Phantom Pain - The Causes and Treatment
Stump Pain - The Causes and Treatment
Phantom and Stump Pain Websites
More Information on Pain Treatment
Any patient who undergoes an amputation, whether
it be traumatic from an unexpected injury or from planned surgery, can
develop phantom pain, stump pain, or both. Some studies suggest if a
patient has pain in the area about to be amputated before the amputation,
there is a greater likelihood of developing phantom pain.
The patient's arms or legs are usually involved, but CRPS may affect
any part of the body, such as the face or trunk. In some patients, many
different areas of the body are affected. CRPS can be progressive (meaning
that it gets worse at one site or spreads to other sites), or it can
stay the same for a long time or even improve on its own.
Following an amputation, abnormal sensations can be felt from the amputated
body part; that is, a patient may feel sensations in a limb (or any
other amputated body part) which is no longer part of his/her body.
In fact, these unusual phantom sensations occur in most people following
amputation. The sensations can be changes in size or position, or actual
feelings of heat, cold, or touch. In some patients, these abnormal sensations
include pain. Because the pain is experienced in a part of the body
that is no longer present, it is called phantom pain. Luckily, for most
patients, both the phantom sensations and pain gradually resolve with
time.
The actual cause of phantom pain is not known. Most authorities currently
believe that both phantom pain and other phantom sensations are generated
from the spinal cord and brain. It is believed that when a body part
is amputated, the brain region responsible for perceiving sensation
from that area begins to function abnormally, leading to the perception
that the body part still exists.
The treatment of phantom pain is difficult. No one treatment has shown
to be effective in a majority of sufferers. Fortunately, there are treatment
approaches that may be helpful in some patients.
Drug Therapy
Drugs used for phantom pain are:
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Antiseizure drugs (such as gabapentin, carbamazepine) |
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Antidepressants (such as amitriptyline, nortriptyline) |
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Antiseizure drugs (such as gabapentin, carbamazepine) |
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Local anesthetics (such as mexiletine) |
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Alpha-2 adrenergic agonists (such as clonidine or
tizanidine) |
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Others, including calcitonin, baclofen, dextromethorphan Opioids
(such as morphine, oxycodone, methadone) |
Other Therapies
Other approaches include:
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Nerve blocks |
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Spinal cord stimulation |
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Hypnosis, biofeedback, and other cognitive techniques (such as
relaxation training and distraction) |
Stump pain is located at the end of an amputated limb's stump.
Unlike phantom pain, it occurs in the body part that actually exists,
in the stump that remains. It typically is described as a "sharp,"
"burning," "electric-like," or "skin-sensitive"
pain.
Stump pain is due to a damaged nerve in the stump region. Nerves damaged
in the amputation surgery try to heal and may form abnormally sensitive
regions, called neuromas. A neuroma can cause pain and skin sensitivity.
No one treatment has been shown to be effective for stump pain. Because
it is a pain due to an injured peripheral nerve, drugs used for nerve
pain may be helpful (see Treatment of Phantom Pain). If the stump pain
affects a limb, revision of the prosthesis is sometimes beneficial. Other
approaches also are tried in selected cases, including:
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Nerve blocks |
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Transcutaneous electrical nerve stimulation (TENS)
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Surgical revision of the stump or removal of the neuroma
(This procedure may fail because the neuroma can grow back; some
patients actually get worse after surgery.) |
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Cognitive therapies |
Applied Neurology (Journal): Clinical Pearls on Phantom Limb Pain
Article: What is the best way to manage phantom limb pain?
(.pdf - Journal of Family Practice)
Clinical Practice Guideline: Rehabilitation of Lower Limb Amputation
(VA/DoD)
Mayo Clinic: Phantom Pain
Amputee
Coalition of America
National
Amputation Foundation
See our
Treatments or
Mind-Body pages.
Ask a question?
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