom limb pain and residual limb pain. Many amputees experience pain in their residual limb. Immediately after surgery it is expected due to the massive tissue disruption of the surgery itself. Later, the pain can be due to a number of mechanical factors such as incorrect prosthetic fit, bruising of the limb, a neuroma, chafing or rubbing of the skin and any number of other causes.  If the source of the pain is a neuroma the following link to an article on “Easing Nerve Pain Post-Surgery” written by Dr. Ducic, a plastic surgeon at Georgetown University Hospital may be of interest to you:  http://www.news8austin.com/content/headlines/Default.asp?ArID=227040&SecID=2
 
Since there are numerous problems that can result in pain in the residual limb, it’s important to discuss residual limb pain with your physician and/or prosthetist. They may be able to solve the problem before it becomes more severe. The problems of pain management are made much more complex by the differences between amputees.  A lot of guesswork is involved and there is much variability. Each case has unique circumstances and must be evaluated individually (ie.,  a teenager who loses a leg above the knee to cancer will require different treatment than the senior motorcycle rider who has his leg amputated below the knee after unsuccessful limb salvage attempts).
 
Although I have not personally experienced phantom pain in many years, I do have phantom “sensation” from time to time, usually when my prosthesis is off. It’s more irritating than painful, sort of a “pins and needles” feeling, but I find that a hot bath or shower helps diminish it.
 
If anyone reading this has had success using the above techniques (or any other method) to relieve phantom limb pain and you don’t mind sharing, I’d love to get your feedback!

This entry was posted on Friday, May 1st, 2009 at 2:57 pm and is filed under Education/Information.