• Phantom Limb Syndrome

    (Phantom Pain; Phantom Limb; Neuropathic Pain)

    Definition

    Phantom limb syndrome is the perception of sensations, usually including pain, in a limb that has been amputated. Patients with this condition experience the limb as if it were still attached to their body as the brain continues to receive messages from nerves that originally carried impulses from the missing limb.
    Nervous System
    CNS and PNS
    Copyright © Nucleus Medical Media, Inc.

    Causes

    The exact cause of of phantom limb syndrome is unknown. Presumably, the sensations are due to the brain’s attempt to reorganize sensory information following the amputation. The brain must essentially “rewire itself” to adjust to the body change.

    Risk Factors

    The following factors increase the chance of developing phantom limb syndrome:
    • Preamputation pain. If there was pain in the limb before it was removed, a patient is more likely to experience phantom pain afterward.
    • Blood clot in the amputated limb.
    • Infection in the limb before amputation.
    • Previous damage to spinal cord or peripheral nerves that supplied the affected limb.
    • Adults more commonly than children.

    Symptoms

    Symptoms occur in people who have had a limb removed and people who are born without a limb. The symptoms are perceived in a limb that does not exist.
    Symptoms include:
    • Pain (by far the most common)
    • Pleasure
    • Sensation of an article of clothing or jewelry
    • Sensation that the limb is still attached and functioning normally

    Diagnosis

    Following an amputation, it is important to tell your doctor if you experience pain or other sensations. Earlier treatment generally improves the chances of success.
    There is no medical test to diagnose phantom pain. Your doctor will take a medical history, do a physical exam, and especially want to know about the signs, symptoms, and circumstances that occurred before and after the removal of the limb.

    Treatment

    Fortunately, most cases of phantom limb following amputation are brief and infrequent. For those patients who suffer from persistent pain, treatment can be challenging.

    Medications

    Selected medications used to treat phantom limb pain include:
    • Antidepressants—usually treat depression, but may be helpful in phantom limb pain at lower doses.
    • Anticonvulsants—usually control seizures, but may also be helpful here.
    • Chlorpromazine—usually treats schizophrenia, but may also be helpful here.
    • Opioids—are powerful pain killers (eg, morphine).
    • Clonidine—usually treats high blood pressure, but is helpful with pain generated in the brain.
    • Baclofen—muscle relaxant and used to treat nerve damage pain.

    Electrical Nerve Stimulation

    In some cases, electrical nerve stimulation may be used. Examples include:
    • Transcutaneous electrical nerve stimulation (TENS)—a tiny electric current is sent through the skin to points on the nerve pathway
    • Transcranial magnetic stimulation—a strong magnetic pulse is sent through the scalp into the brain
    • Spinal cord stimulation—an electrode is inserted and a small electric current is delivered to the spinal cord to relieve pain

    Other Approaches

    • Regional sympathectomy—a surgical procedure that interrupts selected nerves near the spinal cord affecting the perception of localized pain
    • Meditation and relaxation techniques
    • Biofeedback
    • Hypnosis
    • Acupuncture
    • Massage
    • Exercise

    Prevention

    To help reduce your chances of getting phantom limb syndrome, some believe that administering pain medication at the time of the amputation may prevent persistent pain afterward. The effectiveness of this approach has yet to be confirmed.

    RESOURCES

    Amputee Coalition of America http://www.amputee-coalition.org

    Amputee Resource Foundation of America http://www.amputeeresource.org

    Amputee Resources http://www.prostheticdesigners.com/amputee.htm

    National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov

    CANADIAN RESOURCES

    Amputee.ca http://www.amputee.ca

    The War Amps http://www.waramps.ca

    References

    Carlson N. Physiology of Behavior . Boston, MA: Allyn and Bacon; 1998.

    Flor H, Nikolajsen L, Jensen TS. Phantom limb pain: a case of maladaptive CNS plasticity? Nature Reviews Neuroscience . 2006;7:873-881.

    Phantom pain. Mayo Clinic website. Available at: http://www.mayoclinic.com . Accessed August 5, 2005.

    Sekuler R, Blake R. Perception . 4th ed. NewYork: McGraw-Hill Inc.; 1994.

    Revision Information

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