Phantom Limb Pain

What is phantom limb pain?

Phantom limb pain is pain in a limb that has been previously amputated. When people experience phantom limb pain after an amputation, the nervous system continues to function as if the limb is still there. As a result, patients with phantom limb pain continue to feel pain in the limb that in fact is no longer present. In addition to pain, patients can feel other sensations in the missing limb, like tingling, cold or heat.

Phantom limb pain can occur after a surgical procedure that amputates the limb. The amputation many have been necessary for some unrelated reason, such as a traumatic injury or disease. The phantom limb pain is an effect of the surgery.

Phantom limb pain is unfortunately common after an amputation of a limb. In their review of the research literature, Katz and Seltzer1 found that 59-79% of leg amputations lead to phantom limb pain.

Is there a cure for phantom limb pain?

Typically, there are no cures for phantom limb pain symptoms. Healthcare providers and their patients focus on management of the symptoms. Chronic pain management has two broad goals:

  • Reduce symptoms to the extent possible
  • Reduce the emotional distress and functional impairments that are associated with the symptoms

The first goal involves reducing phantom limb pain and its related symptoms. The second goal is two-fold: to reduce the fear, anger, anxiety, depression or sleep problems that tend to go along with living with chronic phantom limb pain, and reducing the sense of disability that tends to occur with pain. Overall, these goals amount to assisting the patient to live well, work, and be involved in life, despite having some chronic phantom limb pain symptoms.

The healthcare system has different ways it pursues chronic pain management. Broadly speaking, there are three different types of pain clinics in our healthcare system:

  • Pain clinics that focus on surgical and/or interventional procedures (surgeries, injections, nerve-burning procedures, and the like)
  • Pain clinics that focus on long-term medication management (such as long-term use of narcotic pain medications)
  • Pain clinics that focus on chronic pain rehabilitation (such as interdisciplinary chronic pain rehabilitation programs)

All three types of clinics treat phantom limb pain symptoms.

Therapies & procedures for phantom limb pain

Common symptom management therapies include lidocaine patches, antidepressant medications, anticonvulsant medications, opioid medications, cognitive behavioral therapy, nerve block injections, implantable spinal cord stimulators, surgeries, and chronic pain rehabilitation programs.

Most, but not all, of these therapies have been shown in research to be effective in reducing pain. It is important to note, however, that ‘effective’ in this context does not mean ‘curative.’ Rather, it means that many of these therapies are helpful in reducing pain, but some degree of pain will typically remain. Also, it is important to note that these therapies, even the ones with demonstrated effectiveness, are not all equally effective. The research shows that some are more effective than others.

References

1. Katz, J. & Seltzer, Z. (2009). Transition from acute to chronic postsurgical pain: Risk factors and protective factors. Expert Reviews of Neurotherapeutics, 9, 723-744.

 

Date of publication: April 27, 2012

Date of last modification: October 23, 2015

Murray J. McAllister, PsyD, is the executive director of the Institute for Chronic Pain (ICP). The ICP is an educational and public policy think tank. Its mission is to lead the field in making pain management more empirically supported. Additionally, the ICP provides Academic quality information on chronic pain that is approachable to patients and their families. Dr. McAllister is also the clinical director of pain services for Courage Kenny Rehabilitation Institute (CKRI), part of Allina Health, in Minneapolis, MN. Among other services, CKRI provides chronic pain rehabilitation services on a residential and outpatient basis.

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