Pain Management Options for Phantom Limb Pain

When a patient undergoes a surgical amputation, they could develop Phantom Limb Pain – an ongoing and extremely painful condition characterized by pain radiating from the amputated limb. The limb may no longer be there, but the pain is very real and will require pain management. Let’s take a closer look at Phantom Limb Pain and some of the treatment strategies that can be used to combat the condition.

What is Phantom Limb Pain?

Phantom Limb Pain usually begins soon after amputation surgery. Sufferers describe it manifesting as some different sensations including burning, itching, twisting or pressure. In the majority of cases, the sensation feels like it is starting in the fingers or toes of the missing limb. As many as 80% of amputees will experience Phantom Limb Pain (PLP) at some stage. The severity of the condition will vary from one patient to the next. For some amputees, the sensation lasts for only a few minutes or hours. For others, the pain lasts for days or weeks. In most cases, the symptoms of PLP reduce in both frequency and severity over the first six months until it ceases altogether. However, for some amputees, the pain continues for years, and that is when ongoing pain management becomes necessary.

Treating Phantom Leg Pain

Phantom Limb Pain is a complex condition, and as such, it requires a multifaceted approach to treatment. The most successful approach is a combination of medication and complementary therapies. Regarding the pain management element, the medications administered will be those designed to interrupt the pain signals in the brain. Various drugs may be offered, depending on the type of pain sensations and their severity. These include:

  • Acetaminophen & Non-Steroid Anti-Inflammatory Drugs (NSAIDs)
  • Opioids (Narcotic Pain Medication)
  • Anticonvulsants
  • Muscle Relaxants
  • Beta-Blockers
  • Antidepressants

However, medication is only one small aspect of pain management for PLP. Often, pain relief is used in conjunction with alternative and complementary therapies, such as acupuncture, massage, TENS (transcutaneous electrical nerve stimulation) and also treatment to retrain the way that the brain interprets pain signals from the missing limb. Essentially, that means training the amputee’s brain to accept that the limb is no longer there and can therefore no longer feel pain and other sensations.

Invasive Therapies

Sometimes, pain management for Phantom Limb Pain can include invasive or semi-invasive procedures including the following:

  • Injection – In some cases pain relief injections, steroids or local anesthetics will be injected into the stump to relieve PLP.
  • Nerve Blocks – A nerve block can be used to interrupt the pain signals sent from the brain to the phantom limb.
  • Spinal Cord Simulation – Small electrodes are inserted along the spinal cord, and an electrical current applied to help relieve pain.
  • Brain Stimulation – Deep brain stimulation and motor cortex stimulation work in a similar fashion to spinal cord stimulation, but the electrical current passes through the brain. Although it is a relatively new procedure with limited data, there are promising results concerning pain management for phantom limb pain.
  • Stump Revision or Neurectomy – In many cases, phantom pain can be triggered by nerve irritation in the stump. If this is the case, then one pain management option is to perform a surgical revision to the stump. However, this does carry a risk of intensifying the pain.

 

Associated Pain Specialists (APS) has two Pain Management Clinics (one in Johnson City, TN and one in Knoxville, TN). Both locations can provide pain management options for patients including those living with chronic pain conditions. APS also operate the Smoky Mountain Ambulatory Surgery Center with its own on-site interventional pain specialist, orthopedic spine surgeon, and fellowship trained anesthesiologist.

www.apspaincenters.com

Phone: (865) 673-5000

Please reference APS’s content disclaimer (located in this channel’s profile description) in regard to this shared content.

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Is Your Dizziness a Result of Vestibular Migraine?

 

Up to 3% of the population are thought to suffer from a vestibular migraine. Half of these people are undiagnosed or are not being treated with the appropriate pain management because a vestibular migraine is hard to diagnose. There is no set test, but if a patient’s symptoms fit several statements about this particular migraine type, then they may be a candidate for diagnosis.

Let’s discuss some of the signs that indicate you could be suffering from a vestibular migraine.

What is a Vestibular Migraine?

First, it might be helpful to understand the definition of Vestibular Migraine. The official name is ‘migrainous vertigo’ and it is so much more than just a headache. In fact, you may not suffer headache pain at all. Some debilitating symptoms can affect your ears, vision, and balance. The most common symptom is vertigo, accompanied by dizziness and neck pain. It can be almost intolerable for sufferers to bend down or turn their head and it is not unusual to experience tinnitus (ringing in the ears) or blurred vision. These symptoms mean that finding the right pain management plan can be a challenge.

5 Signs That You May Be Suffering from Vestibular Migraine

If you find yourself agreeing with all the statements below, then you could be a likely candidate for a vestibular migraine diagnosis. Seek advice from an ENT or neurologist to discuss treatment and an effective pain management plan.

1.     You or Your Family Have a History of Migraines
Vestibular Migraines have a strong genetic component. If a relative has a history of migraines or if you already suffer from migraines, then the chance of vestibular migraine increases.

2.     You Suffer from the Symptoms of Vertigo
One of the key indicators of vestibular migraine is that you suffer from vertigo during a migraine headache. You may not necessarily have pain, which is why pain management can be tricky. Symptoms include vertigo, dizziness, motion sensitivity, poor balance, spatial disorientation, spinning and rocking. These symptoms can last from 5 minutes up to several days.

3.     Your Symptoms Can Vary in Severity
Another hallmark of a vestibular migraine is that the severity of your symptoms will change over time and worsen with exposure to migraine triggers. Some triggers (including behavioral factors, hormonal triggers, environmental factors and dietary/chemical triggers) can cause migraines. If your symptoms are steady, without fluctuation, then it is unlikely to be a vestibular migraine. If they worsen after exposure to a known trigger, then vestibular migraine is more likely.

4.     You Also Suffer Classic Migraine Symptoms

If you are suffering from a vestibular migraine, it is also common to have classic migraine symptoms simultaneously. These might include a headache, sensory sensitivity, nausea, aura and tinnitus.

5.     These Symptoms Are Negatively Impacting Your Life
If your symptoms are severe enough that they begin to reduce your quality of life, this is another strong indication that you could be suffering from a vestibular migraine. Your ability to do everyday tasks like driving, going out with friends or even walking becomes difficult. Some patients who have vestibular migraines find it difficult to even get out of bed without appropriate pain management and treatment.

Treating the Pain

A vestibular migraine is often treated similarly to a classic migraine. However, sometimes finding the correct pain management plan can be difficult since pain is not always present. Medication can be given to treat the most common symptoms and making lifestyle changes to eliminate triggers can also help.

Please reference APS’s content disclaimer (located in this channel’s profile description) in regard to this shared content.

Is Your Dizziness a Result of Vestibular Migraine?