Phantom Limb Pain
Phantom limb pain (PLP) is a sensation where a person feels pain of a body part or limb that is no longer there. After amputation, the person feels as if the limb is still attached.
How common is phantom limb pain?
According to medical statistics, 85% of people experience some type of phantom limb sensations in the first few weeks after amputation. Around 50% of amputees report phantom limb pain that is of a chronic nature. In a study involving 52 amputees, PLP was found in 79%. In addition, phantom sensations involved kinetic, kinesthetic, and exteroceptive components.
What symptoms are associated with phantom limb pain?
Many patients report severe, debilitating painful phantom limb sensations. Sensations are described as tingling, burning, numbness, hot or cold feelings, as well as stabbing, cramping, and throbbing pain. The amputee describes the pain as if the limb is still there. PLP is often long-term and difficult to treat.
What are the risk factors for phantom limb pain?
Phantom limb pain does not develop in every one who has a body part or limb removed. Risk factors include:
- Pain in the stump
- Severe pain prior to amputation
- Use of a prosthetic limb
- Having a lower extremity amputation
- Finger and toe amputations
How is phantom limb pain treated?
Treatment of phantom limb pain often involves a combination of therapies. Options include:
- Medications – Gabapentin is an anticonvulsant medication used for PLP. In addition, clinical studies show that tricyclic antidepressants and sodium channel blockers help with neuropathic pain.
- Intrathecal pump implant – The use of buprenorphine intrathecally was proven significantly effective in a study involving phantom limb pain treatment. Use of this intervention offers an 86% success rate.
- Physical therapy – This involves desensitization therapies and exercises to improve limb flexibility and function. In addition, the therapist assures proper fit of a prosthetic limb, which decreases pain of the stump. Pain relief modalities used in therapy include ultrasound, massage, heat therapy, and electrical stimulation.
- Stellate ganglion block – This involves injecting a bundle of nerves that supply the upper extremities with an anesthetic and/or neurolytic agent. The doctor uses fluoroscopic technique to assure correct needle placement.
- Transcutaneous electrical nerve stimulation (TENS) – This unit is worn on the outside of the body. Wires run from the unit and attach to electrodes placed along the skin of the limb. The mild electric current alters transmission of pain signals. Two medical studies involving TENS for PLP found that it greatly decreased pain scores.
- Spinal cord stimulation (SCS) – This small device is surgically implanted in the body and introduces electric current into the epidural space near the spinal cord. Small electrode leads are surgically placed in the space, and wires run from them and attach to the power unit. A recent study found SCS was 80% effective for phantom limb pain relief.
- Acupuncture – This ancient Chinese therapy involves insertion of tiny needles along body regions called meridians. This promotes tissue healing, restores body energy (called chi), and improves function. In two controlled clinical studies, acupuncture significantly improved pain.
Corrado P, Alperson B, & Wright G (2006). Perceived success and failure of intrathecal infusion pump implantation in chronic pain patients. Neuromodulation, 11(2), 98-102.
Hua X, Trevelyana E, Yangb G, et al. (2014). The effectiveness of acupuncture/TENS for phantom limb syndrome. I: A systematic review of controlled clinical trials. Eur J of Int Med, 6(3), 355-364.
Richardson C, Glenn S, Nurmikko T, & Horgan M (2006). Incidence of phantom phenomena including phantom limb pain 6 months after major lower limb amputation in patients with peripheral vascular disease. Clin J Pain, 22(4), 353-358.
Viswanathan A, Phan PC, & Burton AW (2010). Use of spinal cord stimulation in the treatment of phantom limb pain: case series and review of the literature. Pain Pract, 10(5), 479-484.