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What Causes Phantom Limb Pain and How Do You Treat It?

Phantom limb pain (PLP) is when you feel a sensation of pain or discomfort from a limb that’s no longer there. It’s a common condition in people who’ve had limbs amputated.

Not all phantom sensations are painful. Sometimes, you may not experience pain, but may feel as if the limb is still there. This is different than PLP.

It’s estimated that between 60 to 85 percent of amputees experience PLP. Continue reading as we explore more about PLP, what may cause it, and how it can be treated.

The sensation of PLP may vary by individual. Some examples of how it may be described include:

  • sharp pain, such as shooting or stabbing
  • tingling or “pins and needles”
  • pressure or crushing
  • throbbing or aching
  • cramping
  • burning
  • stinging
  • twisting

What exactly causes PLP is still unclear. There are several things that are believed to contribute to the condition:

Remapping

Your brain appears to remap the sensory information from the amputated area to another part of your body. This remapping can often occur in areas close to or on the residual limb.

For example, sensory information from an amputated hand could be remapped to your shoulder. Therefore, when your shoulder is touched, you may feel phantom sensations in the area of your amputated hand.

Damaged nerves

When an amputation is performed, significant damage can occur to peripheral nerves. This can disrupt signaling in that limb or cause the nerves in that area to become overexcited.

Sensitization

Your peripheral nerves eventually connect to your spinal nerves, which are associated with your spinal cord. After a peripheral nerve is severed, neurons associated with a spinal nerve can become more active and sensitive to signaling chemicals.

There are also some possible risk factors for developing PLP. These can include having pain in a limb prior to amputation or having pain in the residual limb following amputation.

In addition to feeling pain, you may also observe the following characteristics of PLP:

  • Duration. Pain may be constant or may come and go.
  • Timing. You may notice phantom pain shortly after amputation or it may show up weeks, months, or even years later.
  • Location. The pain may mostly affect the part of the limb furthest from your body, such as the fingers or hand of an amputated arm.
  • Triggers. Various things can sometimes trigger PLP, including things like cold temperatures, being touched on another part of your body, or stress.

In some people, PLP may gradually go away with time. In others, it may be long-lasting or persistent.

There are a wide variety of strategies that can be used to help treat PLP and many of them are still being researched. Often, managing PLP can involve utilizing several types of treatment.

Pharmaceutical therapies

There’s no drug that specifically treats PLP. However, there are several different types of drugs that may help to relieve symptoms.

Since drug effectiveness may vary from person to person, you might need to try different ones in order to find what’s optimal for you. Your doctor may also prescribe more than one medication to treat PLP.

Some drugs that can be used for PLP include:

Non-pharmaceutical therapies

There are also some treatments for PLP that don’t involve medications. Often, one or more of these therapies can be used in conjunction with medications to relieve pain.

Mirror box therapy

This uses placement of a mirror to copy the unaffected limb. Exercises are performed with the unaffected limb while imagining that the amputated limb is moving. This tricks the brain into thinking that the amputated limb has returned.

Virtual reality (VR)

VR therapy is similar to mirror therapy. It uses VR technology to create a virtual limb that you can move. This movement can then be observed on the screen of the VR device.

Transcutaneous nerve stimulation (TENS)

TENS uses a small device to send electrical currents to stimulate nerves. The TENS unit can either be placed at the site of amputation or on the unaffected limb.

Biofeedback

Biofeedback involves the placement of electrodes near the site of amputation. These electrodes can monitor body functions relating to muscle tension or temperature.

The information provided can help teach you how your body works. A therapist can work with you to help you learn to control some functions and prevent pain.

Acupuncture

Acupuncture is a technique that involves inserting thin needles into the skin at specific points of the body. Acupuncture studies are ongoing, but it has been shown to ease some types of pain.

Massage therapy

This involves massaging the area around the amputation site. Although much of the evidence is anecdotal, some may find that gentle massage relieves discomfort.

Spinal cord stimulation

This method uses an implanted device to deliver a small electrical current to your spinal cord through tiny electrodes.

Brain stimulation

For this treatment, a surgeon implants electrodes into the brain that are controlled by a pacemaker-like device. These electrodes can use an electrical current to stimulate specific areas of the brain.

There are also several things that you can do at home to help with PLP. Some of them include:

  • Try relaxation techniques. Examples include breathing exercises or meditation. Not only can these techniques help to lower stress, but they may also decrease muscle tension.
  • Distract yourself. Exercising, reading, or doing an activity that you enjoy can help take your mind off of the pain.
  • Wear your prosthesis. If you have a prosthesis, try to wear it regularly. Not only is this beneficial in keeping the residual limb active and moving, but it may also have a similar brain-tricking effect as mirror therapy.
  • Join a support group. Coping with PLP may sometimes feel difficult or frustrating. Discussing your experiences with others that have PLP may help.
  • Stick to your treatment plan. This includes being sure to take medications as directed.

Phantom limb pain often occurs shortly following an amputation. However, it can also develop weeks, months, or years later.

If you’ve undergone an amputation at any time and are experiencing phantom limb sensations, speak to your doctor. They can work alongside you to determine an effective way to manage your symptoms.

PLP is pain that happens in a limb that’s no longer there. It’s common in people who’ve had amputations. The type, intensity, and duration of the pain may vary by individual.

It’s still not clear what exactly causes PLP. It’s believed to occur due to the complex adaptations that your nervous system makes in order to adjust to the missing limb.

There are many ways to treat PLP, including things like medications, mirror therapy, or acupuncture. Many times, you’ll use a combination of treatments. Your doctor will develop a treatment plan that’s appropriate for your condition.

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