What is Phantom Limb Pain?

After you have part of your arm or leg amputated, there’s a chance you could feel pain in the limb that’s no longer there. This is known as phantom limb pain. It’s most common in arms and legs, but some people will feel it when they have other body parts removed, such as a breast.

For some people, the pain will go away on its own. For others, it can be long- lasting and severe. But you can limit it if you tell your doctor about it early on so you can get treatment ASAP.

Don’t worry that your doctor will think you’re imagining the pain. It’s common among people who’ve lost a limb. Most people who have an amputation will have some feelings connected to their missing limb within 6 months of the surgery.

Causes

Researchers don’t know exactly what causes phantom limb pain. One possible explanation: Nerves in parts of your spinal cord and brain “rewire” when they lose signals from the missing arm or leg. As a result, they send pain signals, a typical response when your body senses something is wrong.

Another example of this rewiring: When you touch one body part -- say, your hip or your forearm -- your brain might sense it on your missing limb.

Other possible causes of phantom limb pain include damaged nerve endings and scar tissue from the amputation surgery.

What Phantom Limb Pain Feels Like

Not all pain feels the same. The throbbing of a headache, for example, is very different from the sharp ache of a stomach cramp. So it’s no surprise that phantom limb pain is not the same for everyone. Your pain may feel like it’s:

• Burning
• Shooting
• Like “pins and needles”
• Twisting
• Crushing
• Like an electric shock

Aside from pain, you may also sense other feelings from a body part that’s no longer there:

• Movement
• Temperature
• Pressure
• Vibration
Itch

Medicine Can Help

No drugs specifically treat phantom limb pain. But medicines for other conditions, from depression to epilepsy, may give some relief.

Tricyclic antidepressants. Drugs such as amitriptyline (Elavil), nortriptyline (Pamelor), and tramadol (Conzip, Ultram) can ease nerve pain by changing chemicals in your body that send pain signals.

Anticonvulsants. These drugs treat seizures, but some can also help with nerve pain. Examples include carbamazepine (Carbatrol, Epitol, Tegretol), gabapentin (Gralise, Neurontin), and pregabalin (Lyrica).

Opioids. Drugs such as codeine and morphine may ease phantom limb pain for some people, but not everyone. Tell your doctor if you have a history of substance abuse before you take one of these drugs.

Other painkillers. A few other types may help with phantom limb pain, including:

• NMDA receptor antagonists, such as dextromethorphan and ketamine
• Over-the-counter medicine, such as aspirin and acetaminophen
• A shot of a pain-blocking drug in the area where you got the amputation

Non-drug Therapies

Medicine alone may not provide enough relief, so your doctor may recommend other treatments as well, such as:

Nerve stimulation. You may already know about TENS (transcutaneous electrical nerve stimulation) devices, sold at drugstores for muscle pain relief. They send a weak electrical current via sticky patches you put on your skin. The idea is that it can interrupt pain signals before they get to your brain.

Mirror box therapy. Picture a box with no lid. It has two holes -- one for your remaining limb and one for the stump -- and a mirror in the center. When you put your limb and stump inside, you see the reflection of the intact arm or leg in the mirror. It tricks your brain into thinking you have both limbs as you do therapy exercises. Research shows this can help relieve pain in a missing limb.

Acupuncture. A skilled practitioner will insert very thin needles into your skin at specific places. This can prompt your body to release pain-relieving chemicals.

Your habits. Don’t overlook the power of lifestyle choices to bring some relief. Some things to try:

• Find distractions to take your mind off of the pain
• Get (or stay) physically active
• Practice relaxation techniques, including meditation and visualization

Other Ways to Ease Phantom Limb Pain

If your pain is a problem even when you use medicine and non-drug therapies, your doctor may suggest other medical procedures.

Spinal cord stimulation: Your doctor will put tiny electrodes inside your body along your spinal cord and send a small electrical current through them. In some cases, this can help relieve pain.

Brain stimulation: It’s similar to spinal cord stimulation, except the electrodes send the current to the brain instead. A surgeon will place the electrodes in the right spot in your brain. Scientists are still studying how well it works, but for some people, the research is promising.

Revision surgery: If nerve pain is the root of the problem, surgery on your stump may help correct it.

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