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)
- Muscle Relaxants
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.
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.
Phone: (865) 673-5000
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