Phantom pain: Basics

Courtesy : Prof Nabile Ebraheim, University of Toledo, Ohio, USA

• Phantom pain is a common symptom after amputation of
  limb.
• The term phantom doesnot mean that the symptoms are imaginary or in the patient’s head
• It is a real phenomenon.
• Upto 80% of amputee patients have phantom symptoms.
• The patient will feel the sensation of pain in the area where the limb was amputated.

SYMPTOMS
• May range from mild to severe and the pain may be constant.
• Tingling, cramping,Heat or Cold sensation may be felt in addition to shooting pain and these symptoms usually
decrease or disappear with time.
• The patient may feel like the foot or toes are moving or itchy.
• If the symptoms continue for more than 6 months the prognosis is usually not good.

CAUSES
The causes of phantom pain are not very clear.
• Brain thinks that the limb is still present.
Psychological factors -Memory of the pain is returned. The signal is
interpreted as pain regardless of the signal from the injured nerve.
• Peripheral factors may contribute to the condition of phantom pain
Peripheral factors: Pain may result from the nerve endings making a
Neuroma. Neuroma may generate an abnormal impulse that the brain will
interpet as Pain.

TREATMENT
• Multiple treatment modalities
• Depends on the levels of pain
• It includes :
– Heat
– Massage
– Biofeedback and relaxation techniques
– Physical therapy
– TENS Unit
– Exercises and moving the limbs –can help to relieve the pain from phantom pain

Medical Therapy –

• Anticonvulsants, Antidepressants
• Surgical Therapy -For Neuromas
• Neurostimulation technique –Spinal cord or deep brain
  stimulation

MIRROR BOX VISUAL FEEDBACK THERAPY
• A mirror box is a box with two mirrors in the centre(one facing
each way) that is used to help patients feel like they still have
after having it amputated.
• Here, The patient places both the amputated limb and the
other limb into the holes of the mirror box.
• A mirror is used to create a reflection of the non-amputated
limb.