Phantom Limb Syndrome

To put it simply: phantom limb syndrome is experiencing feelings, sensations, and movements in a limb that is no longer attached to your body. 

It’s a spooky idea, but it is very real. In fact, approximately 60 to 80 percent of people who have had their limbs amputated or lost in an accident experience “phantom sensations” in a limb that no longer exists. 

More importantly, these sensations are usually painful, and many people who experience chronic phantom limb pain require pain management doctors for help. The pain range can be anywhere from mild tingling (a “needles and pins” feeling) to intense burning and shooting pains. 

The same phenomenon is often experienced by stroke patients who have lost function in various body parts, as well as in those who have suffered spinal cord injuries or peripheral nerve injury.

Why Does It Happen?

One of the leading explanations for phantom limb pain lies in the way the body is “mapped” in the brain, specifically in the somatosensory cortex. One interesting point is that people born without limbs can still experience phantom limb pain, and this is likely due to the pre-existing “body map” present in our brains. 

Larger areas in the somatosensory cortex represent more sensitive parts of the body like the lips and hands while smaller areas represent less sensitive areas. These size differentials help determine which parts of the body experience pain, and the degree of that pain, according to what is more important for the body to protect.

Over time, areas in the somatosensory cortex associated with the missing limb may shrink, but some people experience chronic pain and require professional treatment.

Treatment Options

Phantom Limb Syndrome

Medicine

While there is no specific medicine made to treat phantom limb pain, medications primarily used for other disorders can offer relief.

  • Tricyclic antidepressants: These can help ease nerve pain by changing body chemicals that transmit pain signals. Tricyclic antidepressants often used for phantom limb pain include Elavil, Pamelor, and Ultram
  • Anticonvulsants: Drugs for treating seizures can often help dampen nerve pain. Anticonvulsants often used include carbamazepine, gabapentin, and pregabalin
  • Opioids: Codeine and morphine can offer relief from phantom limb pain in many people, but it doesn’t work for everyone. Opioids have been shown to have value in the acute setting but long term use has not proven to improve the outcome and may in fact increase pain perception.

Drug-Free Therapies

  • Nerve stimulation: TENS (transcutaneous electrical nerve stimulation) is a device often used for muscle pain. These may be able to disrupt pain signals.
  • Acupuncture: Experienced and educated acupuncturists can apply needles to various points in the skin (don’t worry, you probably won’t even feel them). Pain-relieving chemicals can be released as a result.
  • Lifestyle changes: Finding productive ways to keep distracted from the pain can work wonders. Physical activity (regular exercise) is another great option. Meditation, visualization, and relaxation techniques are also recommended. 

Advanced Methods

  • Revision surgery: Surgical procedures on the stump can help with problems of direct nerve pain.
  • Spinal cord stimulation: Small electrodes can be placed in the body along the spinal cord. These electrodes send mild electrical currents into them, helping disrupt pain signals and offering relief.
  • Brain stimulation: Small electrodes send electrical current to the brain. These can be placed at specific points in the brain. This is a relatively recent development, but according to the research, there is good reason for optimism.