Phantom Limb Syndrome

(Phantom Pain; Phantom Limb; Neuropathic Pain)

Definition

Phantom limb syndrome is the perception of sensations, including pain, in a limb that has been amputated. People with this condition experience feelings in the limb as if it were still attached to their body. This is because the brain continues to receive messages from nerves that originally carried impulses from the missing limb.
Nervous System
CNS and PNS
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Causes

The exact cause of phantom limb syndrome is unknown. It is thought that the sensations are due to the brain’s attempt to reorganize sensory information following the amputation. The brain must essentially rewire itself to adjust to the changes in the body.

Risk Factors

Phantom limb syndrome is more common in adults than in children. Other factors that may increase your chance of developing phantom limb syndrome include:
  • Preamputation pain
  • A blood clot in the amputated limb
  • Preamputation infection
  • Previous damage to spinal cord or peripheral nerves that supplied the affected limb
  • Traumatic amputation
  • Type of anesthesia used during the amputation

Symptoms

Symptoms may occur in people who have had a limb removed and people who are born without a limb. The symptoms are perceived in a limb that does not exist.Phantom limb syndrome may cause sensations of:
  • Shooting, stabbing, piercing, or burning pain
  • Pleasure
  • An article of clothing or jewelry
  • The limb still being attached and functioning normally
  • Numbness, tickling, or cramping

Diagnosis

Following an amputation, it is important to tell your doctor if you experience pain or other sensations. Earlier treatment generally improves the chances of success.There is no medical test to diagnose phantom pain. You will be asked about your medical history. A physical exam will be done. The doctor will especially want to know about the signs, symptoms, and circumstances that occurred before and after the removal of the limb. Diagnosis can be made based on your symptoms of any sensations from the missing limb.

Treatment

Fortunately, most cases of phantom limb syndrome following amputation are brief and infrequent. For those people who suffer from persistent pain, treatment can be challenging.

Medications

Your doctor may recommend the following to help with your symptoms such as:
  • Antidepressants
  • Anticonvulsants
  • Antipsychotics
  • Prescription pain medication
  • Muscle relaxers

Electrical Nerve Stimulation

In some cases, electrical nerve stimulation may be used. Examples include:
  • Transcutaneous electrical nerve stimulation (TENS)—a tiny electric current is sent through the skin to points on the nerve pathway
  • Transcranial magnetic stimulation—a strong magnetic pulse is sent through the scalp into the brain
  • Spinal cord stimulation—an electrode is inserted and a small electric current is delivered to the spinal cord to relieve pain

Other Approaches

  • Regional sympathectomy—a surgical procedure that interrupts selected nerves near the spinal cord affecting the perception of localized pain
  • Meditation and relaxation techniques
  • Biofeedback
  • Hypnosis
  • Acupuncture
  • Massage
  • Exercise

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Prevention

To help reduce your chances of getting phantom limb syndrome, some believe that administering pain medication at the time of the amputation may prevent persistent pain afterward. The effectiveness of this approach has yet to be confirmed.

RESOURCES

Amputee Coalition of America
http://www.amputee-coalition.org

National Institute of Neurological Disorders and Stroke
http://www.ninds.nih.gov

CANADIAN RESOURCES

Amputee.ca
http://www.amputee.ca

The War Amps of Canada
http://www.waramps.ca

References

Casale R, Alaa L, et al. Phantom limb related phenomena and their rehabilitation after lower limb amputation.Eur J Phys Rehabil Med. 2009;45(4):559-566.

Chahine L, Kanazi G, et al. Phantom limb syndrome: A review. Middle East J Anesthesiol. 2007;19(2):345-355.

Flor H, Nikolajsen L, et al. Phantom limb pain: a case of maladaptive CNS plasticity? Nature Reviews Neuroscience. 2006;7:873-881.

Foell J, Bekrater-Bodmann R, et al. Phantom limb pain after lower limb trauma: origins and treatments. Int J Low Extrem Wounds. 2011;10(4):224-235.

Peripheral neuropathy. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 15, 2014. Accessed December 5, 2014.

Resources for pain management. Amputee Coalition website. Available at: http://www.amputee-coalition.org/limb-loss-resource-center/resources-for-pain-management/index.html. Accessed December 5, 2014.

Rothgangel AS, Braun SM, et al. The clinical aspects of mirror therapy in rehabilitation: a systematic review of the literature.2011;34(1):1-13.

Weeks SR, Anderson-Barnes VC, et al. Phantom limb pain: Theories and therapies. 2010;16(5):277-286.

Wolff A, Vanduynhoven E, et al. 21. Phantom pain. Pain Pract. 2011;11(4):403-413.

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