Post Amputation Pain

Post-amputation pain is pain that occurs after the amputation of a limb or other body part. It can be a complex and distressing problem that can significantly impact a person’s quality of life.

What is Phantom Limb Pain?

After an amputation, some people experience pain in the part of the limb that’s no longer there. This sensation is phantom limb pain. The pain is real. The phantom part refers to the location of the pain: the missing limb or part of the limb (such as fingers or toes).

Phantom limb pain ranges from mild to severe and can last for seconds, hours, days or longer. It may occur after a medical amputation (removing part of a limb with surgery). It can also happen after accidental amputation, when you lose a finger, toe or other body part. Phantom pain can be managed. An estimated 8 out of 10 people who lose a limb experience some degree of phantom pain.

What’s the difference between phantom limb pain, phantom sensation and residual limb pain?

With phantom pain, a person feels pain where the missing body part should be. Other problems associated with losing part of your body include:

Phantom Sensations: The missing limb or extremity still feels like it’s part of the body. There isn’t any pain.
For example: A person experiencing phantom sensations may forget that part of a lower limb is missing and try to walk on both legs.
Residual Limb Pain: This pain affects the remaining part of the limb (stump) where the amputation occurred. Residual limb pain often has a medical reason, such as nerve damage or entrapment (pressure on the nerve). It affects approximately 7 in 10 people with limb loss.

Causes:

Phantom Pain – Phantom pain typically occurs soon after limb loss. It can take three to six months for a wound to heal after amputation. Rarely, the pain comes on months or years later.

Experts believe phantom pain results from a mix-up in nervous system signals, specifically between the spinal cord and brain. When a body part is amputated, the nerve connections from the periphery to the brain remain in place. The brain can misinterpret the information it’s receiving or process the signals as the sensation of pain, even if the amputated portion has since been removed.

Residual Limb Pain – Problems that affect the remaining part of the limb (the stump) cause residual limb pain. These include:

Bruising
Bone infection (osteomyelitis) or bone spurs
Nerve damage (neuropathic pain) or inflammation (neuroma).
Poor blood flow
Poorly fitting prosthetic device
Pressure injuries (bedsores)
Skin or wound infections

Risk Factors for Phantom Limb Pain?

Anyone who has an amputation can develop phantom pain. Some people find the pain is worse when they aren’t wearing a prosthetic device. These factors may trigger phantom limb pain:

Angina (chest pain due to low oxygen to the heart).
Changes in temperature or barometric pressure.
Constipation.
Shingles (herpes zoster).
Sex or physical touch.
Smoking.
Stress.

Symptoms of Phantom Limb Pain?

Phantom pain symptoms may be fleeting or last for days. During the first six months after a limb loss, pain intensity and frequency usually decrease. Still, as many as 8 in 10 people continue to have phantom pain two years after amputation. The phantom pain may feel like:

Burning or aching.
Clamping, pinching or vise-like.
Itching or tingling.
Shooting or stabbing.
Throbbing.
Twisting.

Diagnosis and Tests

Physical examination and blood tests to rule out any chances of infection. Imaging scans like ultrasound.

Management and Treatment

Treatment for phantom limb pain focuses on easing symptoms. They include:

Nonsteroidal anti-inflammatory drugs (NSAIDs) or prescription pain relievers.
Antidepressants.
Anti-seizure medications.
Beta blockers.
Muscle relaxers.
Injections

Treatments that send electrical impulses to the nerves, brain or spinal cord may help ease the pain. These include:

Neurostimulation.
Pulsed radio-frequency
Spinal cord stimulation.
Ultrasound guided dry needling.
Transcutaneous electrical nerve stimulation (TENS).

FAQ’s

What is mirror therapy for Phantom Limb Pain?

Studies suggest that mirror therapy can help ease phantom pain. During this therapy, you view the intact limb in a mirror while doing movement exercises for about 20 minutes a day. The reflection tricks the brain into thinking there are two healthy limbs.
Over time, the brain encodes this information. You may need to repeat the exercises for your pain to diminish. Since the brain doesn’t think the limb is missing, it doesn’t feel pain in the phantom limb.

What other therapies help Phantom Limb Pain?

These complementary therapies may also relieve phantom pain:

Acupuncture.
Biofeedback.
Massage.
Meditation or mindfulness exercises

What are the complications of Phantom Limb Pain?

Chronic phantom pain can harm your quality of life. It can also affect sleep. Patient may develop anxiety or depression. Medications and consultation with a therapist can help.

Post Amputation Pain

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