Phantom limb pain/post amputation pain/stump pain

Introduction:

Phantom limb pain is pain felt in the area where a limb has been amputated. Phantom limb pain can be mild to extremely painful. In some cases, phantom limb pain can be disabling and can lead to a lifelong struggle with chronic pain. Phantom limb sensations usually will disappear or decrease over time. When phantom limb pain continues for more than six months, the prognosis for spontaneous improvement is poor.
In addition to pain in the phantom limb, some people experience other sensations such as tingling, cramping, heat, and cold in the portion of the limb that was removed. Any sensation that the limb could have experienced prior to the amputation might be experienced in the amputated phantom limb.

Causes:

Although the limb is no longer there, the nerve endings at the site of the amputation continue to send pain signals to the brain that make the brain think the limb is still there. Sometimes, the brain memory of pain is retained and is interpreted as pain regardless of signals form injured nerves.

Treatment:

Successful treatment of phantom limb pain is difficult. Treatment is usually based on the amount of pain the patient is feeling, and multiple treatments might be combined. Some treatments include:
  • Heat application
  • Neurostimulation techniques such as spinal cord stimulation or deep brain stimulation
  • Transcutaneous electrical nerve stimulation (TENS) of the stump
  • Physical therapy (Usually, the best approach is to combine multiple treatments.)
  • Surgery to remove scar tissue entangling a nerve
  • Massage of the amputation area
  • Relaxation techniques
  • Biofeedback to reduce muscle tension
In some instances, medicines might need to be administered in combination for optimal pain control. Medicines that are used to diminish and control phantom pain, include:
  • Analgesics
  • Neuroleptics
  • Anticonvulsants
  • Tricyclic antidepressants
  • Beta-blockers
  • Sodium channel blockers.
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