Phantom pain

A. Phantom pain is pain that feels like it's coming from a body part that's no longer there. Experts now recognize that such pain originates in the spinal cord and brain. Most people who've had a limb removed report that it sometimes feels as if the amputated limb is still there. This painless phenomenon, known as phantom limb sensation, isn't the same as phantom pain. For some people, phantom pain gets better over time without treatment. For others, managing phantom pain can be challenging. You and your doctor can work together to treat phantom pain effectively with medication or other therapies.

B. They are still unclear, but it appears to come from the spinal cord and brain. During magnetic resonance imaging (MRI) or positron emission tomography (PET) portions of the brain connected to the nerves of the amputated limb show activity when the person feels phantom pain. It may also be explained as a response to mixed signals from the brain, because the amputated area is no longer able to receive sensory information, it is referred elsewhere — from a missing hand to a still-present cheek, for example. The pain can also by conditioned by damaged nerve endings, scar tissue at the site of the amputation and the physical memory of pre-amputation pain in the affected area.

C. Not everyone who has an amputation develops phantom pain. For example, some researchers have found that people who had pain in a limb before amputation are likely to have it afterward. This may be because the brain holds on to the memory of the pain and keeps sending pain signals, even after the limb is removed. Besides, people who have persistent pain in the remaining part of the limb usually have phantom pain, too. Residual limb pain can be caused by a neuroma that often results in painful nerve activity.

D. Because the risk of developing phantom pain is higher for people who have experienced pain in the limb before amputation, some doctors recommend regional anesthesia (spinal or epidural) in the hours or days leading up to amputation. This may reduce pain immediately following surgery and reduce the risk of lasting phantom limb pain.

E. Characteristics of phantom pain include onset within the first week after amputation, though it can be delayed by months or longer, pain that comes and goes or is continuous, the affecting of the part of the limb farthest from the body, such as the foot of an amputated leg, pain that may be described as shooting, stabbing, cramping, pins and needles, crushing, throbbing, or burning.

F. Although there's no medical test to identify phantom pain, doctors analyse the condition based on your symptoms and the circumstances, such as trauma or surgery, which occurred before the pain started. An accurate information from patients is important. So, describing your pain precisely can help your doctor pinpoint your problem, because treatments for phantom pain and residual limb pain may differ.

G. Relieving your phantom pain can be difficult. Doctors usually begin with medications ( over-the-counter pain relievers, such as ibuprofen, antidepressants, anticonvulsants or narcotics ) and then may add noninvasive therapies, such as acupuncture or spinal cord stimulation. More-invasive options include injections or implanted devices. Surgery (e. g. brain stimulation ) is done only as a last resort.

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