Definition
Phantom limb syndrome is the perception of sensations, usually including pain, in a limb that has been amputated. Patients with this condition experience the limb as if it were still attached to their body as the brain continues to receive messages from nerves that originally carried impulses from the missing limb.
Causes
The exact cause of of phantom limb syndrome is unknown. Presumably, the sensations are due to the brains attempt to reorganize sensory information following the amputation. The brain must essentially rewire itself to adjust to the body change.
Risk Factors
The following factors increase the chance of developing phantom limb syndrome:
- Preamputation pain. If there was pain in the limb before it was removed, a patient is more likely to experience phantom pain afterward.
- Blood clot in the amputated limb.
- Infection in the limb before amputation.
- Previous damage to spinal cord or peripheral nerves that supplied the affected limb.
- Adults more commonly than children.
Symptoms
Symptoms 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.
Symptoms include:
Pain (by far the most common)
Pleasure
Sensation of an article of clothing or jewelry
Sensation that the limb is still attached and functioning normally
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. Your doctor will take a medical history, do a physical exam, and especially want to know about the signs, symptoms, and circumstances that occurred before and after the removal of the limb.
Treatment
Fortunately, most cases of phantom limb following amputation are brief and infrequent. For those patients who suffer from persistent pain, treatment can be challenging.
Medications
Selected medications used to treat phantom limb pain include:
Antidepressantsusually treat depression, but may be helpful in phantom limb pain at lower doses.
Anticonvulsantsusually control seizures, but may also be helpful here.
Chlorpromazineusually treats schizophrenia, but may also be helpful here.
Opioidsare powerful pain killers(eg, morphine).
Clonidineusually treats high blood pressure, but is helpful with paingenerated in the brain.
Baclofenmuscle relaxant and used to treat nerve damage pain.
Electrical Nerve Stimulation
There is evidence to suggest that stimulating the nerves or regions of the brain involved in the pain may help some patients. Examples include:
Transcutaneous electrical nerve stimulation (TENS)a tiny electric current is sent through the skin to points on the nerve pathway
Transcranial magnetic stimulationthis is an experimental procedure involving a strong magnetic pulse sent through the scalp into the brain(provides only temporary relief)
Spinal cord stimulationan electrode is inserted and a small electric current is delivered to the spinal cord to relieve pain
Other Approaches
Regional sympathectomya 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
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
Amputee Resource Foundation of America
http://www.amputeeresource.org
Amputee Resources
http://www.prostheticdesigners.com/amputee.htm
National Institute of Neurological Disorders and Stroke
http://www.ninds.nih.gov
CANADIAN RESOURCES:
Amputee.ca
http://www.amputee.ca
The War Amps
http://www.waramps.ca
References:
Carlson N. Physiology of Behavior . Boston, MA: Allyn and Bacon; 1998.
Flor H, Nikolajsen L, Jensen TS. Phantom limb pain: a case of maladaptive CNS plasticity? Nature Reviews Neuroscience . 2006;7:873-881.
Phantom pain. Mayo Clinic website. Available at: http://www.mayoclinic.com . Accessed August 5, 2005.
Sekuler R, Blake R. Perception . 4th ed. NewYork: McGraw-Hill Inc.; 1994.
Last reviewed January 2008 by Rimas Lukas, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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